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The dichotomies of ‘typical/atypical’ or ‘first/second generation’ have been employed for several decades to classify antipsychotics, but justification for their use is not clear. In the current analysis we argue that this classification is flawed from both clinical and pharmacological perspectives. We then consider what approach should ideally be employed in both clinical and research settings.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
Human trafficking is a grave human rights violation and a major public health concern. Survivors present with high rates of mental health problems including post-traumatic stress disorder (PTSD). Studies of effective treatments for PTSD in survivors of human trafficking are lacking. Narrative exposure therapy (NET) is an effective PTSD treatment for multiple, prolonged and complex trauma, but its efficacy has not been rigorously tested in survivors of human trafficking.
Aims
To test the feasibility and acceptability of a randomised controlled trial (RCT) offering NET as a treatment for PTSD in trafficking survivors with a history of multiple traumatic events, as well as providing preliminary evidence regarding its efficacy (trial registration: ISRCTN95136302).
Method
A single-blind RCT compared NET with a wait-list control in survivors of trafficking with PTSD (n = 25). In the NET arm of the study, participants attended a mean of 17 sessions.
Results
NET was well tolerated by participants. There were significant reductions in PTSD, depression and anxiety symptoms post-treatment in the NET group but no significant change in the wait-list group.
Conclusions
The results indicate that NET is a promising and acceptable treatment for trafficking survivors. Psychological therapy in an RCT design can be safely delivered to this vulnerable group, although modifications are required to ensure their holistic needs are properly addressed.
ABSTRACT IMPACT: Many who suffer from end-stage organ disease do not qualify for solid organ transplantation because of obesity; however, bariatric surgery offers the potential to render select patients transplant-eligible, and in some cases, may lead to weight loss that is sufficient to reverse end-stage organ disease. OBJECTIVES/GOALS: As obesity prevalence grows, more end-stage organ disease patients will be precluded from transplant. Numerous reports suggest bariatric surgery in end-stage organ disease may help patients achieve weight loss sufficient for transplant listing, though the published data are limited. METHODS/STUDY POPULATION: We performed a systematic review/meta-analysis of studies of bariatric surgery to achieve solid organ transplant listing. RESULTS/ANTICIPATED RESULTS: Among 82 heart failure patients, 40.2% lost sufficient weight for listing, 29.3% were transplanted, and 8.5% had sufficient improvement with weight loss they no longer required transplantation. Among 28 end-stage lung disease patients, 28.6% lost sufficient weight for listing, 7.1% were transplanted, and 14.3% had sufficient improvement following weight loss they no longer required transplant. Among 41 cirrhosis patients, 58.5% lost sufficient weight for listing, 41.5% were transplanted, and 21.9% had sufficient improvement following weight loss they no longer required transplant. Among 288 end-stage/chronic kidney disease patients, 50.3% lost sufficient weight for listing and 29.5% were transplanted. DISCUSSION/SIGNIFICANCE OF FINDINGS: Small sample size and publication bias are limitations; however, bariatric surgery may benefit select end-stage organ disease patients with obesity that precludes transplant candidacy.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.
OBJECTIVE
To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS
DESIGN
American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.
SETTING
Multicenter study
PARTICIPANTS
Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
MAIN OUTCOME
The primary outcome of interest was 30-day SSI rate.
RESULTS
A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.
CONCLUSIONS
Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.
Background: Schema Theory proposes that the development of maladaptive schemas are based on a combination of memories, emotions and cognitions regarding oneself and one's relationship to others. A cognitive model of psychosis suggests that schemas are crucial to the development and persistence of psychosis. Little is known about the impact that schemas may have on those considered to be at clinical high risk (CHR) of developing psychosis. Aims: To investigate schemas over time in a large sample of CHR individuals and healthy controls. Method: Sample included 765 CHR participants and 280 healthy controls. Schemas were assessed at baseline, 6 and 12 months using the Brief Core Schema Scale (BCSS). Baseline schemas were compared to 2-year clinical outcome. Results: CHR participants evidenced stable and more maladaptive schemas over time compared to controls. Schemas at initial contact did not vary amongst the different clinical outcome groups at 2 years although all CHR outcome groups evidenced significantly worse schemas than healthy controls. Although there were no differences on baseline schemas between those who later transitioned to psychosis compared to those who did not, those who transitioned to psychosis had more maladaptive negative self-schemas at the time of transition. Associations between negative schemas were positively correlated with earlier abuse and bullying. Conclusions: These findings demonstrate a need for interventions that aim to improve maladaptive schemas among the CHR population. Therapies targeting self-esteem, as well as schema therapy may be important work for future studies.
