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To improve early intervention and personalise treatment for individuals early on the psychosis continuum, a greater understanding of symptom dynamics is required. We address this by identifying and evaluating the movement between empirically derived attenuated psychotic symptomatic substates—clusters of symptoms that occur within individuals over time.
Methods
Data came from a 90-day daily diary study evaluating attenuated psychotic and affective symptoms. The sample included 96 individuals aged 18–35 on the psychosis continuum, divided into four subgroups of increasing severity based on their psychometric risk of psychosis, with the fourth meeting ultra-high risk (UHR) criteria. A multilevel hidden Markov modelling (HMM) approach was used to characterise and determine the probability of switching between symptomatic substates. Individual substate trajectories and time spent in each substate were subsequently assessed.
Results
Four substates of increasing psychopathological severity were identified: (1) low-grade affective symptoms with negligible psychotic symptoms; (2) low levels of nonbizarre ideas with moderate affective symptoms; (3) low levels of nonbizarre ideas and unusual thought content, with moderate affective symptoms; and (4) moderate levels of nonbizarre ideas, unusual thought content, and affective symptoms. Perceptual disturbances predominantly occurred within the third and fourth substates. UHR individuals had a reduced probability of switching out of the two most severe substates.
Conclusions
Findings suggest that individuals reporting unusual thought content, rather than nonbizarre ideas in isolation, may exhibit symptom dynamics with greater psychopathological severity. Individuals at a higher risk of psychosis exhibited persistently severe symptom dynamics, indicating a potential reduction in psychological flexibility.
This Element concerns the civic value of contemplation in Plato and Aristotle: how does intellectual contemplation contribute to the happiness of the ideal state? The texts discussed include the Republic, the Nicomachean Ethics and the Politics, works in which contemplation is viewed from a political angle. The Element concludes that in the Republic contemplation has purely instrumental value, whereas in the Politics and Nicomachean Ethics it has purely intrinsic value. To do justice to the complexity of the issues involved, the author addresses a broader question about the nature of civic happiness: whether it is merely the aggregate of individual happiness or an organic quality that arises from the structure of the state. Answering this question has implications for how contemplation contributes to civic happiness. The Element also discusses how many citizens Plato and Aristotle expected to be engaged in contemplation in the ideal state.
Abrupt cessation of heavy cannabis use can cause a withdrawal syndrome characterised by irritability, anxiety, insomnia, reduced appetite and restlessness. Recent reports have also described people in whom cannabis withdrawal immediately preceded the acute onset of psychosis.
Aims
To identify cases of psychosis associated with cannabis withdrawal.
Method
We completed a systematic review of the literature, which comprised case reports, case series and other studies. We also searched a large electronic database of psychiatric healthcare records.
Results
The systematic review identified 44 individuals from 21 studies in whom cannabis withdrawal preceded the development of acute psychosis. In the health record study, we identified another 68 people, of whom 47 involved a first episode of psychosis and 21 represented further episodes of an existing psychotic disorder. Almost all people were daily cannabis users who had stopped using cannabis abruptly. Individuals who continued to use cannabis after the acute psychotic episode had a much higher risk of subsequent relapse than those who abstained (odds ratio 13.9 [95% CI: 4.1 to 56.9]; χ2 = 20.1, P < 0.00001).
Conclusions
Abrupt cannabis withdrawal may act as a trigger for the first episode of psychosis and a relapse of an existing psychosis. Acute psychotic symptoms can emerge after the cessation, as well as following the use, of cannabis.
The Australian Bragg Centre for Proton Therapy and Research in Adelaide will be Australia’s first center with the capacity to deliver proton beam therapy (PBT). PBT uses energy from protons to target cancer cells while minimizing damage to surrounding healthy tissue, including vital organs. Compared to X-ray (photon) radiation therapy (PRT), PBT reduces the risk of serious and long-term complications.
To improve access to PBT, the South Australian Health and Medical Research Institute (SAHMRI) submitted an application to the Medical Services Advisory Committee (MSAC) including a cost utility analysis (CUA) comparing PBT with PRT to treat specific pediatric/adolescent and young adult (AYA) and rare adult tumors.
Methods
A systematic review identified 28 comparative, mostly real-world studies to support the conclusion that PBT has superior safety and non-inferior efficacy to PRT in the requested indications. The key challenge for the CUA was to quantify the cost and quality of life implications of the superior safety profile across a wide range of indications with a limited comparative evidence base. A simple lifetime decision analytic model was developed which modeled the rates, costs and utilities associated with relevant toxicities. The complications of radiotherapy are often chronic and included secondary malignancies, visual impairments, endocrine dysfunction, dysphagia, hearing loss and intellectual disability. Some of these toxicities are only applicable to patients with cranial cancers. Therefore, the event rates applied in the evaluation were adjusted to account for the proportion of patients within each population estimated to have extracranial cancers.
