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All the Sickly People, Where Do They All Come From? An OLD Problem (Off Load Delay) Rising Ambulance Presentations to an Irish Emergency Department
- Phillip Jordaan, Marco Smit, Robin Andrews, Phillip Jordaan, Keith Kennedy, Ria Abraham, Brendan Orsmond, Rochelle Jansen van Rensburg, Fahd Fayyaz, Yuni Neduchelyn, Andrea van der Vegte, Ashleigh Dowle, Darshini Vythilingam, Bryce Wickham, Thomas Kelly, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, pp. s124-s125
- Print publication:
- May 2023
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Introduction:
Demand for prehospital emergency services has been increasing worldwide. Significant challenges exist in meeting response times in rural environments when faced with surges in demand related to weather events or sustained demand surge such as the pandemic environment. Significant pressure also exists in the hospital environment receiving such large volumes of patients with short duration handovers to allow prehospital assets return to their primary roles. The aim of this study is to determine trends for ambulance presentations in a rural emergency department over seven years with absolute numbers and percentage of overall attendances.
Method:A retrospective analysis of anonymized electronic registration data on the iPMS system from initiation in 2014 to 2022 including total registration numbers, presentation by ambulance, and handover times. Excel is used to record and examine data.
Results:ED attendances rose from 29,236 in 2014 to 43,184 in 2021 with total ambulance presentations ranging from 4,859 in 2014 (16.62% of attendances), maxing in 2019 at 10,326 out of total attendances of 42,637 (24.22% of attendances).Lowest monthly ambulance presentations occurred in April 2014 (441 or 15.82% of 2788 attendances) and maximal monthly presentations was 1,023 in May 2022 (23.38% of 4376 attendances). Lowest percentage of attendances arriving by ambulance occurred in May 2014 with 14.97% (468) out of 3,127 ED presentations. Highest percentage of attendances arriving by ambulance occurred in January 2021 with 33.67% (875) of 2,599 ED presentations which was during the lockdown phase of COVID in Ireland.
Conclusion:Overall total numbers of patients arriving by ambulance has been steadily increasing for years but numbers (and percentages) dramatically increased during COVID and this has been sustained in the POST Lockdown pandemic phase. Strategies are required to manage demand, increase turnaround and educate the public on appropriate use of prehospital emergency services.
Review of Psychiatric Patient Transfer Times in an Emergency Department with Limited Psychiatric Services
- Maria Conradie, Brendan Orsmond, Robin Andrews, Muhammad Bilal, Andrea van der Vegte, Ria Abraham, Rochelle Janse van Rensburg, Syed Taqvi, Phillip Jordaan, Marco Smit, Ashleigh Dowle, Darshini Vythilingam, Bryce Wickham, Keith Kennedy, Thomas Kelly, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s207
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- May 2023
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Introduction:
The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.
Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.
Method:Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.
Results:The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.
Conclusion:There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.
Lodgers, Boarders, Trolley Patients; A Growing Challenge in Emergency Departments (ED). Zero Tolerance for Trolleys or Zero Tolerance for Zero Trolleys; A Crude Examination of Progressive Capacity Issues in an Irish Emergency Department.
- Maria Conradie, Marco Smit, Ria Abraham, Andrea van der Vegte, Muhammad Bilal, Brendan Orsmond, Robin Andrews, Rochelle Janse van Rensburg, Sayed Yousuf Raza Taqvi, Phillip Jordaan, Aishleigh Dowle, Darshini Vythilingam, Bryce Wickham, Thomas Kelly, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, pp. s176-s177
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- May 2023
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Introduction:
The Health Information and Quality Authority (HIQA) Tallaght Report of 2012 found care of lodged admitted patients on ED trolleys was undermined in terms of quality and safety. HIQA advised the practice of lodging in ED adjacent hospital corridors should be discontinued entirely. This message was reiterated during the pandemic. Some lodged patients may spend the total duration of their admission on an ED trolley. ED has 15 Adult rooms, seven pediatric rooms, two minor injury rooms, one procedure room and two resus bays. The aim was to calculate the annual number of days when no admitted patients were lodged on trolleys in ED.