Deterioration in premorbid functioning is a common feature of schizophrenia, but sensitivity to psychosis conversion among clinical high-risk samples has not been examined. This study evaluates premorbid functioning as a predictor of psychosis conversion among a clinical high-risk sample, controlling for effects of prior developmental periods. Participants were 270 clinical high-risk individuals in the North American Prodrome Longitudinal Study—I, 78 of whom converted to psychosis over the next 2.5 years. Social, academic, and total maladjustment in childhood, early adolescence, and late adolescence were rated using the Cannon–Spoor Premorbid Adjustment Scale. Early adolescent social dysfunction significantly predicted conversion to psychosis (hazard ratio = 1.30, p = .014), independently of childhood social maladjustment and independently of severity of most baseline positive and negative prodromal symptoms. Baseline prodromal symptoms of disorganized communication, social anhedonia, suspiciousness, and diminished ideational richness mediated this association. Early adolescent social maladjustment and baseline suspiciousness together demonstrated moderate positive predictive power (59%) and high specificity (92.1%) in predicting conversion. Deterioration of academic and total functioning, although observed, did not predict conversion to psychosis. Results indicate early adolescent social dysfunction to be an important early predictor of conversion. As such, it may be a good candidate for inclusion in prediction algorithms and could represent an advantageous target for early intervention.
Derek Brewer (1923-2008) was one of the most influential medievalists of the twentieth century, first through his own publications and teaching, and later as the founder of his own academic publishing firm. His working life of some sixty years, from the late 1940s to the 2000s, saw enormous advances in the study of Chaucer and of Arthurian romance, and of medieval literature more generally. He was in the forefront of such changes, and his understandings of Chaucer and of Malory remain at the core of the modern critical mainstream. Essays in this collection take their starting point from his ideas and interests, before offering their own fresh thinking in those key areas of medieval studies in which he pioneered innovations which remain central: Chaucer's knight and knightly virtues; class-distinction; narrators and narrative time; lovers and loving in medieval romance; ideals of feminine beauty; love, friendship and masculinities; medieval laughter; symbolic stories, the nature of romance, and the ends of storytelling; the wholeness of Malory's Morte Darthur; modern study of the medieval material book; Chaucer's poetic language and modern dictionaries; and Chaucerian afterlives. This collection builds towards an intellectual profile of a modern medievalist, cumulatively registering how the potential of Derek Brewer's work is being reinterpreted and is renewing itself now and into the future of medieval studies. Charlotte Brewer is Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford; Barry Windeatt is Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge. Contributors: Elizabeth Archibald, Charlotte Brewer, Mary Carruthers, Christopher Cannon, Helen Cooper, A.S.G. Edwards, Jill Mann, Alastair Minnis, Derek Pearsall, Corinne Saunders, James Simpson, A.C. Spearing, Jacqueline Tasioulas, Robert Yeager, Barry Windeatt.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Storytelling may be one of the very oldest human activities after the acquisition of language. Language is a symbolic process that produces signifying sounds as a substitute for the things themselves; story allows those sounds to be linked to describe a sequence of events that are not present as fact but that have their existence in the mind, as memory or conjecture or imagination. The very earliest cave paintings or rock art suggest pre-existing stories of some kind behind them. Studies of memory formation and of childhood psychology suggest that it is the ability to form narratives, to shape random events into the syntax of a story, that enables an infant to make sense of the world it finds itself in.
