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This chapter analyses the changing reception of ‘declinism’ and its evolving depiction in British postmodern fiction. Throughout the second half of the twentieth century, there existed a tradition of characterising Britain by its lack of enthusiasm for science, the indifference of government to commerce, and the low status of research and development, industry, and engineering. Numerous political scientists, economists, columnists, and historians drew on ‘decline’ as an interpretative framework despite many disagreements about its meaning, evidence, causes, and remedies. At mid-century, postmodern British writers created analogies between narratives of national decline and stories of individual dissolution. Following the Thatcher administration, they offered nascent critiques of ‘declinism’, presenting it as a discourse rather than historical fact. Finally, late-twentieth-century writers joined the growing ranks of professional historians who sought to debunk ‘declinism’ and caution against nostalgia for a halcyon past that may not have ever existed.
This chapter explores how the postcolonial predicament bequeathed by the British Empire challenges us to rethink conceptions of ‘postmodernism’ and ‘Britishness’. The specifically Anglo-American sense of the close connection between postmodernism and postcolonial studies is established via the identification of ‘grand narrative’ with the ‘civilising mission’, but this equation is problematised through a reading of Ian McEwan’s novel Saturday (2005) and a review of the changing history of British imperial ideology. A different approach to the interplay of fictive and historical narrative is identified in Ngugi we Thiong’o’s A Grain of Wheat (1967), a novel that locates characteristic postmodern concerns within the late colonial violence of the Kenyan Emergency. The novel is shown to anticipate a contemporary cultural moment in which postmodernism’s choreography of certainty and uncertainty proves increasingly ill-suited.
Two plays that follow the writers Can Themba, Bloke Modisane and Langston Hughes based in the DRUM era of 1950s Johannesburg.
Siphiwo Mahala delves into the lives of iconic figures from South Africa's tumultuous past in this remarkable collection of plays. The collection opens with 'The House of Truth' which explores the complexity of Can Themba, a fearless journalist, playwright and poet living under an oppressive apartheid regime. The one-man play weaves together elements of Themba's life and career, recreating the excitement and pathos of the DRUM era, South Africa's first magazine for a black audience, and his neighbourhood, Sophiatown in Johannesburg, before it was destroyed by apartheid legislation. Themba is brought back to life as an ordinary person with human flaws and attributes both tragic and inspirational.
In the second play, 'Bloke and His American Bantu', Mahala brings to life the extraordinary lives of Bloke Modisane, a South African writer exiled in London, and Langston Hughes, the renowned American poet. This two-hander play celebrates their remarkable camaraderie and intellectual exchange. Through a reimagined correspondence, the play deftly explores how a simple friendship blossomed into a catalyst for international solidarity and cultural exchange across continents, from Africa to the UK to America.
The plays explore the intersections of identity, creativity and resistance. With wit, poise, and unflinching honesty, they bring to life the triumphs and struggles of these remarkable men who left an indelible mark on their worlds, and celebrate the human spirit's capacity to persevere, inspire and uplift.
This study addresses the mental health needs of refugees and migrants in the Netherlands, highlighting the urgent public health challenges they face. Unique psychosocial hurdles, exacerbated by cultural dislocation, language barriers and systemic inequalities, hinder their access to quality mental healthcare. This study explores how coloniality intersects with mental healthcare access, using a decolonial framework to challenge stereotypes and assumptions that marginalize migrant voices. Through semi-structured interviews with migrants and language service providers, this research reveals the complexities of navigating the mental healthcare system. Findings reveal that temporality, professionalism and language barriers are key issues in migrants’ mental healthcare journeys. We advocate for systemic changes that prioritize migrant perspectives. Ultimately, this study aims to inform policy and practice to enhance mental health services for migrant populations in the Netherlands and contribute to the broader dialogue on decolonization in mental health.