Method:A descriptive study using data available from nationally issued reports on patients allocated to trolleys to the ED of Wexford General Hospital from January 2019-September 2022. Data was collected from national HSE daily SBAR reports. “Lodged patients” were those present in ED admitted but for whom no ward bed existed at 0745 daily.
Results:Data was collected for 1,369 days, 90 days were excluded due to missing data sets, and data were included for 1,279 days. 290 days were recorded in 2019 with no lodged patients, 126 in 2020, 55 in 2021, and only 11 days in 2022 with no lodged patients. In 2022 the average number of lodged patients was six (Range 0-19). A total of 47 days had a lodged count of ten or greater.
Conclusion:Despite a strong recommendation from HIQA to terminate the practice of ED patient lodging, this has not been implemented. During the COVID-19 pandemic, there had been a reduction in the overall number of patients visiting the ED. This contributed to the reduction in trolley-lodged patients however post-COVID pandemic there has been a surge in attendance with a clear deficit in bed capacity.
Retrospective Analysis to Assess the Admission Rate Trends in an Irish Public Hospital between February 2014-September 2022
- Rochelle Janse van Rensburg, Maria Conradie, Phillip Jordaan, Marco Smit, Andrea Van Der Vegte, Syed Taqvi, Brendan Orsmond, Robin Andrews, Ria Abraham, Ashleigh Dowle, Darshini Vythilingam, Keith Kennedy, Muhammad Bilal, Bryce Wickham, Thomas Kelly, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s177
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- May 2023
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Introduction:
As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.
The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.
Method:This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.
Results:Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.
Conclusion:This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.
Festina Lente: Bradycardia as a Presenting Feature of Life-Threatening Intra-Abdominal Hemorrhage
- Robin Andrews, Brendan Orsmond, Ria Abraham, Muhammad Bilal, Maria Conradie, Ashleigh Dowle, Rochelle Janse Van Rensburg, Phillip Jordaan, Thomas Kelly, Keith Kennedy, Marco Smit, Syed Yousuf Raza Taqvi, Andrea Van Der Vegte, Darshini Vythilingam, Bryce Wickham, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s125
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- May 2023
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Introduction:
Trauma is one of the leading causes of death in patients under 40 years of age. The Advanced Trauma Life Support (ATLS) Guidelines are widely accepted as the standardized approach to trauma and classify hemorrhagic shock according to heart rate (HR), blood pressure (BP), urinary output, and mental status. Paradoxical bradycardia (defined as HR <60 bpm) in hemorrhagic shock is an uncommon presenting feature and presents a diagnostic challenge to the physician; its true incidence is unknown.
Method:A case of paradoxical bradycardia was examined as a presenting feature in hemorrhagic shock.
Results:A 17-year-old male patient presented to our Emergency Department (ED) with collapse and abdominal pain following a collision with another player during a sports match.
The patient was hypotensive (BP 92/42) and bradycardic at triage, with a heart rate of 50. He was pale and diaphoretic with a Glasgow Coma Scale of 13/15, thready pulses, and localized peritonitis in the left upper quadrant of his abdomen.
An increase in blood pressure was observed following initial fluid resuscitation; however, this was transient and preceded the onset of profound hypotension (BP 64/30). Bradycardia with a heart rate between 50-60bpm was persistent despite resuscitative efforts.
Abdominal ultrasound demonstrated intraperitoneal free-fluid, and Computerized Tomography confirmed the presence of a grade V splenic laceration. He was taken to the operating theater for emergency laparotomy and underwent splenectomy. A 2.3 liter hemoperitoneum was found intraoperatively. There were no further complications post-operatively, and he made a full recovery.
Conclusion:Tachycardia is a potentially unreliable marker of blood loss, especially in young, healthy patients. A high index of suspicion is necessary to prevent this uncommon but life-threatening feature of hemorrhagic shock from being overlooked.
