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While influential accounts grasp African realism as the child of decolonisation in West Africa, we trace its longue durée from formative events and institutions such as colonial and Christian publishing networks in Benin, Cape Verde, and South Africa; through the development of the idea of the African realist novel by intellectuals such as Ngũgĩ wa Thiong’o, Henry Owuor-Anyumba, and Taban Lo Liyong at African universities and literary conferences, such as the 1962 Makerere Conference and 1963 Fourah Bay conference; to contemporary permutations such as the historical novel. If the purpose of the African realist novel is to give shape to regional history, we find the irreal aesthetics of Bessie Head’s Maru (1971) and Tutuola’s The Palm-Wine Drinkard no more or less “real” than the ideal-typical realism of Mahfouz’s Cairo trilogy (1956–1957). We conclude that “realism” and its various antinomies (modernism, naturalism, irrealism, etc.) must ultimately be “reconstellate[d]” in terms of “each text’s relation to history itself” (Nicholas Brown 2–3).
In this chapter, I explore the intersection of spatiality and postcolonial literary writing through a focus on African literatures, broadly speaking, and the practices of worlding therein. Both as a market category and as a subset of what is variously termed ’world literature’ or ’postcolonial literature’, African literary writing offers a rich case study of the ways in which literature functions not merely as a passive repository of space or site of spatial representation, but as a driver of the constitution and performance of space itself. In this manner, the literary functions not as discrete or autonomous but through its entanglements with broader material, social, and ideological circuits. To do so, this chapter begins with an overview of postcolonial spatiality before moving to questions of aesthetics, form, publicness, and circulation to consider the diverse and sometimes divergent ways in which the performance of spatiality in African literary writing operates across uneven and asymmetrically loaded networks of production and distribution. The chapter ultimately argues that differential performances of spatiality in various bodies of African writing demonstrate the ways in which practices of worlding remain mediated by the material, structural, and systemic constitution of literature.
Large-eddy simulation (LES) is performed to study the tip vortex flow in a ducted propulsor geometry replicating the experiments of Chesnakas & Jessup (2003, pp. 257–267), Oweis et al. (2006a J. Fluids Engng128, 751–764) and Oweis et al. (2006b J. Fluids Engng128, 751–764). Inception of cavitation in these marine propulsion systems is closely tied to the unsteady interactions between multiple vortices in the tip region. Here LES is used to shed insight into the structure of the tip vortex flow. Simulation results are able to predict experimental propeller loads and show agreement with laser Doppler velocimetry measurements in the blade wake at design advance ratio, $J=0.98$. Results show the pressure differential across the blade produces a leakage vortex which separates off the suction side blade tip upstream of the trailing edge. The separation sheet aft of the primary vortex separation point is shown to take the form of a skewed shear layer which produces a complex arrangement of unsteady vortices corotating and counter-rotating with the primary vortex. Blade tip boundary layer vortices are reoriented to align with the leakage flow and produce instantaneous low-pressure regions wrapping helically around the primary vortex core. Such low-pressure regions are seen both upstream and downstream of the propeller blade trailing edge. The trailing edge wake is found to only rarely have a low-pressure vortex core. Statistics of instantaneous low pressures below the minimum mean pressure are found to be concentrated downstream of the blade’s trailing edge wake crossing over the primary vortex core and continue in excess of 40 % chord length behind the trailing edge. The rollup of the leakage flow duct boundary layer behind the trailing edge is also seen to produce counter-rotating vortices which interact with the primary leakage vortex and contribute to strong stretching events.