Knowledge of the status of ecosystems is vital to help develop and implement conservation strategies. This is particularly relevant to the Arctic where the need for biodiversity conservation and monitoring has long been recognised, but where issues of local capacity and logistic barriers make surveys challenging. This paper demonstrates how long-term monitoring programmes outside the Arctic can contribute to developing composite trend indicators, using monitoring of annual abundance and population-level reproduction of species of migratory Arctic-breeding waterbirds on their temperate non-breeding areas. Using data from the UK and the Netherlands, countries with year-round waterbird monitoring schemes and supporting relevant shares of Arctic-breeding populations of waterbirds, we present example multi-species abundance and productivity indicators related to the migratory pathways used by different biogeographical populations of Arctic-breeding wildfowl and wader species in the East Atlantic Flyway. These composite trend indicators show that long-term increases in population size have slowed markedly in recent years and in several cases show declines over, at least, the last decade. These results constitute proof of concept. Some other non-Arctic countries located on the flyways of Arctic-breeding waterbirds also annually monitor abundance and breeding success, and we advocate that future development of “Arctic waterbird indicators” should be as inclusive of data as possible to derive the most robust outputs and help account for effects of current changes in non-breeding waterbird distributions. The incorporation of non-Arctic datasets into assessments of the status of Arctic biodiversity is recognised as highly desirable, because logistic constraints in monitoring within the Arctic region limit effective population-scale monitoring there, in effect enabling “monitoring at a distance”.
Although women leaders assume prominent national offices in the United States (and the world), one of the well-established specializations in political science and psychology (i.e., leadership studies) is inundated with male-centric benchmarks. This research often relies on a reference group to develop leaders’ profiles in comparison to other elites. They are predominantly populated, however, with male leaders. This article suggests a remedy and introduces a women leaders reference group for operational code analysis, which is a quantitative approach measuring leaders’ beliefs about politics. We gathered American women leaders’ speeches from the Iowa State University Archives of Women’s Political Communication. Using an automated content analysis, we developed a norming group exclusively for American female politicians in national politics. Whereas our findings indicate noticeable differences and suggest similarities with existing reference groups, we aspire to initiate a conversation and hope that more data will follow and shed more light on women leaders. This reference group can serve as a crucial tool in providing contextualized political-personality profiles of American women leaders and also provide an illustrative example to bridge leadership and gender studies in advancing the study of women leaders in the United States (and beyond).
Major depressive disorder (MDD) and psychostimulant use disorder (PUD) are common, disabling psychopathologies that pose a major public health burden. They share a common behavioral phenotype: deficits in inhibitory control (IC). However, whether this is underpinned by shared neurobiology remains unclear. In this meta-analytic study, we aimed to define and compare brain functional alterations during IC tasks in MDD and PUD.
Methods
We conducted a systematic literature search on IC task-based functional magnetic resonance imaging studies in MDD and PUD (cocaine or methamphetamine use disorder) in PubMed, Web of Science, and Scopus. We performed a quantitative meta-analysis using seed-based d mapping to define common and distinct neurofunctional abnormalities.
Results
We identified 14 studies comparing IC-related brain activation in a total of 340 MDD patients with 303 healthy controls (HCs), and 11 studies comparing 258 PUD patients with 273 HCs. MDD showed disorder-differentiating hypoactivation during IC tasks in the median cingulate/paracingulate gyri relative to PUD and HC, whereas PUD showed disorder-differentiating hypoactivation relative to MDD and HC in the bilateral inferior parietal lobule. In conjunction analysis, hypoactivation in the right inferior/middle frontal gyrus was common to both MDD and PUD.
Conclusions
The transdiagnostic neurofunctional alterations in prefrontal cognitive control regions may underlie IC deficits shared by MDD and PUD, whereas disorder-differentiating activation abnormalities in midcingulate and parietal regions may account for their distinct features associated with disturbed goal-directed behavior.