Under Pressure–TrolleyGar, a Metric Reflecting a Hospital System at Crisis-Capacity
- Maria Conradie, Marco Smit, Rochelle Janse van Rensburg, Sayed Taqvi, Brendan Orsmond, Robin Andrews, Andrea van der Vegte, Aishleigh Dowle, Bryce Wickham, Darshini Vythilingam, Fahd Fayyaz, Keith Kennedy, Phillip Jordaan, Ria Abraham, Yuni Neduchelyn, Thomas Kelly, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s153
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- May 2023
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Introduction:
Health service capacity has been an issue in Ireland since the 1980s swinging cuts. Government reports from 2003 have consistently identified a requirement for 3,000-5,000 extra beds on top of the current approximately 10,500 capacity. Acute hospital bed capacity issues have escalated, the formal system of recording “over capacity” patients or “patients on trolleys” has developed. A “Trolleygar” reports issues from the Health Service Executive (HSE) three times daily. This count is an underestimate as patients temporarily housed in day care units, surgical, or medical assessment units, discharge lounges and other clinical areas which have a bed space are not counted in this overcapacity measure. This study's aim is to calculate the annual number of days on which no patients were lodged on trolleys in Wexford General Hospital.
Method:Descriptive study using anonymized freely available data from the national HSE Trolley GAR reports on trolley patients in Wexford General Hospital from January 2019 until September 2022. A Golden Zero trolley day was stated as a day on which there were no reported trolley-patients at the three time points, Silver Zero trolley day when two of the time periods recorded no trolleys and a Bronze Zero Trolley day when one period recorded a zero trolley count.
Results:Data was collected on 1,369 days, with 90 days excluded due to missing data sets. There were 162 Golden days recorded (12.67% of total days). The year 2020 recorded the highest number of Golden days at 28.69% (105 days), followed by 2021 with 11.23% (41 days). During 2019 there were 3.84% (14 days) Golden days and 2022 had the lowest number (January-September) with 0.73% (2 days).
Conclusion:Despite a zero-tolerance policy, Golden days are disappearing rapidly, capacity is urgently required with post-pandemic ED attendance surges worldwide. True recording of overcapacity patients is required for appropriate capacity modeling.
Emergency Department Attendance Gap during COVID-19 Pandemic: A Comparison of Attendance Trends at Wexford General Hospital from 2014 to 2022
- Marco Smit, Brendan Orsmond, Michael Molloy, Robin Andrews, Muhammad Bilal, Andrea Van Der Vegte, Ria Abraham, Rochelle Janse van Rensberg, Syed Taqvi, Phillip Jordaan, Maria Conradie, Ashleigh Dowle, Darshini Vythilingam, Bryce Wickham, Thomas Kelly, Keith Kennedy, Fahd Fayyaz, Yuni Neduchelyn
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s188
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- May 2023
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Introduction:
COVID-19 resulted in 1.8 million reported deaths in 2020 and an excess mortality of at least 3,000,000 to date. Following the announcement of emergency measures mandating various public health interventions, international studies demonstrated a decline in ED attendances, potentiating a delay in seeking health services.
The objective was to examine ED attendance trends by age group and to categorize the attendances following the implementation of regulations related to COVID-19.
Method:A single-center retrospective observational study of ED attendances from 2014 to 2022 at Wexford General Hospital, a 225-bed acute general hospital. Monthly attendance trends were analyzed covering all phases of the national response. Information was extracted from the electronic health record system iPMS.
Results:Overall attendances decreased by 11.5% {42,637 (2019) to 37,751 (2020)}, well below expected annual growth projections from 2019 to 2020. A significant reduction in pediatric attendance (≤16 years) occurred, with 31.68% negative growth (10,351 to 7,071) in 2020 and sustained decrease of 15.3% (8,767 attendances) in 2021. In contrast, geriatric (≥65 years) attendances were unchanged in 2020 (17,751), with a surge of 8.9% to 19,333 attendances in 2021, the largest year-on-year growth since 2018. Comparisons of month-to-month trends in relation to public health measures correlated to a marked decline in attendances at the extremes of age during “lockdown” periods.