The application of a tube combustion system (pyrolyzer) for the batch combustion of low carbon content environmental matrices, such as soil and sediment, for determining 14C specific activity is examined. The samples were combusted at 600°C, and the CO2 species produced were trapped in 3N NaOH, precipitated as BaCO3 by adding BaCl2, and subjected to acid-hydrolysis to transfer the CO2 species to the absorber-scintillator mixture for liquid scintillation counting (LSC). The method was validated by analyzing the samples by accelerator mass spectrometry (AMS) method. The minimum detectable activity (MDA) for the method, at 2σ confidence level, was 10 Bq kg–1C (4 pMC) for a counting time of 500 min and 7 Bq kg–1C (3 pMC) for 1000 min. The capability of the method to quantify a small excess of 14C specific activity (a few Bq kg–1C or pMC) in the environment of a nuclear facility, when compared to the ambient natural background level, was demonstrated by analyzing a total of 23 soil and 7 sediment samples from the vicinity of a pressurized heavy water reactor (PHWR) nuclear power plant (NPP) at Kaiga, India. The maximum excess 14C specific activity values recorded for soil and sediment matrices were 37 ± 7 Bq kg–1C and 11 ± 7 Bq kg–1C, respectively, confirming minimal radioecological impact of the operation of the NPP on the environment. The 14C specific activity ratio for the recently fallen leaf litter and the soil underneath at most of the sampling points in the vicinity of the NPP had a mean value of 1.03 with an associated standard deviation of 0.07. Statistical tests confirm that the mean values of the data set of 14C specific activity of leaf litter and underlying soil are not significantly different.
Polar ring galaxies (PRGs) are a unique class of galaxies characterised by a ring of gas and stars orbiting nearly orthogonal to the main body. This study delves into the evolutionary trajectory of PRGs using the exemplary trio of NGC 3718, NGC 2685, and NGC 4262. We investigate the distinct features of PRGs by analysing their ring and host components to reveal their unique characteristics through spectral energy distribution (SED) fitting. Using CIGALE, we performed SED fitting to independently analyse the ring and host spatially resolved regions, marking the first decomposed SED analysis for PRGs, which examines stellar populations using high-resolution observations from AstroSat UVIT at a resolved scale. The UV-optical surface profiles provide an initial idea that distinct patterns in the galaxies, with differences in FUV and NUV, suggest three distinct stages of ring evolution in the selected galaxies. The study of resolved-scale stellar regions reveals that the ring regions are generally younger than their host galaxies, with the age disparity progressively decreasing along the evolutionary sequence from NGC 3718 to NGC 4262. Star formation rates (SFR) also exhibit a consistent pattern, with higher SFR in the ring of NGC 3718 compared to the others, and a progressive decrease through NGC 2685 and NGC 4262. Finally, the representation of the galaxies in the HI gas fraction versus the NUV–$\text r$ plane supports the idea that they are in three different evolutionary stages of PRG evolution, with NGC 3718 in the initial stage, NGC 2685 in the intermediate stage, and NGC 4262 representing the final stage. This study concludes that PRGs undergo various evolutionary stages, as evidenced by the observed features in the ring and host components. NGC 3718, NGC 2685, and NGC 4262 represent different stages of this evolution, highlighting the dynamic nature of PRGs and emphasising the importance of studying their evolutionary processes to gain insights into galactic formation and evolution.
The brachyuran crab fauna (Crustacea: Decapoda: Brachyura) collections in the extensive exploratory fishery survey cruises from the northeast coast of India was studied from June 2018 to March 2020. During the study period, 81 species of brachyuran crabs belonging to 19 families and 46 genera were recorded. Among these, 21 species were newly recorded from the northeast coast of India, and 1 species, Naxioides taurus (Pocock, 1890) represents a new record for the mainland coasts of India. This study serves as a baseline for understanding the diversity and distribution of brachyuran crabs in the region. It provides valuable insights for future research and conservation efforts.