Background: Ischemic stroke is a major cause of morbidity and mortality in Canada. Since 2015, mechanical thrombectomy has been the standard of care for eligible large vessel occlusions (LVOs), though anesthetic strategies remain variable. Methods: We conducted a single-center retrospective review of patients undergoing mechanical thrombectomy for anterior circulation LVOs between 2021 and 2023. Patients were categorized by anesthetic strategy (general anesthesia vs. conscious sedation), and outcomes, including time to recanalization, angiographic results (mTICI), and 90-day functional status (mRS), were compared. Statistical analyses included Student’s t-test, Mann-Whitney U-test, and Fisher’s exact test. Results: Among 226 patients, 177 (78%) received general anesthesia and 49 (22%) underwent conscious sedation. Baseline characteristics including sex, age, NIHSS, ASPECTS, collaterals, and laterality were similar between groups. Conscious sedation was associated with a statistically significant shorter time from arrival to the angiography suite to groin puncture (p=0.007), but no differences in time to recanalization (p=0.893), angiographic outcomes (p=0.987), or 90-day functional status (p=0.795) were observed. Conclusions: Conscious sedation led to faster procedural initiation, though no difference in clinical or radiographic outcome was observed. Anesthetic choice should be individualized based on patient and physician factors in acute mechanical thrombectomy.
Understanding patterns and predictors of elevated psychological distress (EPD) among humanitarian migrants compared to the host population is critical for designing effective mental health interventions. However, existing research presents conflicting findings on the prevalence of EPD. This study examined EPD prevalence and associated factors in humanitarian migrants and Australian-born adults using large population-level datasets.
Methods
Kessler 6 scores (range 6–30) were dichotomised, and scores above 19 were defined as EPD and indicative of probable serious mental illness. Comparative 1:2 matched analysis used humanitarian migrant data from the Building a New Life in Australia and Australian-born comparators from the National Health Survey. Each humanitarian migrant was matched by age, sex and location with two Australian-born residents. Modified Poisson regression identified predictors of EPD in both groups.
Results
EPD was higher among humanitarian migrants (17.2%, 95% CI: 15.5, 18.9) compared to Australian-born (14.5%, 95% CI: 13.3, 15.6), with an adjusted relative risk (aRR) with 95% confidence intervals (1.16%, 95% CI: 1.11, 1.21) after adjusting for key factors. In both groups, females had a higher aRR than males, with similar effect sizes: 1.06 (95% CI: 1.04, 1.08) among Australian-born and 1.04 (95% CI: 1.02, 1.07) among humanitarian migrants. The impact of age on distress was more pronounced in Australian-born individuals: compared to the 65+ age group, the youngest group (18–24 years) had an aRR of 1.36 (95% CI: 1.28, 1.43) for Australian-born and 1.19 (95% CI: 1.12, 1.27) for humanitarian migrants. Compared to excellent health, poor and fair self-rated health condition had an aRR of 2.13 (95% CI: 2.03, 2.26) and 1.69 (95% CI: 1.61, 1.79), respectively, for humanitarian migrants and 1.94 (95% CI: 1.82, 2.05) and 1.48 (95% CI: 1.43, 1.56), respectively, for Australian born. Australian-born individuals in the lowest-income quintile had higher distress (aRR: 1.11 [95% CI: 1.06–1.15]) compared to the highest-income quintile, with no significant income effect for humanitarian migrants. In both groups, females with poorer self-rated health had higher aRRs than females reporting excellent health.
Conclusions
Although distress prevalence was higher in the humanitarian migrants, age and sex differences followed similar patterns in both groups. Income level was a factor in Australian-born adults but not in humanitarian migrants. Clinically, this highlights the need for culturally sensitive and group-specific mental health support. From a policy perspective, the use of matching methodology from large, separate datasets offers a valuable model for generating actionable insights, supporting the development of targeted and equitable mental health programmes.
This chapter names and surveys a racially attuned subgenre of US historical fiction, the historical novel of whiteness. It studies a variety of authors from the nineteenth, twentieth, and twenty-first centuries, all of whom used the historical novel form to question the coherence and ontological status of “whiteness” as a racial concept. The essay focuses on three historically situated companies of works that epitomize the subgenre: novels of European–Native American contact from the 1820s, “color-line” novels from the Jim Crow era, and African American historical fiction from the post-1945 period. In all the novels under review, whiteness is shown to be a mutable, contingent, surprisingly unstable phenomenon, even as it is also shown to have been a powerful, all but hegemonic force throughout US history.