Conclusion:The reduction in attendances is likely multifactorial, such as a reduction in school-related stress and patients deciding to stay home for fear of attending during the pandemic with non-emergent conditions. The increase in geriatric presentations in 2021 may reflect continuing restricted access to primary care and GP services, or neglect of prior conditions. Examining changing demographic attendances may offer opportunities to develop alternative ways of supporting frail populations and families in community care avoiding ED presentations.
What is OSFED? The predicament of classifying ‘other’ eating disorders
- Zoe M. Jenkins, Serafino G. Mancuso, Andrea Phillipou, David J. Castle
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- BJPsych Open / Volume 7 / Issue 5 / September 2021
- Published online by Cambridge University Press:
- 12 August 2021, e147
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The transition from DSM-IV to DSM-5 relaxed diagnostic criteria for anorexia nervosa and bulimia nervosa, and recognised a third eating disorder, binge eating disorder. However, a large proportion of cases remain in the ill-defined category of ‘other specified feeding and eating disorders’. We sought to investigate the utility of a proposed solution to classify this group further, subdividing based on the dominant clinical feature: binge eating/purging or restraint. Cluster analysis failed to identify clusters in a treatment-seeking sample based on symptoms of restraint, binge eating, purging and over-evaluation of shape and weight. Further investigation of this highly heterogeneous group is required.
A multimethod dating study of ancient permafrost, Batagay megaslump, east Siberia
- Julian B. Murton, Thomas Opel, Phillip Toms, Alexander Blinov, Margret Fuchs, Jamie Wood, Andreas Gärtner, Silke Merchel, Georg Rugel, Grigoriy Savvinov, Sebastian Wetterich
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- Journal:
- Quaternary Research / Volume 105 / January 2022
- Published online by Cambridge University Press:
- 15 June 2021, pp. 1-22
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Dating of ancient permafrost is essential for understanding long-term permafrost stability and interpreting palaeoenvironmental conditions but presents substantial challenges to geochronology. Here, we apply four methods to permafrost from the megaslump at Batagay, east Siberia: (1) optically stimulated luminescence (OSL) dating of quartz, (2) post-infrared infrared-stimulated luminescence (pIRIR) dating of K-feldspar, (3) radiocarbon dating of organic material, and (4) 36Cl/Cl dating of ice wedges. All four chronometers produce stratigraphically consistent and comparable ages. However, OSL appears to date Marine Isotope Stage (MIS) 3 to MIS 2 deposits more reliably than pIRIR, whereas the latter is more consistent with 36Cl/Cl ages for older deposits. The lower ice complex developed at least 650 ka, potentially during MIS 16, and represents the oldest dated permafrost in western Beringia and the second-oldest known ice in the Northern Hemisphere. It has survived multiple interglaciations, including the super-interglaciation MIS 11c, though a thaw unconformity and erosional surface indicate at least one episode of permafrost thaw and erosion occurred sometime between MIS 16 and 6. The upper ice complex formed from at least 60 to 30 ka during late MIS 4 to 3. The sand unit above the upper ice complex is dated to MIS 3–2, whereas the sand unit below formed at some time between MIS 4 and 16.
The Relationship between Negative Symptoms and Both Emotion Management and Non-social Cognition in Schizophrenia Spectrum Disorders
- Caitlin O. B. Yolland, Sean P. Carruthers, Wei Lin Toh, Erica Neill, Philip J. Sumner, Elizabeth H. X. Thomas, Eric J. Tan, Caroline Gurvich, Andrea Phillipou, Tamsyn E. Van Rheenen, Susan L. Rossell
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- Journal:
- Journal of the International Neuropsychological Society / Volume 27 / Issue 9 / October 2021
- Published online by Cambridge University Press:
- 21 December 2020, pp. 916-928
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Objective:
There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition.
Method:Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman’s correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition.
Results:Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition.
Conclusions:The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.
