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This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used – the Dissociative Experiences Scale – II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale – and a proforma was used to collect demographic data.
Results
Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI.
Clinical implications
The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.
Essays offering insights into the ecclesiastical, political, cultural and social history in the north of England during the fourteenth century through an exploration of the administrative archives of archbishops.
On 8 October 2020 Yorkshire poet Ian McMillan took to Twitter to comment, in verse, on the news that swathes of northern England were to enter Tier 3 lockdown in response to the Covid-19 pandemic:
I am The North.
I am various
I contain multitudes
Except when I am glimpsed
Through a long telescope
From The Seat of Power.
Then I am one terraced street
Where Batley
Is next door to Egremont
And I talk funny
And the cry comes:
‘Lock ‘em down, boys,
Lock ‘em down!’
McMillan, ‘the Bard of Barnsley’, neatly captures that cultural and political dissonance of long standing in England (or at least a perception thereof) between the centre, the capital, and those areas at geographical removes. In some senses, he is reaching for that ‘Grim up north’ trope beloved of playwrights and screenwriters. Principally, of course, his is a furious response to the government's perceived mishandling of the coronavirus pandemic, its lack of empathy for, and experimentation on, communities with large pockets of deprivation where the Conservative Party had made significant gains in the General Election of December 2019. It conveys a sense that the North is seen as an amorphous mass whose economy, culture and communities have again been thrown to the wolves. Since then, of course, the abandonment of the northern extension of the High Speed 2 railway into Yorkshire and Greater Manchester has driven another nail into improved connectivity between north and south and east and west. That is a far cry from the ‘Northern Powerhouse’ agenda espoused by former Conservative chancellors George Osborne and Philip Hammond that built on the civic regionalism developed under the Blair government, which itself contained many who would describe themselves as ‘northerners’, and aimed (perhaps still aims) to achieve a connected, competitive economy and transport infrastructure alongside a focus on education and skills. Ian McMillan, though, also taps into the centuries’ old debate about the place of ‘the North’ and what constitutes northernness and northern identity.
This collection of essays takes us back to a formative period for both the North and the kingdom of England as political-cultural entities: a century during which northern England was exposed to Scottish raids (causing the northern Church to mobilise material supplies, soldiers and bureaucrats), famine, epidemics (human and animal) and widespread poverty, as attested by higher rates of remission of government and papal taxation.
The registers of the fourteenth-century archbishops of York are among the best preserved episcopal registers in the United Kingdom, both in terms of their survival as a series and in terms of the range of their contents. David Smith's survey of both surviving and lost materials remains the fullest account of the range and location of the manuscripts. While the majority are now housed in the Borthwick Institute for Archives at the University of York, some strays are to be found in the British Library and some copies of lost materials are in York Minster Archives. Further small quantities of material relating to the archbishop's jurisdiction, especially ordinations, can be found in the diocesan archives at Carlisle and Durham.
By 1304, the archbishops of York were endowed with many powers and responsibilities in the spiritual administration of both the diocese of York and the Northern Province, and in the secular administration of their temporal estates. However, they did not usually exercise this authority in person. Their surviving registers provide a detailed record of the ways in which their powers were delegated to many other officials who exercised authority and provided spiritual services on their behalf. Indeed, the selection of records for registration became fundamental to the process through which archbishops delegated power and yet retained authority. Registered records provided evidence of entitlement to office, a framework for consistency of governance and enabled officials to be held accountable. These registered records were, however, far from the totality of records produced by members of the archbishop's administration; there were many other series of court records and papers to which they contributed, as will become clearer as this chapter progresses.3 Many administrative records that emanated from the archbishops’ household (familia) can be found as originals and copies in other archives, with the largest concentration being in TNA. Other archiepiscopal acta from the period survive in the cartularies and archives of other institutions with whom the archbishops corresponded and conducted business, such as other diocesan archives and those of religious houses and borough governments. It is on such survivals that the distinguished series of publications of episcopal acta for the twelfth and thirteenth centuries are based.
Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.
Apathy, a disabling and poorly understood neuropsychiatric symptom, is characterised by impaired self-initiated behaviour. It has been hypothesised that the opportunity cost of time (OCT) may be a key computational variable linking self-initiated behaviour with motivational status. OCT represents the amount of reward which is foregone per second if no action is taken. Using a novel behavioural task and computational modelling, we investigated the relationship between OCT, self-initiation and apathy. We predicted that higher OCT would engender shorter action latencies, and that individuals with greater sensitivity to OCT would have higher behavioural apathy.
Methods
We modulated the OCT in a novel task called the ‘Fisherman Game’, Participants freely chose when to self-initiate actions to either collect rewards, or on occasion, to complete non-rewarding actions. We measured the relationship between action latencies, OCT and apathy for each participant across two independent non-clinical studies, one under laboratory conditions (n = 21) and one online (n = 90). ‘Average-reward’ reinforcement learning was used to model our data. We replicated our findings across both studies.
