Psychological studies of art: with special reference to pictorial art

Few artists have the hardihood to set up as psychologists. it is meet, therefore, that I should preface these studies with an apology. The conspicuous failure of attempts by artists to write psychology requires no recalling. This fact might well have been a salutary warning against entering so specialised a province as that of aesthetics. But the desire to comprehend those secret processes by which I have, to some extent, been able to achieve my artistic aims has always been strong and at times imperious. It was not, therefore, any undue confidence in my ability to prosecute these investigations or any self - assurance that I could bring new light to bear on so vast and so difficult a problem that prompted the undertaking, but a keen desire to satisfy a clamant personal need.There was perhaps another motive present in my mind besides mere curiosity as to the nature of my own psychological processes: the desire to compare representative views and theories with my own experience as a producing artist, and to observe the extent to which they appeared to confirm or disprove my own speculations and introspective results. Throughout I have aimed at accuracy rather than novelty, facts rather than originality. I have tried not to obtrude unduly my own theoretical predilections, but rather to examine such doctrines as have come up for discussion in the double light of my own creative experience and the accredited facts of psychology. To what extent I have been successful in these pursuits the following studies will presently bear witness.The work has undergone many modifications since its inception. Originally the plan included the study of the appreciative as well as the productive aspect of art. 13ut circumstances early led to the curtailment of its scope: first, the realisation that the task was impossible because of its immensity; and second, prolonged periods of illness between the years 1930 and 1933 which forced we to reduce my activities to essential duties. Perhaps the curtailment of the field has not been without some compensatory virtue; for I have been able to concentrate on one aspect and that, one in which I am naturally chiefly interested. The appreciation of art has to a limited degree been dealt with in an Appendix, where the problem has been approached from a pedagogical standpoint. I have also added an Appendix dealing with representation in art - this, too, from the pedagogic point of view. :Both appendices, I hope, will clear up minor difficulties which could not conveniently be discussed in the main text without involving some divagation

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Community engagement to reduce inequalities in health : a systematic review, meta-analysis and economic analysis

Background: Community engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base. Objectives: To undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation. Data sources: Databases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included. Review methods: Study eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence. Results: The theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework. Limitations: Differences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base. Conclusions: Community engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation. Funding: The National Institute for Health Research Public Health Research programme