Results
When results in the adult and pediatric/AYA populations were weighted across the expected utilization of PBT (34% adults, 66% pediatric/AYA) in each population, PBT was dominant relative to PRT.
Conclusions
In November 2020, MSAC recommended funding PBT in specific populations at high risk of long-term side effects from PRT. To address uncertainties around the evidence base, MSAC further requested the following:
• All patients receive comparative photon/proton plans to determine eligibility
• A national registry is established for patients treated with PBT.
Questions about learning and discovery have fascinated philosophers from Plato onwards. Does the mind bring innate resources of its own to the process of learning or does it rely wholly upon experience? Plato was the first philosopher to give an innatist response to this question and in doing so was to provoke the other major philosophers of ancient Greece to give their own rival explanations of learning. This book examines these theories of learning in relation to each other. It presents an entirely different interpretation of the theory of recollection which also changes the way we understand the development of ancient philosophy after Plato. The final section of the book compares ancient theories of learning with the seventeenth-century debate about innate ideas, and finds that the relation between the two periods is far more interesting and complete than is usually supposed.
Given its brevity, Plato's Meno covers an astonishingly wide array of topics: politics, education, virtue, definition, philosophical method, mathematics, the nature and acquisition of knowledge and immortality. Its treatment of these, though profound, is tantalisingly short, leaving the reader with many unresolved questions. This book confronts the dialogue's many enigmas and attempts to solve them in a way that is both lucid and sympathetic to Plato's philosophy. Reading the dialogue as a whole, it explains how different arguments are related to one another and how the interplay between characters is connected to the philosophical content of the work. In a new departure, this book's exploration focuses primarily on the content and coherence of the dialogue in its own right and not merely in the context of other dialogues, making it required reading for all students of Plato, be they from the world of classics or philosophy.
Aims: Evaluation of users’ perspectives on ward meetings on a low secure challenging behaviour unit with high levels of morbidity as a means towards increasing their sense of empowerment.
Method: Semi-structured questionnaire designed and administered by a user to all users on the unit over the period of June–Aug 2004 and review of ward meeting minutes over the same period.
Results: 60% response rate. Issues were analysed and issues of importance highlighted and changes made.
Conclusion: On challenging behaviour wards with very high morbidity and long stays, involving the users actively in ward meetings and addressing concerns with feedback is empowering and can be therapeutic. This study highlights this need.
The well known Wiener-Kuratowski explicit definition of the ordered pair, which sets (x,y) = {{x}, {x,y}}, works well in many set theories but fails for those with classes which cannot be members of singletons. With the aid of the Axiom of Foundation, we propose a recursive definition of ordered pair which addresses this shortcoming and also naturally generalizes to ordered tuples of greater length. There are many advantages to the new definition, for it allows for uniform definitions working equally well in a wide range of models for set theories. In ZFC and closely related theories, the rank of an ordered pair of two infinite sets under the new definition turns out to be equal to the maximum of the ranks of the sets.
By
Dominic Scott, Professor of Philosophy University of Virginia Charlottesville,
Alex Oliver, University Reader in Philosophy University of Cambridge; Caius College,
Miguel Ley-Pineda, Faculty of Philosophy University of Cambridge
In this chapter, we investigate the idea of trade marks as property. Three questions need to be answered. The first is a conceptual matter: are trade marks capable of being property or are they ruled out as a matter of conceptual necessity? The second is conceptual-cum-descriptive: is the current law's treatment of trade marks treatment of them as property? The third is normative: if the current law does in fact treat them as property, is it right to do so? The questions need to be tackled in turn.
Are trade marks capable of being property?
When we ask whether trade marks are capable of being property, we are of course assuming that it makes sense to speak of things (resources, assets) being property. In other words, we assume with the layman and the practising lawyer that it makes sense to speak of an owner of a thing, where the thing owned is the property. Admittedly, among legal theorists there is a long tradition going back to Bentham that ridicules this way of speaking. It insists that property is best characterized not as the thing itself but as a bundle of normative relationships between people concerning the use of the thing. But, as Harris has rightly argued, this is a false opposition. In particular, scepticism about the very idea of ownership of a thing is generally based on the thesis that ownership involves the right to use a thing in any way one pleases.
Socrates rounds off this whole passage (80–6) on a note of caution, followed by a strong exhortation:
As for the other points, I wouldn't absolutely insist on the argument. But I would fight, both in word and deed, for the following point: that we would be better, more manly and less lazy if we believed that we ought to inquire into what we do not know, than if we believed that we cannot discover what we do not know and so have no duty to inquire.