Polygenic risk for schizophrenia and schizotypal traits in non-clinical subjects
- Igor Nenadić, Tina Meller, Simon Schmitt, Frederike Stein, Katharina Brosch, Johannes Mosebach, Ulrich Ettinger, Phillip Grant, Susanne Meinert, Nils Opel, Hannah Lemke, Stella Fingas, Katharina Förster, Tim Hahn, Andreas Jansen, Till F. M. Andlauer, Andreas J. Forstner, Stefanie Heilmann-Heimbach, Alisha S. M. Hall, Swapnil Awasthi, Stephan Ripke, Stephanie H. Witt, Marcella Rietschel, Bertram Müller-Myhsok, Markus M. Nöthen, Udo Dannlowski, Axel Krug, Fabian Streit, Tilo Kircher
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- Psychological Medicine / Volume 52 / Issue 6 / April 2022
- Published online by Cambridge University Press:
- 06 August 2020, pp. 1069-1079
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Background
Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.
MethodsWe tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.
ResultsWe did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.
ConclusionsThis important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).
Brain structural correlates of schizotypal signs and subclinical schizophrenia nuclear symptoms in healthy individuals
- Tina Meller, Simon Schmitt, Ulrich Ettinger, Phillip Grant, Frederike Stein, Katharina Brosch, Dominik Grotegerd, Katharina Dohm, Susanne Meinert, Katharina Förster, Tim Hahn, Andreas Jansen, Udo Dannlowski, Axel Krug, Tilo Kircher, Igor Nenadić
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- Journal:
- Psychological Medicine / Volume 52 / Issue 2 / January 2022
- Published online by Cambridge University Press:
- 24 June 2020, pp. 342-351
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Background
Subclinical psychotic-like experiences (PLE), resembling key symptoms of psychotic disorders, are common throughout the general population and possibly associated with psychosis risk. There is evidence that such symptoms are also associated with structural brain changes.
MethodsIn 672 healthy individuals, we assessed PLE and associated distress with the symptom-checklist-90R (SCL-90R) scales ‘schizotypal signs’ (STS) and ‘schizophrenia nuclear symptoms’ (SNS) and analysed associations with voxel- and surfaced-based brain structural parameters derived from structural magnetic resonance imaging at 3 T with CAT12.
ResultsFor SNS, we found a positive correlation with the volume in the left superior parietal lobule and the precuneus, and a negative correlation with the volume in the right inferior temporal gyrus [p < 0.05 cluster-level Family Wise Error (FWE-corrected]. For STS, we found a negative correlation with the volume of the left and right precentral gyrus (p < 0.05 cluster-level FWE-corrected). Surface-based analyses did not detect any significant clusters with the chosen statistical threshold of p < 0.05. However, in exploratory analyses (p < 0.001, uncorrected), we found a positive correlation of SNS with gyrification in the left insula and rostral middle frontal gyrus and of STS with the left precuneus and insula, as well as a negative correlation of STS with gyrification in the left temporal pole.
ConclusionsOur results show that brain structures in areas implicated in schizophrenia are also related to PLE and its associated distress in healthy individuals. This pattern supports a dimensional model of the neural correlates of symptoms of the psychotic spectrum.
