Neuropsychological assessment and functional magnetic resonance imaging of verbal declarative memory performance in relatives of schizophrenia patients and controls

BACKGROUND: While the aetiology of schizophrenia has yet to be established, genetic liability is currently the most robust determinant of propensity for the development of schizophrenia, with a risk rate of between 15 and 20% in first-degree relatives of schizophrenia patients. Unaffected relatives of schizophrenics have shown similar, but less severe neuropsychological impairments, to those seen in schizophrenia patients, which are stable over time in individuals beyond the age of risk for the disorder. Such deficits may be reflective of a genetic vulnerability to the disorder (Byrne et al 2003; (Faraone et al 1999). Declarative memory has emerged as a core cognitive impairment in schizophrenia (Cirillo and Seidman 2002) and evidence shows functional brain response differences between patients and controls in frontal, temporal, and parietal areas during tests of memory (Ragland et al 2004). Nonetheless, it is unclear how far behavioural and functional deficits reflect increased risk, at what stage, if at all, these deteriorate in those who develop the disorder, or whether pre-morbid impairments in those who go on to develop schizophrenia could be predictive of psychosis. The Edinburgh High Risk Study recruited 162 individuals (16-25 years) with at least one first or second degree relative with schizophrenia and 43 closely matched controls. A broad neuropsychological and clinical assessment battery was administered every 18-24 months over 10 years, while participants underwent between 1 and 3 functional magnetic resonance imaging (fMRI) scans during a verbal memory and executive function task over 5 years. | | METHODS: Baseline predictors of schizophrenia, performance changes over 2 neuropsychological assessments, and the influence of genetic liability were examined in high risk participants with (HR+) and without psychotic symptoms (HR-), those who are now ill (Scz) and controls (C), using one-way ANOVAs and repeated measures ANCOVAs. Aspects of verbal and non-verbal learning and memory were also compared between the HR and C in the first 100 participants to undergo a functional MRI scan using one-way ANOVAs. In the same participants, differences between groups in blood oxygen level dependent (BOLD) fMRI brain responses during an event related verbal encoding (word classification) and retrieval task were investigated using fixed and random effects general linear models. | | RESULTS: On a test of verbal learning at baseline, Scz performed significantly less well than HR However, there were no significant interactions of time by group, and HR showed stable impairments relative to controls on immediate and delayed prose recall, delayed list recall and response suppression across both assessments before and after controlling for IQ. A measure of quantitative genetic liability was inversely correlated with delayed prose recall over time. HR showed poorer cued delayed recall, and less word retention between short and long delay recall trials on a verbal learning test. A visual recognition test also significantly discriminated between HR and C. Behavioural analysis of the fMRI verbal encoding and retrieval task revealed no differences between groups in reaction time or accuracy. However, during a word classification task (encoding) there was a greater BOLD response in the right inferior frontal lobe (BA45/44) in HR relative to C and in the right inferior parietal lobule (BA7/40) in HR+ relative to C and HR-. A greater bilateral cerebellar and left inferior frontal response was also apparent in HR relative to C, and an increased ventral anterior thalamus response in HR- relative to HR+, during correct recognition compared to correct rejection responses. | | CONCLUSIONS: Stable differences in NP performance over time suggest a trait deficit, which is relatively unaffected by the presence of psychotic symptoms and schizophrenia onset, although small numbers might have precluded detection of significant time by group interactions. Poorer verbal memory performance overall in Scz suggests that this deficit is more pronounced in those who go on to develop schizophrenia. Non-verbal learning impairments reflect encoding deficits, while verbal learning impairments reflect encoding and retention difficulties in the HR group. Increased BOLD response in frontal and cerebellar areas in the HR group could be due to a requirement for greater effort to perform the task equivalently to C, and may reflect a biological trait deficit in the brains of relatives of schizophrenia patients. Subtle differences in the inferior parietal lobe between HR+ and HR- and C may be indicative of state related functional abnormalities, which possibly herald the onset of schizophrenia

Teachers’ discourses around accountability measures and low-attaining pupils: How an economic model of education has commoditised children

In a bid to raise standards in education, policy has defined an accountability system for schools including Ofsted inspections, league tables and teacher performance management, that is underpinned by high-stakes testing. Pupils that fall below expected levels are regarded as ‘low-attaining’ and contribute to data which suggest schools have not met required standards. The present research explored GCSE teachers’ discourses around accountability measures and low-attaining pupils, and how these discourses upheld and/or challenged the structures in place that enable the system. A focus group was conducted with seven teachers who taught Year 11 in a high-performing secondary school. The transcript was analysed using Fairclough’s (2015) three-dimensional framework; a procedure for Critical Discourse Analysis. This framework required analysis at a micro-, meso- and macro- level, the latter of which was done using a Marxist lens. The findings illuminated three overarching discourses: ‘the ‘high-stakes’ nature of accountability measures is pervasive and all consuming’, ‘low-attaining pupils are problematic, with little value’ and ‘the structures in place that enable the system are upheld through avoidance’. The Marxist analysis proposed that the marketisation of schools has led to pupils being seen as commodities, with exam data as currency. This has led to differing levels of value being placed on pupils depending on the data they are able to produce. This has resulted in low-attaining pupils being seen as having little value, and not worthy of investment. The analysis suggests that this view of pupils contradicts teachers’ value systems creating cognitive dissonance, which they are motivated to reduce to continue working in the current education environment, ultimately upholding the structures in place

