We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The COVID-19 pandemic has been a catalyst for a shift towards virtual forms of working, and specific support for the provision of virtual therapy (BPS, 2020). Remotely delivered therapy has known potential benefits, such as improving access to people living in underserved areas and for those who struggle to attend face-to-face appointments due to psychosocial, physical or geographical constraints. Those with neurological conditions frequently fall in these groups.
Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention which aims to improve the physical and mental health of people living with neurological conditions. However, there are several considerations to translating this into a virtual therapy for this clinical group that have not yet been thoroughly empirically evaluated. Such considerations include: fatigue, cognitive difficulties in the context of virtual communication, adaptations within the therapeutic alliance, and translation of dynamic and interactive therapeutic exercises within a virtual medium.
This study aimed to describe the experiences of Clinical Psychologists delivering ACT remotely in the context of two randomised controlled feasibility and acceptability clinical trials for young people (aged 11 to 24) who have experienced a brain tumour or Tuberous Sclerosis Complex. Exploring therapist perceptions and experiences provides valuable insights into potential barriers and facilitators to engagement with remote ACT delivery.
Participants and Methods:
Clinical Psychologists who were trained to deliver ACT via videoconferencing were invited to take part in virtual interviews. The semi-structured interview guide aimed to draw on their experience of ACT training, supervision, remote delivery, and perceived impact of ACT. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.
Results:
Five Clinical Psychologists were interviewed. Interview data were coded into broad themes around the experience of delivering ACT, engaging with remote systems, the wider perceived impact of ACT and the adaptability of ACT. ACT training was reported to be an effective, positive experience and the opportunity for regular peer and group supervision worked to solidify the training and support fidelity to the ACT processes. It was largely acknowledged that while remote delivery of the intervention did create some initial challenges to the therapeutic process, this approach created opportunity for the young people to access psychological support that they might not have been able to engage with due to logistical considerations. Clinical Psychologists also shared that training in and experience of delivering ACT had a positive and meaningful impact on their clinical practice and personal conduct. They also reported that ACT was adaptable to the needs of the young people in the clinical trials and felt appropriate to deliver in this context.
Conclusions:
This in-depth, qualitative study demonstrated the clinical promise of remotely delivered ACT. Clinical Psychologists viewed remotely delivered ACT as an appropriate, acceptable and feasible intervention for young people with experience of brain tumour and Tuberous Sclerosis Complex within the context of research, that would be generalisable to everyday clinical practice.
A testing rate for measles above 80% is required by the WHO European Region Measles Elimination strategy to verify elimination. To comply with this rate, we explored factors associated with the return of oral fluid kits (OFK) by suspected measles cases. We described the cases and conducted a mixed-effects analysis to assess the relationship between socio-demographic and public health management characteristics and the likelihood of returning an OFK to the reference laboratory. Of 3,929 cases who were sent a postal OFK, 2,513 (67%) returned the kit. Adjusting for confounding, registration with a general practitioner (GP) (aOR:1.48, 95%CI:1.23–1.76) and living in a less deprived area (aOR:1.35, 95%CI:1.04–1.74) were associated with an increased likelihood of returning the OFK. The odds of returning the OFK also increased if the HPT contacted the parents/guardians of all cases prior to sending the kit and confirmed their address (aOR:2.01, 95%CI:1.17–3.42). Cases notified by a hospital (aOR:1.94, 95%CI:1.31–2.87) or GP (aOR:1.52; 95%CI:1.06–2.16) also had higher odds of returning the OFK. HPTs may want to consider these factors when managing suspected cases of measles since this may help in increasing the testing rates to the WHO-recommended level.
In this prospective study of mental health, we examine the influence of three interrelated traits — perceived stress, rumination, and daytime sleepiness — and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9−14 years at baseline and 152 pairs aged 10−16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8−11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic–pituitary–adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.
