We're In the Wrong Story

We humans move through the world in a perpetual story which we are frequently unaware that we are writing. Our awareness is imperative, though, since this story is powerful enough to mediate and fundamentally direct the ways in which we interact with our surroundings. This essay uses the lens of genre and the concept of narrative patterning to illustrate the reason for our persistence in self- and Earth-damaging behavioural patterns, and then suggests the narrative pattern we need to adopt in order to avoid the ending we are inevitably writing for ourselves

Experimental approaches to studying cumulative cultural evolution

In humans, cultural traditions often change in ways which increase efficiency and functionality. This process, widely referred to as cumulative cultural evolution, sees beneficial traits preferentially retained, and it is so pervasive that we may be inclined to take it for granted. However, directional change of this kind appears to distinguish human cultural traditions from behavioural traditions that have been documented in other animals. Cumulative culture is therefore attracting an increasing amount of attention within psychology, and researchers have begun to develop methods of studying this phenomenon under controlled conditions. These studies have now addressed a number of different questions, including which learning mechanisms may be implicated, and how the resulting behaviours may be influenced by factors such as population structure. The current article provides a synopsis of some of these studies, and highlights some of the unresolved issues in this field

Human teaching and cumulative cultural evolution

Although evidence of teaching behaviour has been identified in some nonhuman species, human teaching appears to be unique in terms of both the breadth of contexts within which it is observed, and in its responsiveness to needs of the learner. Similarly, cultural evolution is observable in other species, but human cultural evolution appears strikingly distinct. This has led to speculation that the evolutionary origins of these capacities may be causally linked. Here we provide an overview of contrasting perspectives on the relationship between teaching and cultural evolution in humans, and briefly review previous research which suggests that cumulative culture (here meaning cultural evolution featuring a trend towards improving functionality) can occur without teaching. We then report the results of a novel experimental study in which we investigated how the benefits of teaching may depend on the complexity of the skill to be acquired. Participants were asked to tie knots of varying complexity. In our Teaching condition, opportunities to interact with an experienced partner aided transmission of the most complex knots, but not simpler equivalents, relative to exposure to completed products alone (End State Only condition), and also relative to information about the process of completion (Intermediate States condition). We conclude by considering the plausibility of various accounts of the evolutionary relationship between teaching and cultural evolution in humans

Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection

Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications which may result in prolonged hospitalisation or readmission are highly undesirable. Surgical site infection (SSI) is one such complication which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative and survival data were collected on 152 patients undergoing surgery for spinal metastases at Salford Royal NHS Foundation Trust. American Society of Anesthesiologists (ASA) grade and the Revised To kuhashi Score (RTS) were obtained as measures of health status at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Results Mean age at operation was 60.5 years (standard deviation 12.9 years). Seventeen patients (11.2%) experienced SSI. At the time of last follow up, 117 patients had died. RTS score (p<0.001; hazard ratio 0.82; 95% confidence interval: 0.76-0.87) and ASA grade (p=0.022; hazard ratio 1.40; 95% confidence interval: 1.05-1.87) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (p=0.075). Age was not substantively related to survival (p=0.299). Overall, median survival time from operation was 262 days (95% confidence interval: 190-334 days). Conclusions Five-year survival in patients undergoing surgery for spinal metastases is approximately 23%. Either or both of RTS or ASA scores can be used as indicators of patient survival. There is insufficient evidence to conclude that the presence of SSI retards survival

The management and cost of surgical site infection in patients undergoing surgery for spinal metastasis

Background Surgical site infection (SSI) is a serious potential complication of spinal surgery. SSI can impact significantly on in-patient hospitalisation and the costs associated with extra care. Aim To investigate the management of patients experiencing SSI following surgery for spinal metastatic tumours, and to estimate the costs associated with SSI in this context. Methods Patients experiencing SSI following spinal tumour surgery at a large spinal surgery centre between January 2009 and December 2012 were identified. Existing case notes were reviewed and patient and procedural data, details of the infection and treatment interventions were collected. A bottom-up approach to calculating costs associated with infection was used for patients experiencing SSI and compared with a quasi-random sample of similar patients without SSI. Findings The mean cost of treating patients with SSI was significantly greater than costs associated with those without SSI (p=0.019). Mean cost of in-patient hospital stay was 60% higher in patients with SSI compared to those without SSI (p=0.004). In-patient hospital stay alone accounted for 59% of total costs. Return to theatre was the second most costly intervention overall, accounting for 38% of costs, and was the most expensive single intervention involved in the treatment of SSI. Conclusion SSI significantly increases healthcare costs for patients undergoing surgery for spinal metastasis, with prolonged in-patient hospitalisation and return to theatre for wound management being major contributors. The actual total cost to society derived from SSI in this patient group is likely to be far beyond just the direct costs to healthcare providers

Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site 2 infection

Summary Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190–334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76–0.89; P < 0.001) and ASA grade (1.37; 1.03–1.82; P = 0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (P = 0.075). Conclusion Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significan