A region in transition : politics and power in the Pacific Island Countries

Around one third of the Earth’s surface is covered by the Pacific Ocean. When looking at “the“ Pacific, public and scientific discourse – especially in Europe - is mostly centered on the periphery of this ocean, which includes important actors like Australia, the USA, Russia, China, Japan as well as the booming Asian and Latin-American states. This ignores that the Pacific itself is not only covered by water, but is also a political space in the sense of different political units summarized in the term of Pacific Island Countries (PICs). In fact, the Pacific Islands Region has been one of the politically most dynamic regions of the world in the last decade and even more so today. There are ongoing transformations to regionalism and the regional system of cooperation, in national politics and in the relationships to larger actors as well as the international activities of the Pacific Island States. This book brings together renowned international experts on politics in Oceania as well as researchers and scholars from Germany to provide a comprehensive overview of many of these current developments and issues in the Pacific Islands Region. It offers a theoretical framework as well as contributions analysing actors, institutions and structures in Oceania, substantiated by case studies from various island states

The Politics of Reproduction

The Politics of Reproduction: Adoption, Abortion and Surrogacy in the Age of Neoliberalism uniquely brings together three sites of reproduction and reproductive politics to demonstrate their entanglement in creating or restricting options for family-making. The original essays in this collection—which draw from a wide range of disciplinary and theoretical perspectives—are attentive to neoliberalism’s reshaping of economies and intimacies to better understand the politics of reproduction. By looking at particular instances (surrogacy in Mexico, forced sterilization in Peru, and racialized biopolitics in post-Katrina Mississippi, among other sites), The Politics of Reproduction focuses on the effects of a radically altered economic landscape on individual choice-making. As a whole, the volume critically engages the question of choice to better understand the costs of a political and ideological climate that encourages, even demands, individual solutions to intractable social problems

The Politics of Reproduction

The Politics of Reproduction: Adoption, Abortion and Surrogacy in the Age of Neoliberalism uniquely brings together three sites of reproduction and reproductive politics to demonstrate their entanglement in creating or restricting options for family-making. The original essays in this collection—which draw from a wide range of disciplinary and theoretical perspectives—are attentive to neoliberalism’s reshaping of economies and intimacies to better understand the politics of reproduction. By looking at particular instances (surrogacy in Mexico, forced sterilization in Peru, and racialized biopolitics in post-Katrina Mississippi, among other sites), The Politics of Reproduction focuses on the effects of a radically altered economic landscape on individual choice-making. As a whole, the volume critically engages the question of choice to better understand the costs of a political and ideological climate that encourages, even demands, individual solutions to intractable social problems

Brown Girl in the Ring: What are the Experiences of Senior Female Black, Asian, Minority Ethnic Leaders in Social Work today?

There has been extensive concern with race and racism in social work as a discipline, including empirical enquiry examining the experiences of social workers from Black and Minority Ethnic (BAME) backgrounds. However, insufficient attention has been paid to the experiences of BAME female social work leaders. This thesis reports on a practitioner research enquiry addressing this group’s experiences. The study relied on a psychoanalytically informed, psychosocial methodological approach, alongside autoethnographic reflection. Biographical narrative interviews were undertaken with five female BAME leaders working in a local authority adult social care context. Data generated from these interviews were then subject to an in-case/cross-case analysis based on a constructivist epistemological framework. Themes identified from the analysis related to experiences in the workplace and leadership journeys, illuminating ways in which personal and professional biographies converged in the participants’ understanding of the demands and challenges of leadership, as well as wider organisational and social forces that had an impact on them as professionals and BAME women, particularly racism. The analysis revealed how the participants were prompted to be attentive to both their inner experiences and work contexts to understand themselves as leaders. The study’s principal contribution is in helping to develop psychosocial knowledge that may help inform action to challenge racism and organisational barriers bearing upon the career trajectories of BAME women. Key terms: Black and Minority Ethnic, leadership, psychoanalytically informed research, psychosocial social work research, race, racism, social work leadership

Brown Girl in the Ring: What are the Experiences of Senior Female Black, Asian, Minority Ethnic Leaders in Social Work Today?