The hippocampus is a complex brain structure with key roles in cognitive and emotional processing and with subregion abnormalities associated with a range of disorders and psychopathologies. Here we combine data from two large independent young adult twin/sibling cohorts to obtain the most accurate estimates to date of genetic covariation between hippocampal subfield volumes and the hippocampus as a single volume. The combined sample included 2148 individuals, comprising 1073 individuals from 627 families (mean age = 22.3 years) from the Queensland Twin IMaging (QTIM) Study, and 1075 individuals from 454 families (mean age = 28.8 years) from the Human Connectome Project (HCP). Hippocampal subfields were segmented using FreeSurfer version 6.0 (CA4 and dentate gyrus were phenotypically and genetically indistinguishable and were summed to a single volume). Multivariate twin modeling was conducted in OpenMx to decompose variance into genetic and environmental sources. Bivariate analyses of hippocampal formation and each subfield volume showed that 10%–72% of subfield genetic variance was independent of the hippocampal formation, with greatest specificity found for the smaller volumes; for example, CA2/3 with 42% of genetic variance being independent of the hippocampus; fissure (63%); fimbria (72%); hippocampus-amygdala transition area (41%); parasubiculum (62%). In terms of genetic influence, whole hippocampal volume is a good proxy for the largest hippocampal subfields, but a poor substitute for the smaller subfields. Additive genetic sources accounted for 49%–77% of total variance for each of the subfields in the combined sample multivariate analysis. In addition, the multivariate analyses were sufficiently powered to identify common environmental influences (replicated in QTIM and HCP for the molecular layer and CA4/dentate gyrus, and accounting for 7%–16% of total variance for 8 of 10 subfields in the combined sample). This provides the clearest indication yet from a twin study that factors such as home environment may influence hippocampal volumes (albeit, with caveats).
A lively and comprehensive review of policy change, Multidisciplinary Public Health: Understanding the Development of the Modern Workforce concludes with a reflection on the new public health system underway in England, making useful comparisons with the rest of the UK.
Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line–associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system.
METHODS
Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed.
RESULTS
A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort.
CONCLUSIONS
Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs.
This article draws on case study research of a low-income neighbourhood in Leeds to explore experiences of, and attitudes towards, place-based community. Through tracing social relations in the neighbourhood over time, from the early twentieth century to the present day, the ways in which community is embedded in everyday activities and social interactions, and the social impact of socioeconomic change on local neighbourhoods, is demonstrated. It is argued that the relentless and nostalgic focus on local communities as an idealised form of social solidarity has meant that the reasons why place-based community has declined over time have been overlooked. The article challenges the assumption that social fragmentation on neighbourhood levels necessarily indicates antisocial trends or a lack of a sense of duty towards others, and draws attention to the constraints people face in developing relationships with others. Questions are raised about the viability of top-down attempts to shape social relations in particular ways.
People who have read War and Peace more than once, and enjoyed it immensely, can often scarcely remember a thing about it.
The concept of redundancy employed in this essay is the one used in mathematics and linguistics to designate symbols that do not add information to a sequence. One of the hazards of teaching twentieth-century war literature is the tacit inference of redundancy by readers, namely that the representational conventions as well as the facts and values represented are ‘predictable from … context’. The claim that twentieth-century war writing is made superfluous by War and Peace (1869) is polemical, but it is also intended to do serious work: to draw attention to representations of war which are not predictable from context, and to renew questions such as why representing war as irrational, murderous activity is unefficacious, and why we would imagine otherwise.
The designs of War and Peace as war writing can be recognised as early as 1853, when Tolstoy published a story drawing on his own military experience in the Caucasus:
War always interested me: not war in the sense of manoeuvres devised by great generals – my imagination refused to follow such immense movements, I did not understand them – but the reality of war, the actual killing. I was more interested to know in what way and under the influence of what feeling one soldier kills another than to know how the armies were arranged at Austerlitz and Borodino.
In october 1099, following the conquest of Jerusalem, First Crusade forces led by Duke Godfrey of Bouillon laid siege to the city of Arsuf, about fifteen miles north of modern Tel Aviv. According to the early-twelfth-century chronicler Albert of Aachen, the city's defenders attempted to distract Godfrey by crucifying one of Godfrey's men, Gerard of Avesnes. They placed him on the city walls within sight of the siege forces. Dying yet still able to talk, Gerard begged Godfrey to avenge his suffering and death. Godfrey told Gerard that, unfortunately, he could not avenge him; diverting men to do so would cost them the city. Furthermore, he added, ‘Certainly if you have to die, it is more useful that you alone should die than that our decree and be violated and this city remain always unsafe for pilgrims. For if you die to the present life, you will have life with Christ in heaven.’ With that Gerard was left to his fate, while the crusaders continued to assault the city.
