Building on Bildung in the 20th century – individual and institutional learning in Wittgenstein and Hesse

This thesis will undertake a comparison of the figurative use of “games” in Philosophische Untersuchungen by Ludwig Wittgenstein and Das Glasperlenspiel by Hermann Hesse. Both works use “games” as an analogy to explore language use as a collective activity. ‘Bildung’ for the purposes of this thesis denotes the authors’ shared interest in how a good education should not only consist in applying oneself to scholarly study but also personal, moral development. I argue that ‘Sprachspiele’ and the ‘Glasperlenspiel’ are literary devices that the authors use in contrasting but complementary ways to explore the following questions: how do we help people to learn to think for themselves (to become well-rounded, independent thinkers) within an institutional environment that is necessarily conformist? How can students be taught to think for themselves, while also encouraging them to have the humility to listen to the opinions of others? The fact that games involve an element of freedom and spontaneity, while also being confined within rules that govern what can and cannot be done, means that the authors’ analogies were carefully chosen. This tension between freedom and rules within games reflects a tension at the heart of Bildung, identified by Georg Bollenbeck as dual process of ‘bilden’ and ‘sich bilden’ (whereby an individual is moulded by external forces, but also retains agency within their learning journey). By reading Wittgenstein and Hesse alongside one another, I would like to consider the question: If we were to think of our academic forms of life as a game, how might that change the way we think about what we do

Helium Emission from Classical T Tauri Stars: Dual Origin in Magnetospheric Infall and Hot Wind

High-resolution emission-line profiles of He I and He II in 31 classical T Tauri stars are analyzed with the aim of probing the environs of the star-disk interface in accreting low-mass young stars. The diagnostic power of the helium lines lies in their high-excitation potentials, which restrict their formation to a region either of high temperature or close proximity to a source of ionizing radiation. The He I profiles are decomposed into kinematic components that support the paradigm of magnetically controlled accretion from the disk onto the stellar surface but also require a significant contribution from a hot wind. A narrow component, seen in 28/31 stars, is characterized by relatively uniform line widths and centroid velocities among all the helium lines. Our analysis supports previous conclusions that this feature is consistent with formation in the decelerating postshock gas at the magnetosphere footpoint. A broad component, seen in 22/31 stars, displays a diversity of kinematic properties. Our analysis suggests that in many stars the He I broad component is itself composite. At one extreme are stars where the broad component is redshifted in excess of 8 km s-1, as would occur if helium emission arises primarily from polar angles less than 547 in the funnel flow. At the other extreme are stars where the broad component is blueshifted in excess of -30 km s-1, requiring an origin in outflowing gas. The additional occurrence of maximum blue wing velocities exceeding -200 km s-1 in 14 stars leads us to argue that hot winds are present in about half of our sample. The relation between the narrow component and the optical veiling differs between the stars with or without a hot helium wind, suggesting that when the hot wind is present the luminosity and temperature of the accretion shock are reduced. A comparison of broad component helium emission with standard outflow indicators leads us to suggest that there are two sources of inner wind in T Tauri accretion disk systems: one a hot polar/coronal wind that prevails in stars with high veiling, and the other a more widespread cool disk wind that is likely launched at the magnetosphere/disk boundary

Permitted Iron Emission Lines in the Classical T Tauri Star DR Tauri

We present a study of permitted emission lines of Fe I and Fe II in the spectrum of the high-accretion rate classical T Tauri star DR Tau. Echelle spectra collected at the 4 m Mayall telescope at Kitt Peak National Observatory between 1988 and 1992 include four epochs with red spectral coverage (~5000-6800 Å) and three with blue spectral coverage (~4000-4950 Å). A total of 62 unblended Fe I and Fe II lines are identified, their profiles are examined, and ratios of line pairs that are sensitive to column density or temperature are analyzed. The unblended Fe profiles exhibit a systematic behavior, with FWHM increasing from 20 to between 70 and 90 km s-1 as the equivalent width increases from 0.05 to several Å. Two-component fits to the profiles suggest a composite origin, comprising a narrow component (NC), with FWHM ~ 20 km s-1 and a radial velocity at rest with respect to the photosphere, and a broad component (BC), with FWHM ~ 100 km s-1 and a tendency to be blueshifted by ≤10 km s-1. These two kinematic components are present in differing proportions among lines of differing intensity, thereby accounting for the systematic behavior of the profiles with line strength. Estimates of opacities and column densities are obtained by comparing observed intensity ratios of lines from a common upper level with values expected from a local escape probability calculation. We find that (1) opacities in the NC exceed those in the BC by factors of 2-4 and (2), for the BC, NFe I 1017-1018 cm-2 and NFe II 1018-1019 cm-2 for kinetic temperatures in the range 4000-10,000 K. Ratios of NC-to-BC emission from a pair of Fe I lines that are insensitive to opacity suggest that the kinetic temperature in the NC exceeds that in the BC by several thousand degrees. The centroid velocity and width of the NC in Fe I and Fe II are comparable to those from photospheric lines, suggesting a thermal or turbulent origin further broadened by stellar rotation. In the context of a magnetospheric accretion model, the NC is consistent with an origin in the postshock gas close to the stellar surface. In contrast, the BC is likely to be broadened by bulk motion, such as infalling gas in the accretion funnel or rotation in the region coupling the inner disk to the stellar magnetic field