There has been extensive concern with race and racism in social work as a discipline, including empirical enquiry examining the experiences of social workers from Black and Minority Ethnic (BAME) backgrounds. However, insufficient attention has been paid to the experiences of BAME female social work leaders. This thesis reports on a practitioner research enquiry addressing this group’s experiences. The study relied on a psychoanalytically informed, psychosocial methodological approach, alongside autoethnographic reflection. Biographical narrative interviews were undertaken with five female BAME leaders working in a local authority adult social care context. Data generated from these interviews were then subject to an in-case/cross-case analysis based on a constructivist epistemological framework. Themes identified from the analysis related to experiences in the workplace and leadership journeys, illuminating ways in which personal and professional biographies converged in the participants’ understanding of the demands and challenges of leadership, as well as wider organisational and social forces that had an impact on them as professionals and BAME women, particularly racism. The analysis revealed how the participants were prompted to be attentive to both their inner experiences and work contexts to understand themselves as leaders. The study’s principal contribution is in helping to develop psychosocial knowledge that may help inform action to challenge racism and organisational barriers bearing upon the career trajectories of BAME women. Key terms: Black and Minority Ethnic, leadership, psychoanalytically informed research, psychosocial social work research, race, racism, social work leadership

Brexit, Brexlit and the (Dis)United Kingdom: Responses to Brexit in post-referendum British novels

The United Kingdom’s decision to leave the European Union – the so-called ‘Brexit’ referendum of 23 June 2016 – represents one of the most significant political moments in recent British history. The Brexit vote revealed long-established divisions within British society, ones which threaten the continued unity of the four constituent countries of England, Scotland, Wales and Northern Ireland. Brexit is undoubtedly an event in national and international politics, but it is also an event in culture, contributing to the emergence of new cultural forms which seek to reflect on and represent the state of the UK in the contemporary moment. This thesis’s focus is on fictional literatures which have arisen in the aftermath of the referendum – or ‘Brexlits’, to use Kristian Shaw’s term. Specifically, it employs a close analysis of several British novels published since June 2016 in order to shed light on Brexit’s divisions, and offer somewhat of an explanation for disparate voting patterns across the four constituent countries. Recognising that conceptions of national identity both contributed to Brexit, and will inevitably be influenced by its aftermath, the thesis adopts national identity as a lens through which to read the fictions, with Northern Ireland, Wales, Scotland and England treated as distinct entities. While some similarities are noted across the national literatures, differences with respect to content, style and form are of greater significance. These divergences affirm the national divisions Brexit represents, and suggests that the continued existence of the United Kingdom in its current form is not guaranteed

Children with HIV: the Consolidation of medicine, science and the social into the clinical practice of paediatric HIV

This thesis explores how medicine is practiced in a paediatric HIV clinic in outer London. It draws on ethnographic research that took place in the clinic over the course of a year. The significance of the topic is situated in the complexity of the issues presented clinically by children with HIV in London. During practice recurrent associations of confidentiality, stigma, vulnerability, naivety and innocence emerges around the patient cohort that mainly comprises recent African migrants living their lives in complicated urban environments. These associations are contrasted by the uncompromising requirements of antiretroviral medicine which needs almost perfect dosing adherence in order to suppress the virus. The incompatibilities between complex patient lives and medical requirements must be made compatible through clinical practice. Therefore, the thesis emphasises the clinic as the key site where the ‘cultural’ issues presented by patients are consolidated with drug requirements to form a functional medicine. The argument is informed by discussions around Science and Technology Studies (STS), and the Sociology of Childhood (SoC). These discussions highlight practice as ‘enacted’, where objects such as disease, the body or medicine are not ‘given’ but gain their shape through their recurrent enactions (Mol 2002, Mol and Law 2004). I have used these discussions to argue that medicine and protocol do not pre-exist practice but must be enacted by practitioners and (child) patients in the clinic. Clinical practice is shown in the thesis as consolidating protocol, drug requirements, patients, practitioners and representations of HIV in ongoing clinical enactions to make the antiretroviral medicine amongst the paediatric cohort operational. To do this, the research focuses on a set of procedures enacted in the clinic: disclosure, adherence, HIV as chronic illness and transition. These procedures inform practitioners on how to maintain care and make medical requirements explicit to child patients (and their parents), enforcing behaviour that accords with the goals of antiretroviral medicine. In this way practice and protocol are negotiated and renegotiated to ensure their effectiveness between all of the associations involved in participating with the condition, paediatric HIV and the corresponding medicine. Compared to existing STS on the subject of medicine and the clinic, paediatric HIV practice emphasises the clinic’s role to consolidate seemingly incompatible associations around patients such as stigma, vulnerability and innocence into medical requirements. The result is that STS that advertently or inadvertently implies that medical practice is messy or disjointed are questioned in light of two important features of paediatric HIV. Firstly, that practice must necessarily consolidate disparate patient lives into medical requirements if treatment is to be successful, and secondly, that practitioners must employ a logic to generate a coherent, well-organised clinical practice that is flexible and pliable to diverse eventualities. The significance of this argument demonstrates the clinic’s importance in enacting interventions and attuning medicine, displacing a notion of protocol or guidelines as dictating practice without negotiation, or the belief that the ideal course of clinical practice is fully predefined in protocol. Therefore, the implications of this research underline the clinic as a key site in rationalising how medicine is formulated and applied to patients