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Contention remains as to the impact of withdrawal of Early Intervention Services (EIS) on subsequent hospitalisation rates. The UK NICE guideline continues to state that such clinical gains of EIS are diminished following discharge and recommends further study at 5 years (accessed July 2025; https://www.nice.org.uk/Guidance/CG178).
Objectives
We aimed to explore hospitalisation rate by year in the UK Sussex First Episode Psychosis Cohort study (S1P).
Methods
We retrospectively recorded hospitalisations in the S1P cohort for those who had continued to receive secondary mental health care at 5 years from first psychotic episode, including 2 years following discharge from EIS. Data was collected between 2009 and 2017. Ethical conduct of the study was approved by the Sussex Partnership NHS Foundation Trust.
Results
184 patients received 5 years of care following a first episode of psychosis (52% of the original cohort enrolling with EIS). 69% had at least 1 hospitalisation episode between baseline and 5 years. Actual total new hospitalisations per year were 72 at baseline, then 59, 44, 49, 54 and 41 in subsequent years. Mean hospitalisations per person per year excluding the index admission when comparing the 0-3 (under EIS care) vs 4-5 years period was 0.275 [95% CI - 0.215 to 0.335] vs 0.219 [0.159 to 0.278] respectively (n = 183; p = 0.050).
No changes in external factors influencing overall bed availability were identified during the study period
Conclusions
The group of patients requiring care up to 5 years had initial declining hospitalisation rates but relative stability following the first year. The group not requiring 5 years of specialist mental health care, not studied here, likely had much lower hospitalisation. The hypothesis of rebound hospitalisation in the 2 years following EIS discharge is not supported.
The presence of tobacco (Nicotiana spp.) seeds in a terminal Pleistocene cultural feature confirms human use of tobacco in the Americas for more than 12,000 years. Throughout the Americas, the practice of smoking tobacco came to be a central element in prayer and purification rituals and medical treatments, as well as part of a solemnizing ritual in diplomatic settings. However, the nature of its earliest use—whether smoked, chewed, steeped, or otherwise ingested—remains uncertain, and the question of when smoking with pipes developed as a common cultural practice remains unresolved. Our review of pipes from dated contexts indicates that pipes were present in the interior of the West of North America—where native tobaccos are endemic—by about 6,000 years ago and possibly as early as 8,000 years ago, far earlier than has been noted in other regions. We address the ancient role of pipes and tobacco use in ritual and community-building, the role of tobacco in the development of plant management and horticultural practices, and the critical positioning of pipes and tobacco in Native commerce and diplomacy. We also report new radiocarbon dates from the Connley Caves and Dirty Shame Rockshelter in Oregon.
The visual images of Queen Elizabeth I displayed in contemporary portraits and perpetuated and developed in more recent media, such as film and television, make her one of the most familiar and popular of all British monarchs. This book is a collection of essays that examine the diversity of the queen's extensive iconographical repertoire, focusing on both visual and textual representations of Elizabeth, in portraiture, literature, contemporary sermons, speeches and alchemical treatises. It falls into three sections. The first part looks at the diverse range of religious and quasi-religious images that were employed by and about Elizabeth, such as the Prophetesse Deborah, the suggestive parallel with Joan of Arc, and finally Lady Alchymia, the female deity in alchemical treatises. When Queen Elizabeth I, the first female Protestant monarch, was enthroned in 1558, male poets, artists, theologians, and statesmen struggled to represent this new phenomenon. The second part turns to one of the major enterprises of the Elizabethan era, the attempt to colonise the New World, during which the eastern seaboard of America was renamed Virginia in celebration of the Virgin Queen. The last part focuses on the ways in which the classical world was plundered for modes of imaging and figuring the queen. Finally, the book summarises the enormously wide range of Elizabeth's iconographical repertoire of its appeal, and provides a fitting end to a book which ranges so widely across the allegorical personae of the queen.
A Midsummer Night's Dream is a play which is heavily imbued with the iconography of virginity which had been developed by and for Elizabeth I in the final phase of her reign. This chapter is concerned with several strategies of retrospection employed by William Shakespeare in Dream in order to critique Elizabeth and her iconography of virginity. The first example of this is the relationship between Dream and John Marlowe's Dido, Queen of Carthage. The second strategy of retrospection is Shakespeare's use of the figure of Titania to reassess Elizabeth's status in the 1590s as perpetual virgin. The myth of Dido was one which had been used in Elizabethan entertainments as early as 1564. The use of the myth increased significantly, however, during the period 1579 to 1583 which coincided with the marriage negotiations between Elizabeth and Francis, Duke of Anjo.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book addresses the full range of the queen's extraordinary iconographical repertoire, focusing specifically on its development during Elizabeth I's forty-five-year reign. It looks at the diverse range of religious and quasi-religious images that were employed by Elizabeth. The book turns to one of the major enterprises of the Elizabethan era, the attempt to colonise the New World, during which the eastern seaboard of America was renamed Virginia in celebration of the Virgin Queen. It considers the development of the iconography of Elizabeth as a collaborative enterprise, through the examination of some of the most famous paintings of Elizabeth, paying particular attention to The Ditchley portrait, the Siena Sieve Portrait and the Rainbow Portrait. The book notes that a good deal has been written on the subject of Elizabeth's identification with Petrarch's Laura.
This book approaches the rich and diverse figure of the earl by looking at a wealth of diverse visual and textual manifestations of Essex produced during the sixteenth century and up to the present day. It resituates his life and career within the richly diverse contours of his cultural and political milieu. Included in the discussion are not just those texts of which Essex is the subject, such as poems, portraits or films, but also those texts produced by Essex himself, including private letters, poems and entertainments. The book first offers important insights into the composition and ethos of the Essex circle. It then provides an important intervention in the debate about the relationship between Essex and the theatre and Essex and Shakespeare, considering his role as a patron of a company of players. The book also explains Essex's use of non-professional theatrical entertainments at court in 1595 to promote an agenda he had shared with Sidney by campaigning for an increased level of English involvement in international affairs. It deals with a frequently neglected entertainment called the device of the Indian Prince, referred to here as Seeing Love as it dramatises the story of the blind Indian prince. Finally, the book offers a detailed examination of Essex's relationship with another dangerously public discourse, 'politic history', by tracing the influence of a range of competing texts.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book describes the rich and diverse figure of the earl by looking at a wealth of diverse visual and textual manifestations of Essex produced during the sixteenth century and up to the present day. It traces the critical assessment of the earl's decision to undertake a campaign in Ireland and considers the suggestion that his political enemies considered it politically expedient to have the earl personally embroiled in a foreign war. The book also describes the biographical commonplace that Essex identified himself with the chivalric code valued by Sir Philip Sidney and actively fashioned an identity for himself as Sidney's heir. It presents Essex's use of non-professional theatrical entertainments at court to promote an agenda he had shared with Sidney by campaigning for an increased level of English involvement in international affairs.