Psychotic disorders are severe mental health conditions frequently associated with long-term disability, reduced quality of life and premature mortality. Early Intervention in Psychosis (EIP) services aim to provide timely, comprehensive packages of care for people with psychotic disorders. However, it is not clear which components of EIP services contribute most to the improved outcomes they achieve.
Aims
We aimed to identify associations between specific components of EIP care and clinically significant outcomes for individuals treated for early psychosis in England.
Method
This national retrospective cohort study of 14 874 EIP individuals examined associations between 12 components of EIP care and outcomes over a 3-year follow-up period, by linking data from the National Clinical Audit of Psychosis (NCAP) to routine health outcome data held by NHS England. The primary outcome was time to relapse, defined as psychiatric inpatient admission or referral to a crisis resolution (home treatment) team. Secondary outcomes included duration of admissions, detention under the Mental Health Act, emergency department and general hospital attendances and mortality. We conducted multilevel regression analyses incorporating demographic and service-level covariates.
Results
Smaller care coordinator case-loads and the use of clozapine for eligible people were associated with reduced relapse risk. Physical health interventions were associated with reductions in mortality risk. Other components, such as cognitive–behavioural therapy for psychosis (CBTp), showed associations with improvements in secondary outcomes.
Conclusions
Smaller case-loads should be prioritised and protected in EIP service design and delivery. Initiatives to improve the uptake of clozapine should be integrated into EIP care. Other components, such as CBTp and physical health interventions, may have specific benefits for those eligible. These findings highlight impactful components of care and should guide resource allocation to optimise EIP service delivery.
The mobility of a weed species is a strong determinant of the optimal management strategy, including whether area-wide management will be beneficial. In this paper, we examine the mobility and dispersal distances of flaxleaf fleabane [Conyza bonariensis (L.) Cronquist; syn.: Erigeron bonariensis L.], widely regarded as a highly mobile weed. We sampled individual weeds from two regions and sampled the same sites in the following season to conduct parentage analysis and assess intergenerational dispersal distances. We find high values of FIS across populations consistent with mostly self-fertilization, but also relatively high genotypic diversity, suggesting that outcrossing does occur at low rates. We find evidence for long-distance dispersal (more than 350 km) and detect dispersal distances of up to 71 km and 36 km within each of the two regions using parentage analysis. We also find high spatial genetic structure within the Riverina region, with sites in 2021 genetically very similar to sites in 2020, indicating that local dispersal may be a more important driver of population genetics than long-distance dispersal, perhaps due to the high rates of seed production and self-fertilization. Glyphosate resistance was not spatially structured in C. bonariensis in these regions, highlighting the role of movement, and significant proportions of susceptible plants were found in both regions. The high levels of mobility, including over potentially long distances, indicate that the value of control and preventing weed seed set is likely to extend beyond the farm and offer “area-wide” benefit.
To quantify the impact of a changing cohort strategy on COVID-19 transmission in an acute inpatient behavioral health facility.
Design:
Cohort study.
Patients:
Behavioral health inpatients exposed to COVID-19.
Interventions:
This cohort project compared COVID-19 conversion rates during two periods. In the first period (July 2020–April 2022), exposed patients (regardless of vaccination status) were cohorted separately from unexposed individuals. In the second period (May 2022–September 2022), exposed vaccinated patients remained with unexposed patients. COVID-19 conversion was identified through post-exposure asymptomatic testing or test-confirmed symptom development, with rates quantified per all admissions, per 10,000 patient days at risk, and per patient-specific exposure.
Results:
The 27-month project included 11,761 admissions and 164,762 patient days of care. The proportion of patients up-to-date on COVID-19 vaccination at admission and discharge ranged from 11%–19%. The second period showed an increased risk of SARS-CoV-2 conversion per admission (1.87% vs 0.36%, P < 0.001) and per 1,000 patient-days at risk (1.44 vs 0.27 conversions per 1,000 patient days, P < 0.001), but not per exposure (3.44% vs 3.13%, P = 0.68).