(86b6–c2)
The first few words suggest a disclaimer of some sort; but we should be careful about what we take them to imply. In saying that he would not insist on the argument too strongly, he is acknowledging that it needs further support. We have noted at various points how the Phaedo attempts to do this, in regard to both recollection and immortality. But Socrates' words cannot be used as evidence that he only proposed recollection as a metaphor for something else. Of course, many modern readers may feel a deep unease with the whole recollection episode. On the one hand they might admire Plato's insights into the nature of learning and see his theory as a landmark in the theory of knowledge to which later theorists have, to a greater or lesser extent, been returning ever since.
On pages 60–65 above, I claimed that Plato draws an extremely vivid portrait of Meno's character throughout the work, and has Socrates attempt to reform it as the conversation goes on. One of his main stratagems is to use the slave boy and Anytus as object lessons from which Meno is supposed to learn. I now wish to examine the last section of the dialogue, 96d onwards, to see whether Socrates ultimately has any success.
Let us turn back to the point where Anytus leaves Socrates and Meno to continue the discussion as to whether virtue is teachable. After concluding that it is not (95b1–96c10), Socrates introduces the distinction between knowledge and true belief (96d1–98b6); finally they agree that virtue is true belief, not knowledge, and comes not by teaching but by divine dispensation (98b7–100c2). What I wish to show is that throughout this passage Meno's behaviour as an interlocutor undergoes a marked change, especially in comparison to the first ten pages of the dialogue.
He is much milder and more co-operative. There are certainly no abrupt or peremptory demands, nor any obstructions. At no point does Socrates need to comment on his failings, even light-heartedly. The third section (98b7–100c2) is a particularly striking contrast to Meno's behaviour in the first part of the dialogue: in all his answers he agrees straightforwardly with Socrates.
In the previous chapter, I went against the trend of many recent commentators who take the conclusion of the Meno to be largely ironic. In doing so, I concentrated solely on the evidence internal to the text. This, however, is to overlook what many of these commentators would see as crucial evidence: the trenchant critique of Athenian politicians in the Gorgias. If, as these sceptics assume, the Gorgias predates the Meno can we not assume that Plato's earlier views are in the background when he has Socrates revisit the question of what the Athenian politicians did for their city?
I wish to continue to go against this trend and argue for a different way of relating the two dialogues. I shall begin by rehearsing the essentials of the political critique of the Gorgias and then argue that, by comparison with the Meno, it operates at a greater level of sophistication where the analysis of political virtue is concerned. It is more likely that the Meno represents an earlier point in Plato's career as a political commentator. To support this claim, I shall attempt to undermine the reasons usually given for dating the Meno after the Gorgias. The upshot will be that there is no longer any reason at all to read the Meno in the shadow of the Gorgias; and any external evidence for finding the Meno's conclusion ironic fades away altogether.
Meno offers his third definition of virtue at 77b2–5:
Well then, I think virtue is, as the poet says, ‘rejoicing in fine things and being able to have them’. And that's what I say virtue is – desiring fine things and being able to acquire them.
Socrates' first move is to substitute the word ‘good’ (agathos) for ‘fine’ (kalos). Although he does this very swiftly, the move is not as straightforward as it is made to sound. The word kalos can mean ‘beautiful’, and is commonly applied to physical objects. But it can also apply to actions or characters in the sense of ‘noble’. (I have used the translation ‘fine’ in an attempt to cover both senses.) In Plato's works, the concept of the agathon is very closely connected with whatever is beneficial or useful – prima facie a different sense from that of kalon. Nevertheless, agathon and kalon draw very close together in other dialogues, and it is interesting that here Meno accepts the substitution without any complaint. This allows Socrates to proceed straight to the business of refutation, which he does by examining each of its two components in turn: that virtue involves (1) the desire for good things and (2) the ability to acquire them.
DESIRE AND THE GOOD (77b–78b)
The underlying assumption of this section is that, if something is to act as a mark of the virtuous, it cannot be common to all people, because not everyone is virtuous.
We have now reached a turning point in the dialogue. Meno's definitions have all been refuted and, in response to the demand to inquire into the nature of virtue, he is about to issue a notorious challenge to the possibility of inquiry and discovery (80d). En route to this point, Plato has revealed a number of details about his character, details that will turn out to be fundamental in two ways: first, and more immediately, they will help us understand exactly why Meno issues his challenge at 80d. Second, and more generally, throughout the dialogue Socrates not only discusses education as one of his central themes, but also shows it happening in practice by confronting some of Meno's failings and trying to change them. To appreciate this point, we first need to be aware of what exactly these failings are.
INTELLECTUAL LAZINESS
Right from the beginning, we have seen how Meno appears as someone imbued with the ethos of memorising answers to be recycled at a later date. I mentioned how this was anticipated in the very opening lines and in Socrates' immediate response – his snide comments about the Thessalians and the ‘wisdom’ they have just acquired from Gorgias. The implied criticism comes still closer to the surface at 71c8–d2 when Socrates asks Meno to recall what Gorgias said about virtue, hastily correcting this into a request for Meno to state his own view (which will of course coincide with Gorgias').