The assault failed dramatically, prompting reflection on the potential causes of God's disfavour. In particular, Godfrey's response to Gerard's request for vengeance was called into question. Arnulf of Chocques, the newly appointed patriarch of Jerusalem, roundly condemned Godfrey not only for abandoning Gerard to his fate, but especially for failing to avenge his death. Arnulf described Godfrey's actions as ‘treachery and hardheartedness … impiety … base filth of all crimes’.
The officer stared at him curiously, as though doubting the evidence of his own ears.
‘A war?’ he chuckled at last, as though the word had amused him. ‘I'm afraid you're rather simplifying the issue, aren't you? The conception of war, you know, is rather an old-fashioned one, don't you agree? There's surely not much distinction nowadays between being at war and being at peace.’
Most writing about British Cold War culture has concentrated on nuclearism, pacifism, decolonisation, socialism, postmodernism, Americanisation – in short, on everything but war. One effect of the attention paid to these various narratives has been to obscure the fact that citizens of the USSR and those of Western capitalist democracies alike understood and feared the Cold War as war, even if later accounts have tended to lose sight of what Holger Nehring has called the ‘warlike character’ of their experiences. If the Cold War is to have any explanatory force as a context for literary works beyond serving as a useful periodising shorthand, then we need to know in what sense, if any, the literature of the Cold War era understood itself as a war literature. ‘What kind of war was this?’ asks the historian Anders Stephanson. ‘The two sides never went to war with each other. There is no obvious beginning, no single moment of initial aggression, no declaration of war, no crossing of a certain line, and no open military engagement.
W. H. Auden wrote that the Great War was ‘the decisive experience’ of Wilfred Owen's life. In the absence of such experience, Auden and his generation struggled to find grounds from which to write during the 1930s. In the present essay, I show that Auden's ‘Journal of an Airman’, which is Book II of The Orators (1932), reflects the legacy of the Great War for interwar English writers and ‘the guilt that every noncombatant feels’, as he calls it. This guilt is a manifestation of a larger cultural turn that military historians have traced back to the Enlightenment, in which non-transmittable knowledge is understood to be gained exclusively through sensory experience on the battlefield. That knowledge grants combat veterans the ‘authority of flesh-witnessing’. After discussing this cultural turn and how it affected Auden and his generation, I explore how positions of optical dominance inform the ‘Journal of an Airman’ and the text's concern with the idea of the poet as wartime orator – elements that presage Auden's World War II poetics. I conclude by considering an often-overlooked episode in Auden's life, when he was sent to assess the effects of air bombing on German morale as part of the 1945 US Strategic Bombing Survey.
Josef stalin's claim that ‘one death is a tragedy, a million deaths … a statistic’ we might take as an aesthetic and moral gloss on another well-known comment, this one attributed to Napoleon Bonaparte: ‘A man like me does not give a shit about the lives of a million men.’ Stalin's statement makes two assumptions that this essay will question. It assumes that moral feeling – the sort formalised in tragedy – operates on the level of the individual, the one, and is not susceptible to multiplication (or, for that matter, division). It assumes additionally that statistics, the signs for large aggregates of human beings, do not occasion moral feeling. Apparently we do not feel the deaths of a million men with anything like the force we feel for the death of one, ‘a man’, as Napoleon says, ‘like me’.
Stalin contributes to an ongoing debate in moral philosophy, set here in the context of modern mass warfare, a context embracing the Napoleonic era as well as our own. The terms of the debate and its governing assumptions were laid out helpfully, if bluntly, by C. S. Lewis in 1957. Writing in the gloom of the Cold War and against a utilitarian outlook, Lewis argued that none of us can possibly experience suffering on a scale other than that of the single person.