Conclusions:
Reducing the population of patients cohorted after a SARS-COV-2 exposure is associated with increased risk of SARS-COV-2 transmission in inpatient psychiatric settings.
Aims: People with Severe Mental Illness (SMI) have a reduced life expectancy of 15–20 years compared with the general population. This disparity is largely due to preventable health conditions like cardiovascular disease and diabetes. Certain antipsychotics (APs) can contribute to this increased burden due to their association with cardio-metabolic side-effects. Despite the availability of lower-risk APs, risperidone, olanzapine, and quetiapine remain the most prescribed APs in the UK. Switching to improve cardio-metabolic side-effects is rarely implemented in clinical practice. Improving the physical health of people with SMI is a key NHS priority. We conducted a qualitative study to explore the perceptions and experiences of patients and their caregivers surrounding switching APs for physical health benefits to inform the development of an educational intervention for clinicians to support switching APs.
Methods: Semi-structured interviews were conducted with patients who have experienced AP-induced cardiometabolic side-effects (ascertained by the treating clinician) and their caregivers. Participants were recruited through two NHS trusts and primary care. Interviews were by telephone or online and transcripts were thematically analysed using NVIVO. A patient advisory group contributed to all phases of the study.
Results: Seventeen interviews (16 one-on-one and one dyadic) were conducted with thirteen people with SMI (Bipolar Disorder [9], Schizophrenia [2], Psychosis [2]) and five caregivers.
We will present two themes:
(1) Managing the dual challenge of mental and physical health conditions: Managing this challenge can be overwhelming and impact their everyday life; patients often normalise side-effects of medication as a necessary trade-off for mental health stability.
(2) Enabling a change in medication: The possibility of medication changes was met with optimism as well as apprehension. Past experiences of medication adjustments, fear of relapse and concerns about new side-effects were important from both patient and caregiver perspectives; addressing these requires inviting patients and caregivers into decision-making. Carers play a crucial role in supporting patients, and recognising their contributions can ease the transition. Improving collaboration at the system level is equally important.
Conclusion: The study highlights the complex interplay between mental and physical health; patients and caregivers often face significant challenges in balancing mental and physical health. Switching medication is a challenge for patients and their caregivers. Addressing patients’ concerns like fear of relapse, lack of support, and clear communication would help foster confidence in switching. Recognising the importance of caregivers is essential for effective patient support. Improving overall collaboration can foster a more patient-centred approach to managing the switching process.
There is a lack of knowledge on deaths related to police use of force across Canada. Tracking (In)Justice is a research project that is trying to make sense of the life and death outcomes of policing through developing a collaborative, interdisciplinary, and open-source database using publicly available sources. With a collaborative data governance approach, which includes communities most impacted and families of those killed by police, we document and analyze 745 cases of police-involved deaths when intentional force is used across Canada from 2000 to 2023. The data indicate a steady rise in deaths, in particular shooting deaths, as well as that Black and Indigenous people are over-represented. We conclude with reflections on the ethical complexities of datafication, knowledge development of what we call death data and the challenges of enumerating deaths, pitfalls of official sources, the data needs of communities, and the living nature of the Tracking (In)Justice project.
Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.
Results
In total, 185 trainees from all UK training regions completed the survey. Although 43.6% expressed interest in a neuropsychiatry career, only 10% felt they would gain sufficient experience by the end of training. Insufficient access to clinical rotations was the most common barrier, with significantly better access in London compared with other regions. Most respondents were in favour of additional neurology training (83%) and a formal accreditation in neuropsychiatry (90%).
Clinical implications
Strong trainee interest in neuropsychiatry contrasts with the limited training opportunities currently available nationally. Our survey highlights the need for increased neuropsychiatry training opportunities, development of a formalised training programme and a clinical accreditation pathway for neuropsychiatry in the UK.