Marine propellers are studied in design and off-design modes of operation like crashback, where the propeller rotates in reverse while the vehicle is in forward motion. Past experiments (Jessup et al., Proceedings of the 25th Symposium on Naval Hydrodynamics, St John's, Canada, 2004; Proceedings of the 26th Symposium on Naval Hydrodynamics, Rome, Italy, 2006) studied the marine propeller David Taylor Model Basin 4381 in the open-jet test section of the 36-inch variable pressure water tunnel (VPWT). In crashback, a significant discrepancy with unclear sources exists between the mean propeller loads from the VPWT and open-water towing tank (OW) experiments (Ebert et al., 2007 ONR Propulsor S & T Program Review, October, 2007). We perform large-eddy simulation at $Re=561\,000$ and advance ratios $J=-0.50$ and $-0.82$ with the VPWT geometry included, contrasting to the unconfined (OW) case at those same $J$ and $Re=480\,000$. We identify and delineate the water tunnel interference effects responsible, and demonstrate that these effects resemble those of a symmetric solid model or bluff body. Solid blockage due to jet expansion and nozzle blockage due to proximity to the tunnel nozzle are identified as the primary interference effects. Their impact varies with the advance ratio $J$ and strengthens for higher magnitudes of $J$. The effective length scale to assess the severity of interference effects is found to be larger than the vortex ring diameter.
A method is given for finding a linear combination of binary item scores that minimizes the expected frequency of misclassification, in discriminating between two groups. The item scores are not assumed to be stochastically independent. The method uses the theory of threshold functions, developed by electrical engineers. Since psychometricians may not be familiar with this theory an elementary introduction to the required material is also given.
The association between heatwave and heat-related outcomes in people with mental health conditions with and without psychotropics was unclear.
Methods
We identified people with severe mental illness (SMI) and depression, respectively, using Japanese claim data of Ibaraki prefecture during 1/1/2014–31/12/2021. We conducted self-controlled case series to estimate the incidence rate ratio (IRR) of heat-related illness, myocardial infarction and delirium, respectively, during 5-day pre-heatwave, heatwave, and 5-day post-heatwave periods v. all other periods (baseline) within an individual, stratified by periods prescribed psychotropics and periods not prescribed psychotropics, respectively.
Results
Among people with SMI, heatwave was associated with an increased rate of heat-related illness v. baseline, with no evidence of a difference in the IRRs between those prescribed v. not prescribed antipsychotics (IRR: 1.48 [95% CI 1.40–1.56]; 1.45 [95% CI 1.35–1.56] respectively, p interaction: 0.53). Among people with depression, heatwave was similarly associated with heat-related illness, with no evidence of a difference in the IRRs between those prescribed v. not prescribed antidepressants (IRR: 1.54 [95% CI 1.46–1.64]; 1.64 [95% CI 1.57–1.71] respectively, p interaction: 0.33). Smaller increased rates of heat-related illness were also observed in pre- and post-heatwave periods, v. baseline in both cohorts. There was weak evidence of an increased risk of MI and delirium associated with heatwave v. baseline.
Conclusions
We showed an increased risk of heat-related illness, myocardial infarction and delirium associated with heatwave in people with mental health conditions regardless of whether being prescribed psychotropics. Risks of heat-related illness, myocardial infarction and delirium associated with heatwave might not be factors to influence decisions about the routine use of psychotropics.
A hydrodynamic theory of premixed flame propagation within closed vessels is developed assuming the flame is much thinner than all other fluid dynamic lengths. In this limit, the flame is confined to a surface separating the unburned mixture from burned combustion products, and propagates at a speed determined from the analysis of its internal structure. Unlike freely propagating flames that propagate under nearly isobaric conditions, combustion in a closed vessel results in continuous increases in pressure, burning rate and flame temperature, and a progressive decrease in flame thickness. The flame speed is shown to depend on the voluminal stretch rate, which measures the deformation of a volume element of the flame zone, and on the rate of pressure rise. Both effects are modulated by pressure-dependent Markstein numbers that depend on heat release and mixture properties while capturing the effects of temperature-dependent transport and stoichiometry. The model applies to flames of arbitrary shape propagating in general flows, laminar or turbulent, within vessels of general configurations. The main limitation of hydrodynamic flame theories is the assumption that variations inside the flame zone due to chemistry or turbulence, which could potentially alter its internal structure, are physically unresolved. Nonetheless, the theory, deduced from physical first principles, identifies the various mechanisms involved in the combustion process as demonstrated in detailed discussions of planar flames propagating in rectangular channels and spherically expanding flames in spherical vessels. It also enables the construction of instructive models to numerically simulate the evolution of multi-dimensional and corrugated flames under confinement.