Developmental changes in neural stem cell expression in the spinal cord and the influence of painful stimulation

Background and Aims: Neural stem cells (NSCs) are progenitors that play a fundamental role in the generation of glial cells and neurons in the developing central nervous system, but also remain in specific neurogenic regions in adulthood including the central canal of the spinal cord. NSCs have been explored in the spinal cord following adult spinal cord injury (SCI) but not in response to pain, and there is little understanding of NSC regulation in the spinal cord during postnatal development. The aims were to investigate NSC expression in the mouse spinal cord during different stages of postnatal development and determine whether there are changes in NSC marker distribution in the spinal cord following painful stimulation during early life. Methods: The expression of NSC markers Sox1 and Sox2 was assessed by immunohistochemical analysis in the spinal cord from transgenic Sox1-GFP and wild-type mice during different stages of postnatal maturation (postnatal day (P) 7-40). The potential effects of painful stimuli on NSC marker distribution in the spinal cord was studied using inflammatory (carrageenan) and neuropathic (cisplatin) pain models. In the carrageenan model, mice received an intraplantar injection of carrageenan or vehicle (saline) into the left hindpaw at P7 (0.5% carrageenan) or P14 (1% carrageenan). Nociceptive behavioural testing (von Frey testing) was performed at 4 hours, 24 hours, 48 hours, 72 hours, 96 hours and 120 hours following injection. The expression of NSC markers (Sox1 and Sox2) in the neonatal spinal cord following the carrageenan model was assessed by immunohistochemistry. The cisplatin model was induced at P14, mice received 1 mg/kg of cisplatin or vehicle (saline) subcutaneously for five consecutive days and von Frey testing was performed up to 35 days post-model induction. The expression of markers for glial cells (GFAP and Iba1), primary afferent fibres (CGRP and IB4) and NSCs was investigated in the spinal cord of adult mice that had received cisplatin during early life by immunohistochemistry. Results: GFP, Sox1 and Sox2 expression was observed around the central canal at all time points, but was also detected in other areas of the spinal cord including the superficial dorsal horn and directly lateral to the central canal. Expression in the superficial dorsal horn and directly lateral to the central canal was higher at P7 than at the later time points, although this was not statistically significant, indicating that NSC expression remained stable over the period considered. An intraplantar injection of carrageenan into the left hindpaw of P7 and P14 mice caused hyperalgesia at 4 hours post-injection that resolved by 120 hours with no significant differences in Sox1 and Sox2 expression observed. Analogous studies with the cytotoxic anti-cancer drug cisplatin produced delayed hyperalgesia in neonatal mice at 14 days post-model induction (onset P32) that persisted into adulthood (P53) compared to controls. There were also no significant differences in Sox1, Sox2, Iba1, GFAP, CGRP and IB4 expression. Conclusions: NSC marker expression in the spinal cord was investigated throughout postnatal development in mice and no significant changes were observed. This understanding is useful for the investigation of potential changes to NSCs in the spinal cord following different types of stimulation over the postnatal period. Although NSCs are activated in response to SCI, no significant changes in NSC marker expression were observed in the spinal cord following an acute inflammatory stimulus (carrageenan) or during a chronic neuropathic pain state (cisplatin) induced during early life. Although a behavioural response was observed, the cisplatin injected mice only had mild hyperalgesia, indicating that a higher dose of cisplatin may be required to induce a greater degree of hyperalgesia and assess whether this is linked to changes in NSC distribution

Anxiety in autistic individuals who speak few or no words:A qualitative study of parental experience and anxiety management

Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (m age = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words. Lay abstract: Anxiety is a common condition in autistic individuals, including those who also have an intellectual disability. Despite this, autistic individuals who have severe to profound intellectual disability, or use few or no words, are often excluded from autism research. There are also very few assessment tools and interventions with known effectiveness for autistic individuals with intellectual disability. In this study, we aimed to learn more about parent/carers experiences of recognising and managing anxiety in autistic individuals who use few or no words. We conducted semi-structured interviews with parents and carers to address three research questions: (1) what techniques and management strategies do parents describe for anxiety-related behaviour in their child; (2) how do communication difficulties impact parental understanding and management of anxiety provoking situations and behaviours; (3) what is the impact of anxiety-related behaviours on the quality of life of autistic individuals and their families? During the interviews, parents described difficulties recognising anxiety in their child, mostly due to reduced verbal language use and anxiety behaviours overlapping with other behaviours (e.g. autism characteristics). However, parents also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. We will use the findings of this study to inform future research to develop assessment tools and interventions for anxiety in autistic individuals who use few or no words

Do published patient decision aids for end-of-life care address patients' decision making needs? A systematic review and critical appraisal

BACKGROUND: Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. AIMS AND DESIGN: This systematic review aimed to (a) identify the range of patients' decision-making needs and (b) assess the extent to which patient decision aids address these needs. DATA SOURCES: MEDLINE, PsycINFO and CINAHL electronic literature databases were searched (January 1990-January 2017), supplemented by hand-searching strategies. Eligible literature reported patient decision-making needs throughout end-of-life decision-making or were evaluations of patient decision aids. Identified decision aid content was mapped onto and assessed against all patient decision-making needs that were deemed 'addressable'. RESULTS: Twenty-two studies described patient needs, and seven end-of-life patient decision aids were identified. Patient needs were categorised, resulting in 48 'addressable' needs. Mapping needs to patient decision aid content showed that 17 patient needs were insufficiently addressed by current patient decision aids. The most substantial gaps included inconsistent acknowledgement, elicitation and documentation of how patient needs varied individually for the level of information provided, the extent patients wanted to participate in decision-making, and the extent they wanted their families and associated healthcare professionals to participate. CONCLUSION: Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life

Utilising Interview Methodology to Inform the Development of New Clinical Assessment Tools for Anxiety in Autistic Individuals Who Speak Few or no Words

Autistic individuals with intellectual disability who speak few or no words are at high risk of anxiety but are underrepresented in research. This study aimed to describe the presentation of anxiety in this population and discuss implications for the development of assessments. Interviews were conducted with 21 parents/carers of autistic individuals and nine clinicians. Data were analysed using content analysis and interpretative phenomenological analysis. Anxiety behaviours described by parents/carers included increased vocalisation, avoidance and behaviours that challenge. Changes to routine were highlighted as triggering anxiety. Clinicians discussed the importance of identifying an individual’s baseline of behaviour, knowing an individual well and ruling out other forms of distress. This study raises considerations for early identification of anxiety and for subsequent support

Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: a systematic review and meta-analysis

Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9% (95% CI: 4-14) in Down syndrome to 73% in Rett syndrome (95% CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles

Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department

Introduction: Femoral neck fractures are a common and painful injury. Femoral nerve blocks, and a variant of this technique termed the ‘3-in-1’ block, are often used in this patient group, but their effect is variable. The fascia iliaca compartment block (FIB) has been proposed as an alternative, but the relative effectiveness of the two techniques in the early stages of care is unknown. We therefore compared the FIB versus the 3-in-1 block in a randomised trial conducted in two UK emergency departments. Methods: Parallel, two-group randomised equivalence trial. Consenting patients >18 years with a femoral neck fracture were randomly allocated to receive either a FIB or a 3-in-1 block. The primary outcome was pain measured on a 100 mm visual analogue scale at 60 min. The between-group difference was adjusted for centre, age, sex, fracture type, pre-block analgesia and pre-block pain score. Results: 178 patients were randomised and 162 included in the primary analysis. The mean 100 mm visual analogue pain scale score at 60 min was 38 mm in the FIB arm and 35 mm in the 3-in-1 arm. The adjusted difference between the arms was 3 mm, with a 95% CI (−4.7 to 10.8) that excluded a clinically important difference between the two interventions. Conclusions: FIB is equivalent to the 3-in-1 block for immediate pain relief in adult neck of femur fractures