Derek Brewer was increasingly fascinated by story and storytelling – not just in particular stories, though his delight in those masters of narrative Chaucer and Malory makes that evident, but in the principles underlying story itself. That is apparent even in the titles of some of his publications, in his Symbolic Stories: Traditional Narratives of the Family Drama in English Literature (1980), or in the collection of articles he entitled Chaucer: The Poet as Storyteller (1984b). That contains a reprint of his earlier Gollancz lecture, delivered in 1974, ‘Towards a Chaucerian Poetic’, which is perhaps his most concise and detailed consideration of the principles underlying story as such, and of the importance of story – especially traditional forms of narrative, folk-tales, fairy-tales and many medieval romances – over whatever meanings might be attached to them.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
The trajectory of Derek Brewer's academic career does not invariably reflect trends of modern scholarship. Relatively few of his many publications are directly concerned with the topics of this chapter. But his activities in these areas of manuscript and textual study show that his sense of the potential for new forms of scholarly enquiry in medieval English studies was often remarkably prescient. By the time of his death, Middle English manuscript study and editing had come to enjoy positions of importance in which their historical and cultural significance were increasingly acknowledged. Brewer's own roles in these developments warrant some exploration, not least for what they suggest about the changing climate of Middle English scholarship in these areas over the course of his long careers as scholar, publisher and teacher.
Brewer's interest in manuscript study can be traced back to his uncompleted BLitt thesis, which he began at Oxford in 1948. Some of the research from this period was published in an early article that described Gloucester Cathedral, MS 22, a collection of sixty-six fifteenth-century sermons, some associated with Mirk's Festial, bound with a fragment of the Gesta Romanorum, in a different hand, all in Middle English. Brewer's article is perhaps less interesting for its substance than for some aspects of its method, particularly his consideration of the whole manuscript itself as a proper object of study.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Having completed his studies at Oxford after military service in the war, Derek Brewer took up a lectureship at the University of Birmingham in 1949. He joined there with Geoffrey Shepherd and, two years later, Eric Stanley to form a remarkable medieval triumvirate. During the years in which they worked together, Birmingham was a power-house of Old English and Middle English Studies, perhaps second to none in its day. Derek Brewer, who left for Cambridge in 1964, taught across the medieval syllabus, including Anglo-Saxon, but Chaucer, even in those earliest days, was the principal focus of his interest. He soon took over the Chaucer lectures from Margaret Galway, a scholar of the old school whose principal interest was in speculations about the details of Chaucer's life at court and the identity of his ‘Muse’. Derek Brewer's ambition, by contrast, was to share with students his love and understanding of Chaucer, not as a subject of biographical speculation nor as a repertoire of linguistic data, nor as a ‘set text’ to be hammered through remorselessly and translated line by line, but as a full member of the European community of poets and of the English poetic tradition. It was a revelation to those of us who were privileged to be his students at that time to hear Chaucer talked about as if he were important to us now, and important in the same way as Shakespeare or Milton or T. S. Eliot. We had heard of the New Criticism: we thought this was it.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
‘I love you,’ he says, kissing her throat, stroking her breasts, tracing the curve of her hip.
‘No, you don't, Vic.’
‘I've been in love with you for weeks.’
‘There's no such thing,’ she says. ‘It's a rhetorical device. It's a bourgeois fallacy.’
‘Haven't you ever been in love, then?’
‘When I was younger,’ she says, ‘I allowed myself to be constructed by the discourse of romantic love for a while, yes.’
(David Lodge, Nice Work)
‘Years ago when I wrote about medieval love-poetry and described its strange, half make-believe, “religion of love”, I was blind enough to treat this as an almost purely literary phenomenon. I know better now.’