3131 ONCOSTREAMS: NOVEL DYNAMICS PATHOLOGICAL MULTICELLULAR STRUCTURES INVOLVED IN GLIOBLATOMA GROWTH AND INVASION
- Andrea Comba, Patrick Dunn, Anna E Argento, Padma Kadiyala, Sebastien Motsch, Phillip Kish, Alon Kahana, Daniel Zamler, Karin Muraszko, Maria G Castro, Pedro R Lowenstein
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, p. 111
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OBJECTIVES/SPECIFIC AIMS: Oncostreams represent a novel growth pattern of GBM. In this study we uncovered the cellular and molecular mechanism that regulates the oncostreams function in GBM growth and invasion. METHODS/STUDY POPULATION: We studied oncostreams organization and function using genetically engineered mouse gliomas models (GEMM), mouse primary patient derived GBM model and human glioma biopsies. We evaluated the molecular landscape of oncostreams by laser capture microdissection (LCM) followed by RNA-Sequencing and bioinformatics analysis. RESULTS/ANTICIPATED RESULTS: Oncostreams are multicellular structures of 10-20 cells wide and 2-400 μm long. They are distributed throughout the tumors in mouse and human GBM. Oncostreams are heterogeneous structures positive for GFAP, Nestin, Olig2 and Iba1 cells and negative for Neurofilament. Using GEMM we found a negative correlation between oncostream density and animal survival. Moreover, examination of patient’s glioma biopsies evidenced that oncostreams are present in high grade but no in low grade gliomas. This suggests that oncostreams may play a role in tumor malignancy. Our data also indicated that oncostreams aid local invasion of normal brain. Transcriptome analysis of oncostreams revealed 43 differentially expressed (DE) genes. Functional enrichment analysis of DE genes showed that “collagen catabolic processes”, “positive regulation of cell migration”, and “extracellular matrix organization” were the most over-represented GO biological process. Network analysis indicated that Col1a1, ACTA2, MMP9 and MMP10 are primary target genes. These genes were also overexpressed in more malignant tumors (WT-IDH) compared to the less malignant (IDH1- R132H) tumors. Confocal time lapse imagining of 3D tumor slices demonstrated that oncostreams display a collective motion pattern within gliomas that has not been seen before. DISCUSSION/SIGNIFICANCE OF IMPACT: In summary, oncostreams are anatomically and molecularly distinctive, regulate glioma growth and invasion, display collective motion and are regulated by the extracellular matrix. We propose oncostreams as novel pathological markers valuable for diagnosis, prognosis and designing therapeutics for GBM patients.
23 - Eating disorders and body dysmorphic disorder
- from Part IV - Women and specific disorders
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- By Sandeep Ranote, Consultant Child and Adolescent Psychiatrist, Andrea Phillipou, Postdoctoral Research Fellow at St Vincent's Hospital, Melbourne, Susan Rossell, Director of the Centre for Mental Health and a Professor of Cognitive Neuropsychology at Swinburne University, David Castle, Psychiatry at St Vincent's Health Australia and the University of Melbourne
- Edited by Kathryn M. Abel, Rosalind Ramsay
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- The Female Mind
- Published online:
- 02 January 2018
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- 01 October 2017, pp 146-154
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Summary
‘Who wants to recover? It took me years to get that tiny. I wasn't sick; I was strong.’
– Laurie Halse Anderson (2011)Jo's story
Looking back, I didn't think I was ill at the start. I felt in control and I felt good because I was thin, which made me feel strong and successful. Aren't all successful women thin and beautiful?
That was when I was 15 years old; at 19, I know that none of that is true. I did have an illness, a real illness that hit me in secondary school, preparing for important exams while also breaking up with my first boyfriend.
I thought I wasn't beautiful enough for him and the breakup meant that I also lost my peer group at the time. I felt alone, under pressure and hated myself. I started to diet, like most people do, and joined the gym. I started getting results, which for me was important, in the same way exams were. I lost weight and saw this as positive, so I began to do more exercise, eat less and stopped eating sugary and fatty foods. I didn't see my headaches and dizziness as a problem, I just thought I needed to sleep more. But eventually I wasn't sleeping and my grades began to drop. I felt tired and low and remember sometimes having thoughts that I no longer wanted to live.
I didn't understand why my parents were anxious and arguing with each other about me. They could see something was wrong but I couldn't see it; they tried to talk to me but I couldn't hear them. When I fainted, I was taken to hospital, and this was when I accepted and started treatment with a specialist eating disorder team, who became almost part of our family. They gave not only me much needed support but also the whole family.
My message to you all is that there is hope and you can get help. Don't delay, share your concerns, get the treatment and don't let this illness steal your life.
Eating disorders
Self-starvation in women is not a modern phenomenon. Medieval women in the 13th century believed it would lead to sainthood, sometimes referred to as ‘anorexia mirabilis’.