Results
We show that the latency of self-initiation is driven by changes in the OCT. Furthermore, we demonstrate, for the first time, that participants with higher apathy showed greater sensitivity to changes in OCT in younger adults. Our model shows that apathetic individuals experienced greatest change in subjective OCT during our task as a consequence of being more sensitive to rewards.
Conclusions
Our results suggest that OCT is an important variable for determining free-operant action initiation and understanding apathy.
Professor Mark Ormrod is among the leading historians of the later Middle Ages in Britain. His contributions to the field are enormous: over his career he has published extensively and he has also fostered the field through the creation of funded projects that have brought previously hard-to-access archival resources into much wider public use, through the supervision of research students and through mentoring early career researchers. He has provided leadership at the highest level, both within his own institution, the University of York, and through his service to a number of national research councils and scholarly societies and, in particular, The National Archives.
Mark completed his doctorate in 1984 at the University of Oxford under the supervision of Professor James Campbell and then held a number of temporary and part-time positions at the Universities of Sheffield, Evansville (British Campus), and Queen's University Belfast before holding a British Academy Postdoctoral Research Fellowship at Cambridge from 1987–90. From there he moved to a lectureship at the University of York in 1990 and was promoted to full Professor in 1995. His experience of what is now widely known as ‘precarity’ in this early phase of his career always informed his later nurturing of graduate students and postdoctoral researchers, whose careers were always at the forefront of his mind in the creation of the many funded research projects that he so successfully established.
At York, Mark found a very happy home in both the Department of History and the interdisciplinary postgraduate Centre for Medieval Studies where his co-supervisors and co-teachers included Jeremy Goldberg, Jon Finch, Richard Marks, Nicola McDonald, Alastair Minnis, Linne Mooney, Sarah Rees Jones, Felicity Riddy and Craig Taylor. He was Director of the Centre for Medieval Studies 1998–2001 and 2002–3, and was Head of the Department of History in 2001 and 2003–7. He also struck up a very close working relationship with the Borthwick Institute for Archives, working with colleagues including Philippa Hoskin, Chris Webb and Gary Brannan. It was little surprise to his colleagues when he was appointed as the first Dean of the newly created Faculty of Arts and Humanities at York in 2009, a position that he held until his retirement in 2017.
Co-production relates to patients and health professionals working in equal partnership with shared decision-making. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly being used to involve patients and measure healthcare quality. We set out to develop a set of universal experience questions for use across Wales. These will be used in various settings, including the national electronic PROMs and PREMs platform, which is already collecting outcome data across Wales and has received over 7,000 responses to date.
Methods:
Patient experience leads and clinical leads were invited to a workshop to discuss standardized PREMs collection in Wales, with all health boards and trusts represented. It was agreed that quantitative patient experience data collection, while limited, would be a pragmatic way to collect responses from a large cohort. It was agreed that a previously developed set of PREMs questions could be adapted for use in all healthcare settings. Patient focus groups reduced the number of questions to a shortlist of those considered most important by patients. Wording was improved and an additional question was added.
Results:
In partnership with stakeholders we developed and agreed on a set of universal PREMs questions. These have been added to the national electronic platform, with collection commencing imminently. This will allow patients accessing secondary care in Wales to provide PREMs and PROMs responses.
Conclusions:
Development of a standardized set of PREMs has allowed us to initiate collection on a national basis. Addition of PREMs to the national electronic platform provides a unique means of collecting large volumes of data consistently, allowing us to benchmark across and within organizations. It will also allow experience teams to target improvement initiatives and identify good practice. Together with outcomes responses, the data will be used to measure experience of care in Wales.
Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex.
Electronic Records in Ambulances (ERA) is a two-year study which aims to investigate and describe the opportunities and challenges of implementing EHR and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision-making skills.
METHODS:
Our study includes a scoping review of relevant issues and a baseline assessment of progress in all UK ambulance services in implementing EHR. These will inform four in-depth case studies of services at different stages of implementation, assessing current usage, and examining context.
RESULTS:
The scoping review identified themes including: there are many perceived potential benefits of EHR, such as improved safety and remote diagnostics, but as yet little evidence of them; technical challenges to implementation may inhibit uptake and lead to increased workload in the short term; staff implementing EHR may do so selectively or devise workarounds; and EHR may be perceived as a tool of staff surveillance.
CONCLUSIONS:
Our scoping review identified some complex issues around the implementation of EHR and the relevant challenges, opportunities and workforce implications. These will help to inform our fieldwork and subsequent data analysis in the case study sites, to begin early in 2017. Lessons learned from the experience of implementing EHR so far should inform future development of information technology in ambulance services, and help service providers to understand how best to maximize the opportunities offered by EHR to redesign care.