To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens.
Design and setting:
Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015.
Methods:
Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups.
Results:
A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08–2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68–1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%–.5%) and did not differ statistically.
Conclusions:
Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.
Disclosing individual research results to participants is not standard practice. The return of individual research results to participants may increase recruitment, retention, and engagement in research. This study’s objective was to explore the preferences, expectations, and experiences of research participants receiving individual research results.
Methods:
A mixed-methods approach, consisting of semi-structured interviews and a health literacy assessment, was used with participants enrolled in a cohort study. The interviews were analyzed to produce an understanding of current experiences. Using descriptive analyses, responses were compared to identify alignments and divergences among participants.
Results:
Forty-three English-speaking and 16 Spanish-speaking participants enrolled. Ninety-eight percent of participants wanted to receive their individual research results. Seventy-five percent of participants reported they shared results with their healthcare providers. More participants aged 18–65 reported the need to follow up with their provider (70%) as compared to participants > 65 (20%). Two-thirds of participants reported a positive experience receiving their research results; however, 22% reported anxiety and worry. Most participants (69%) described the electronic medical record (EMR) as their preferred method for receiving their results. Yet only 50% of Spanish speakers preferred receiving research results through the EMR compared to 77% of English speakers. Participants with low health literacy preferred receiving study results in person or by phone.
Conclusion:
Research participants value receiving their individual research results, and this may increase recruitment and retention within the research enterprise. While more research is needed, the lessons learned from this study lay the groundwork for developing best practices and policies around the return of individual research results.
Medical students have been under immense pressure throughout their studies, impacting their mental health and academic performance. Stress reduction is a fundamental skill that all students require to manage their studies and lives efficiently. Biofeedback devices providing information about physiological states have been shown to aid stress reduction. Methods to reduce stress should be taught to medical students to help them tackle the challenges of medical school.
Objectives
Our goal was to teach stress reduction methods such as extracurricular activities and paced breathing aided by biofeedback training and its application in simulated healthcare situations to medical students.
Methods
15 medical students who completed medical physiology were recruited for an elective course of 7 sessions on practical techniques in stress management. One credit was offered to those who completed the course requirements consisting of participation in sessions and individual biofeedback training.
Sessions (classes) consisted of presentations on good sleeping and eating patterns, group simulations of stressful hospital environments, visiting a science centre with interactive displays, an orchestra performance, and nature walks. Before biofeedback training, heart and respiration rates were taken individually by a biofeedback device during the first week of the course. Data was processed using a code created in statistical software. Heartbeats per minute and heart rate variability (HRV) for every 10 seconds were calculated and plotted on a graph. Two measurements were taken with each student: a baseline measurement for 10 minutes and another measurement during controlled breathing paced at 6 breaths per minute for 15 minutes, of which the first 10 minutes were used for calculation and plotting. Students provided narrative feedback in an essay submitted after the course was completed.
Results
5 males and 10 females from years 2-5 registered for the elective, and 12 participated in individually scheduled sessions. Heart beats per minute decreased, whereas HRV increased during paced breathing sessions in 83% of them. Most students reported feeling calm and drowsy during the sessions, and 2 students fell asleep by the end.
Feedback from 11 students showed that the music session and the science centre visit were the highlights throughout the elective. Improvements recommended were to have a consistent time slot for all sessions and fewer simulations.