Branched-chain amino acid, meat intake and risk of type 2 diabetes in the Women’s Health Initiative
- Masoud Isanejad, Andrea Z. LaCroix, Cynthia A. Thomson, Lesley Tinker, Joseph C. Larson, Qibin Qi, Lihong Qi, Rhonda M. Cooper-DeHoff, Lawrence S. Phillips, Ross L. Prentice, Jeannette M. Beasley
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- Journal:
- British Journal of Nutrition / Volume 117 / Issue 11 / 14 June 2017
- Published online by Cambridge University Press:
- 19 July 2017, pp. 1523-1530
- Print publication:
- 14 June 2017
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Knowledge regarding association of dietary branched-chain amino acid (BCAA) and type 2 diabetes (T2D), and the contribution of BCAA from meat to the risk of T2D are scarce. We evaluated associations between dietary BCAA intake, meat intake, interaction between BCAA and meat intake and risk of T2D. Data analyses were performed for 74 155 participants aged 50−79 years at baseline from the Women’s Health Initiative for up to 15 years of follow-up. We excluded from analysis participants with treated T2D, and factors potentially associated with T2D or missing covariate data. The BCAA and total meat intake was estimated from FFQ. Using Cox proportional hazards models, we assessed the relationship between BCAA intake, meat intake, and T2D, adjusting for confounders. A 20 % increment in total BCAA intake (g/d and %energy) was associated with a 7 % higher risk for T2D (hazard ratio (HR) 1·07; 95 % CI 1·05, 1·09). For total meat intake, a 20 % increment was associated with a 4 % higher risk of T2D (HR 1·04; 95 % CI 1·03, 1·05). The associations between BCAA intake and T2D were attenuated but remained significant after adjustment for total meat intake. These relations did not materially differ with or without adjustment for BMI. Our results suggest that dietary BCAA and meat intake are positively associated with T2D among postmenopausal women. The association of BCAA and diabetes risk was attenuated but remained positive after adjustment for meat intake suggesting that BCAA intake in part but not in full is contributing to the association of meat with T2D risk.
Cotton Stage of Growth Determines Sensitivity to 2,4-D
- Seth A. Byrd, Guy D. Collins, A. Stanley Culpepper, Darrin M. Dodds, Keith L. Edmisten, David L. Wright, Gaylon D. Morgan, Paul A. Baumann, Peter A. Dotray, Misha R. Manuchehri, Andrea Jones, Timothy L. Grey, Theodore M. Webster, Jerry W. Davis, Jared R. Whitaker, Phillip M. Roberts, John L. Snider, Wesley M. Porter
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- Journal:
- Weed Technology / Volume 30 / Issue 3 / September 2016
- Published online by Cambridge University Press:
- 20 January 2017, pp. 601-610
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The anticipated release of EnlistTM cotton, corn, and soybean cultivars likely will increase the use of 2,4-D, raising concerns over potential injury to susceptible cotton. An experiment was conducted at 12 locations over 2013 and 2014 to determine the impact of 2,4-D at rates simulating drift (2 g ae ha−1) and tank contamination (40 g ae ha−1) on cotton during six different growth stages. Growth stages at application included four leaf (4-lf), nine leaf (9-lf), first bloom (FB), FB + 2 wk, FB + 4 wk, and FB + 6 wk. Locations were grouped according to percent yield loss compared to the nontreated check (NTC), with group I having the least yield loss and group III having the most. Epinasty from 2,4-D was more pronounced with applications during vegetative growth stages. Importantly, yield loss did not correlate with visual symptomology, but more closely followed effects on boll number. The contamination rate at 9-lf, FB, or FB + 2 wk had the greatest effect across locations, reducing the number of bolls per plant when compared to the NTC, with no effect when applied at FB + 4 wk or later. A reduction of boll number was not detectable with the drift rate except in group III when applied at the FB stage. Yield was influenced by 2,4-D rate and stage of cotton growth. Over all locations, loss in yield of greater than 20% occurred at 5 of 12 locations when the drift rate was applied between 4-lf and FB + 2 wk (highest impact at FB). For the contamination rate, yield loss was observed at all 12 locations; averaged over these locations yield loss ranged from 7 to 66% across all growth stages. Results suggest the greatest yield impact from 2,4-D occurs between 9-lf and FB + 2 wk, and the level of impact is influenced by 2,4-D rate, crop growth stage, and environmental conditions.