(C. S. Lewis, The Four Loves)
My title carries an implicit question: was falling in love in the Middle Ages different from falling in love today? The question reflects the still widespread belief that medieval lovers adhered to a systematized ‘code’ of ‘courtly love, a special, artificial variety of romantic love that obliged the lover to act in strange and exaggerated ways – to love without necessarily revealing his love to the lady concerned, to remain her devoted slave for years without seeking so much as a kiss by way of reward, to obey her every whim, however humiliating, to faint, to weep, to adore her as if she were a goddess rather than a woman.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Early on in Chaucer's Troilus and Criseyde, the adolescent prince Troilus, while cruising the Trojan girls at the Palladion festival in Troy, happens to see the young widow Criseyde standing in the crowd (1. 269–301). ‘His eye percede’ the crowd deeply until it ‘smote’ Criseyde and stopped (‘stente’), like an arrow (1. 272–3; cf. 1. 325). The effect on him is immediate: ‘he wax ther-with astoned … And of hire look [appearance] in him ther gan to quyken/ So gret desire … / That in his hertes botme gan to stiken/ Of hir his fixe and depe impressioun’ (1. 274, 295–8). Snail-like, he draws in his horns (1. 300), quits the scene at once, and goes home to his bed chamber, alone. This is emphasized. There he rehearses in full detail the event that had at first so ‘astoned’ him and turned him mentally to stone. He sees again Criseyde in the temple, fully and exactly as she appeared and acted:
And whan that he in chambre was allone,
He doun vp-on his beddes feet hym sette,
And first he gan to sike, and eft to grone,
And thought ay on hire so with-outen lette,
That as he sat and wook, his spirit mette
That he hire saw, and temple, and al the wise
Right of hire look, and gan it newe a-vise.
(1. 358–64)
He is completely alone, sitting on his bed, groaning, and in that physical posture, undertaken deliberately like a preparatory exercise, he thinks on his experience of Criseyde with such complete concentration that his ‘spirit’ – animus, mind – sees it all again: ‘Thus gan he make a mirour of his mynde,/In which he saugh al holly hire figure’ (1. 365–6).
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
Derek brewer was the founding figure in the post-war study of Chaucer. Through his eponymous publishing firm, he subsequently went on to contribute more than any other individual to furthering modern study of the early literatures and cultures of these islands. An irrepressibly positive and genial personality, his humanity and kindness as a teacher, scholar and publisher enabled and changed many lives. In a sixty-year career as a critic of medieval English and other literature, Brewer foresaw and pioneered much that has since developed into defining aspects of the field. Far from being a backward-looking memorial volume or Festschrift, the present book celebrates how some of the topics Brewer made central to the study of medieval literature are being taken forward, both because of his influence and beyond it. In so doing, this book aims to build towards an intellectual biography of a very modern medievalist.
Derek Brewer was born into a relatively modest background, the son of a clerk with the General Electric Company. Educated at his local Crypt Grammar School in Gloucester, he won a scholarship (‘demyship’) to Magdalen College, Oxford for the year 1941–42. As he later remarked, ‘getting to Oxford to read English had been my heart's desire’, and he wrote in his eighties that Magdalen was still, for him, simply the most beautiful place in the world. But after one short year at Oxford he joined the army and in 1944 was posted to Italy; he taught himself Italian on the troopship with the aid of a Hugo's language course, a characteristic foresight.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge
The consonance between the character of Derek Brewer and the character of much medieval literature was elegantly noted in the fine obituary which Barry Windeatt wrote for The Independent newspaper:
People often commented that it was the moral concerns of English medieval literature – courtesy, honour, loyalty and integrity – that they observed to be lived out in Brewer's life.
(Windeatt 2008)
Here Windeatt evokes the gentlemanly virtues – the remnants of a knightly value-system wherein great store was set by honour and gentilesse (nobility of birth or rank together with the attendant moral qualities of nobility of character or manners; generosity, kindness, gentleness, graciousness and the like). Indeed, it was no surprise to read, in the Telegraph obituary, Derek Brewer being described as ‘a gentlemanly, kindly man’. The thought that I want to offer in this paper is that those same virtues enabled Derek to gain some of his greatest insights into Chaucer's mind and art (to use a phrase in vogue in the late 1960s and early 1970s, when he was producing much of his best work). I am going to celebrate some of those insights – expanding them here, qualifying them there – because I believe they have withstood very well the buffets of changing academic fashions.
Edited by
Charlotte Brewer, Professor of English Language and Literature at Oxford University and a Fellow of Hertford College, Oxford,Barry Windeatt, Professor of English in the University of Cambridge and a Fellow of Emmanuel College, Cambridge