Conclusions
In concert with the literature, biofeedback training seems to be a feasible and effective method for relaxation in medical students. This method could be offered as part of mental health services for students. Data could be used to follow students’ progress and identify those requiring extra support. Providing them with avenues to de-stress while emphasizing activities outside medicine could boost their confidence and improve their coping skills.
This clinical audit aimed to assess if the recording of patients seen for their diagnostic appointments in memory clinic measures up to the minimum standards required in the delivery of dementia services. This standard mandated primarily that a minimum body of key information must be promptly recorded by clinicians, in patient electronic records within 24 hours, as stipulated by Trust and NICE guidelines.
Methods
The first cycle was conducted from 16 October 2022 to 10 February 2023. In this cycle random sampling was used to select 25 patients on the caseloads of the mental health services for older people. Before the start of the second phase all diagnosing clinicians within the team were informed about the project and the expected improvements against which compliance would be audited. The second phase was conducted between 10 February 2023 to 31 March 2023 and another 25 patients on the caseloads were obtained via random sampling for the second cycle. Inclusion criteria for both phases were patients who had received a diagnostic assessment in these periods.
Results
In the first set of records, the minimum body of information was recorded in 90–100% of cases according to the team's recommended standards namely diagnostic information, prognostic information, treatment plans, post-diagnostic contact plans and documentations being made within 24hrs of consultation. In the Set 2 the minimum body of information was recorded in 95–100% records studied. That is, diagnosis, treatment, medication treatment plans (prescription plans), and post-diagnostic contact plans were covered in the diagnostic sessions. In particular, case note documentations were made within 24 hours in all but one of the records applicable.
Conclusion
Given that a diagnosis of dementia can be life-changing, not discussing prognostic information would not prepare patients and carers adequately with information on how to live well with dementia following their diagnosis. This could potentially lead to poor adjustment to the condition and anxiety for some. At a trust-wide level, this means there is still room for improvement for the trust as regards dementia care ideals recommended by NICE.
To create a safe and effective induction programme for Higher Specialist Trainees (HST) at Nottinghamshire Healthcare NHS Foundation Trust.
An effective induction improves trainees' satisfaction, they feel welcomed and valued. It improves patient safety, retention, and recruitment (GMC Report 2020).
Methods
Based on GMC report, published in 2020, a survey was developed locally and data for 2021 HST induction was collected using digital platform. Initial stakeholder analysis completed, and relevant parties were invited to share the results. Two key deliverables were identified after consultation, one was a dedicated induction programme for HST which was co-produced along with trainees and stakeholders. The other deliverable was updating the induction booklet. The proposed induction plan was implemented in August 2023, the survey was repeated to the new HST cohort following induction via digital platform. Results of the survey were analysed via mixed methods (qualitative & quantitative).
Results
The surveys conducted in 2021 and 2023 were compared and there was an increase in response rate from 50% to 64%. The domains were devised from GMC standards and assessed by if staff had received everything in the domain within a week of starting their placement and results evaluated using a t-test.
Domain A is gaining access to places and system (keys, fobs, security passes, computers, ID badges, mobile phones, IT system). This significantly improved from 27% to 88% with a p-value of < 0.001.
Domain B is physical orientation of the setting (staff facilities such as lockers, parking, library, and site layout). This significantly improved from 45% to 88% with a p-value of < 0.018.
Domain C is gaining day to day knowledge (HR, rota, annual leave, study leave, pay-roll, mandatory training, e-expenses, and guardian of safe working). There was no significant change between 9% and 19% with a p-value of < 0.48.
Domain D is an understanding of expectations (duties and responsibility during working hours, on-call, team introduction). This significantly improved from 9% to 69% with a p-value of < 0.002.
HSTs were given the chance to add comments and the responses in 2023 were more positive “excellent induction compared to previous years” compared with 2021 when HSTs felt isolated and devalued “worst ever induction in whole career in NHS”.