Nanoparticles for light management in ultrathin chalcopyrite solar cells
- Martina Schmid, Phillip Manley, Andreas Ott, Min Song, Guanchao Yin
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- Journal:
- Journal of Materials Research / Volume 31 / Issue 21 / 14 November 2016
- Published online by Cambridge University Press:
- 10 November 2016, pp. 3273-3289
- Print publication:
- 14 November 2016
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We evaluate the potential of inserting metallic, metal-dielectric core-shell, and fully dielectric nanoparticles in ultrathin chalcopyrite solar cells to enhance absorption which experiences a significant drop for absorber thicknesses below 500 nm. For different integration positions at the front or at the rear of the solar cell structure theoretical expectations and potential benefits originating from light scattering, near-field enhancement and coupling into waveguide modes by the nanoparticles are presented. These benefits are always balanced against experimental challenges arising for particular geometries due to the very specific fabrication processes of chalcopyrite solar cells. In particular high absorber deposition temperatures as well as contact layers that are relatively thick compared to other devices need to be considered. Based on this, we will need to go beyond some geometries that have proven beneficial for other types of solar cells and identify the most promising configurations for chalcopyrite-based devices.
Chapter 16 - Body image disorders in women
- from Section 4 - Depression, anxiety and related disorders
- Edited by David J. Castle, University of Melbourne, Kathryn M. Abel, University of Manchester
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- Book:
- Comprehensive Women's Mental Health
- Published online:
- 05 March 2016
- Print publication:
- 07 March 2016, pp 197-207
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Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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four - Maintaining health and well-being: overcoming barriers to healthy ageing
- Edited by Alan Walker, The University of Sheffield
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- Book:
- The New Science of Ageing
- Published by:
- Bristol University Press
- Published online:
- 04 March 2022
- Print publication:
- 29 August 2014, pp 113-154
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Summary
This chapter concentrates on health and well-being, drawing on 11 New Dynamics of Ageing (NDA) projects covering the whole range, from basic biology to the arts and humanities. Our main purpose is to employ the findings from our projects to examine the barriers to healthy ageing and how to overcome them. By way of introduction to this discussion of healthy ageing we first consider some key concepts in this field: ageing and ill health, older age, quality of life and subjective well-being. We begin with an overview of the main demographic changes that underline the importance of research on healthy ageing.
Key concepts for healthy ageing
Demographic changes
Major demographic shifts are currently under way in countries of the developed world such as the UK. In the 25-year period from 1985 to 2010 the number of adults aged over 65 in the UK increased by 1.7 million, and the number of those aged over 85 almost doubled to 1.4 million (ONS, 2011a). This is partly due to improvements in mortality leading to higher numbers in old age. Life expectancy is increasing at a rate of two years per decade in developed societies. However, there are sharply divergent views about how trends in life expectancy may develop during this century. For example, Christensen et al (2009, p 1196) pointed out, ‘if the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 … [in] countries with long life expectancies will celebrate their 100th birthdays … research suggests that ageing processes are modifiable and that people are living longer without severe disability.’ On the other hand, Olshansky et al (2005, p 1142) stated, ‘as a result of the substantial rise in the prevalence of obesity and its life-shortening complications such as diabetes, life expectancy at birth and at older ages could level off or even decline within the first half of this century’.
The magnitude and implications of population ageing depend heavily on the magnitude of mortality improvement in decades to come. At present, overall age-standardised mortality rates (both sexes combined) are improving at about 2.5 per cent per annum in the UK (based on ONS, 2012a), but current trends are heavily influenced by patterns at ages where deaths are concentrated.