Conclusion
Overall, the results of the 2023 survey showed considerable improvement in all the key areas of induction within one week of starting the placement. Domain C demonstrates a challenge still and needs further work.
Patients referred to a Personality Disorder (PD) Service are frequently not offered treatment. This has profound implications for patients (who feel dismissed or rejected), referrers (who are perplexed as they have clearly diagnosed a PD) and the PD services themselves (their raison d'etre being to treat PD patients). A systematic search identified no literature on reasons for non-acceptance. This study aimed to describe reasons for not offering therapy in patients, after a specialist assessment.
Methods
We conducted a case series of 50 patients assessed in a specialist PD service. We collected data from routine service notes, using thematic analysis to identify categories of the reasons identified for treatment unsuitability.
Results
Reasons for assessing treatment unsuitability (in descending order) were:
1. (20%) – Lack of engagement (e.g. repeated non-attendance of appointments) and motivation to change (e.g. externalising all responsibility, or believing they completely lacked agency in their actions).
2. (18%) – Extremely harmful substance misuse or dependence.
3. (13%) – The underlying diagnosis (e.g. not meeting diagnostic criteria for a personality disorder or a severe psychopathy) and level of severity (e.g. too mild for a specialist service).
4. (11%) – Identified areas of psychological work has very little to no relation to interpersonal difficulties or relationships.
1. To accept that many patients with PD will fail to actively engage in psychotherapy.
2. To consider whether severity is of a level requiring specialist PD treatment; or if the patient needs a forensic psychotherapy service rather than a non-forensic PD service.
3. To consider whether the comorbid conditions (e.g. dependent alcohol use) are in fact the primary diagnosis and thus require treatment before the PD service intervention.
PD services
1. Need to develop novel interventions to help patients become more active and engaged in the assessment and thus progress onto treatment.
2. Need to inform referrers on their criteria for not offering treatment, allowing referrers the ability to gauge more accurately when to refer the patient.
RCPsych Dean's Grand Rounds focuses on understanding a problem or an opportunity for change in clinical practice using a patient story, academic evidence, and contextual data in this area to bridge the evidence-practice gap using a quality improvement approach. The Dean's Grand Rounds aims to embed the lived experience in clinical practice and use data to drive change.
Methods
We held five virtual Dean's Grand Rounds with this format from June 2022 to January 2024. The sessions included a variety of medical professionals, carers and expert patients presenting on the chosen theme, followed by a panel discussion. The sessions were then made available for on-demand viewing via the RCPsych website for those unable to attend the live session. Qualitative and quantitative feedback helped us improve the sessions iteratively.
Results
The sessions have enabled discussion of broader issues facing staff and patients, facilitating the exchange of ideas between professionals from divisions of the RCPsych from around the world. Participants globally attended these sessions, with over 1,000 registrations for the Grand Rounds on memory clinics and catatonia. The feedback for the sessions was overwhelmingly positive, with many participants praising the involvement of patients and carers and the opportunity to come together at the RCPsych level for learning. Many were attracted to the sessions because of the themes discussed, with 68.5% having excellent overall experience. Over 92% of the feedback participants thought the Grand Rounds had improved their professional practice. The majority of the feedback participants strongly agreed that lived experience is an important element in understanding the evidence-practice gap (4.4 on a Likert scale of 1, strongly disagree; 5, strongly agree) and that the Grand Rounds had enhanced their understanding of academic evidence and contextual data in the area (4.4, 4.39 respectively on a Likert scale of 1, strongly disagree; 5, strongly agree). The themes that stood out in the feedback were that participants liked the Grand Rounds format and were grateful to hear from patients, with suggestions to allocate more time for questions and answers. Learning from the feedback, we set up a resources page for each Grand Rounds to enable further learning.
Conclusion
In their revitalised format, these sessions are proving highly effective in bringing the worldwide RCPsych community together to improve patient care and deliver educational and informative interactive content available on demand.