The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring

BACKGROUND: To test the hypothesis that certain psychotic symptomatology is due to a defect in self-monitoring, we investigated the ability of groups of psychiatric patients to differentiate perceptually between self-produced and externally produced tactile stimuli. METHODS: Responses to tactile stimulation were assessed in three groups of subjects: schizophrenic patients; patients with bipolar affective disorder or depression; and normal control subjects. Within the psychiatric groups subjects were divided on the basis of the presence or absence of auditory hallucinations and/or passivity experiences. The subjects were asked to rate the perception of a tactile sensation on the palm of their left hand. The tactile stimulation was either self-produced by movement of the subject's right hand or externally produced by the experimenter. RESULTS: Normal control subjects and those psychiatric patients with neither auditory hallucinations nor passivity phenomena experienced self-produced stimuli as less intense, tickly and pleasant than identical, externally produced tactile stimuli. In contrast, psychiatric patients with these symptoms did not show a decrease in their perceptual ratings for tactile stimuli produced by themselves as compared with those produced by the experimenter. This failure to show a difference in perception between self-produced and externally produced stimuli appears to relate to the presence of auditory hallucinations and/or passivity experiences rather than to the diagnosis of schizophrenia. CONCLUSIONS: We propose that auditory hallucinations and passivity experiences are associated with an abnormality in the self-monitoring mechanism that normally allows us to distinguish self-produced from externally produced sensations

'Education, education, education' : legal, moral and clinical

This article brings together Professor Donald Nicolson's intellectual interest in professional legal ethics and his long-standing involvement with law clinics both as an advisor at the University of Cape Town and Director of the University of Bristol Law Clinic and the University of Strathclyde Law Clinic. In this article he looks at how legal education may help start this process of character development, arguing that the best means is through student involvement in voluntary law clinics. And here he builds upon his recent article which argues for voluntary, community service oriented law clinics over those which emphasise the education of students

Isospin influences on particle emission and critical phenomenon in nuclear dissociation

Features of particle emission and critical point behavior are investigated as functions of the isospin of disassembling sources and temperature at a moderate freeze-out density for medium-size Xe isotopes in the framework of isospin dependent lattice gas model. Multiplicities of emitted light particles, isotopic and isobaric ratios of light particles show the strong dependence on the isospin of the dissociation source, but double ratios of light isotope pairs and the critical temperature determined by the extreme values of some critical observables are insensitive to the isospin of the systems. Values of the power law parameter of cluster mass distribution, mean multiplicity of intermediate mass fragments ($IMF$), information entropy ($H$) and Campi's second moment ($S_2$) also show a minor dependence on the isospin of Xe isotopes at the critical point. In addition, the slopes of the average multiplicites of the neutrons ($N_n$), protons ($N_p$), charged particles ($N_{CP}$), and IMFs ($N_{imf}$), slopes of the largest fragment mass number ($A_{max}$), and the excitation energy per nucleon of the disassembling source ($E^*/A$) to temperature are investigated as well as variances of the distributions of $N_n$, $N_p$, $N_{CP}$, $N_{IMF}$, $A_{max}$ and $E^*/A$. It is found that they can be taken as additional judgements to the critical phenomena.Comment: 9 Pages, 8 figure

The evolution of language: a comparative review

For many years the evolution of language has been seen as a disreputable topic, mired in fanciful "just so stories" about language origins. However, in the last decade a new synthesis of modern linguistics, cognitive neuroscience and neo-Darwinian evolutionary theory has begun to make important contributions to our understanding of the biology and evolution of language. I review some of this recent progress, focusing on the value of the comparative method, which uses data from animal species to draw inferences about language evolution. Discussing speech first, I show how data concerning a wide variety of species, from monkeys to birds, can increase our understanding of the anatomical and neural mechanisms underlying human spoken language, and how bird and whale song provide insights into the ultimate evolutionary function of language. I discuss the ‘‘descended larynx’ ’ of humans, a peculiar adaptation for speech that has received much attention in the past, which despite earlier claims is not uniquely human. Then I will turn to the neural mechanisms underlying spoken language, pointing out the difficulties animals apparently experience in perceiving hierarchical structure in sounds, and stressing the importance of vocal imitation in the evolution of a spoken language. Turning to ultimate function, I suggest that communication among kin (especially between parents and offspring) played a crucial but neglected role in driving language evolution. Finally, I briefly discuss phylogeny, discussing hypotheses that offer plausible routes to human language from a non-linguistic chimp-like ancestor. I conclude that comparative data from living animals will be key to developing a richer, more interdisciplinary understanding of our most distinctively human trait: language

Complex needs in homelessness practice; a review of 'new markets of vulnerability'

This article reviews institutional responses to adult homeless people, to argue that there is a contemporary flourishing of debates about complex needs across homelessness research and practice fields. These understand housing need as a mental and physical health issue and a care and support need, with foundations in biographical and societal events, issues and experiences, including trauma. Responses to complex needs are conceptualised as enterprising in scope; articulated as fresh, proactive, preventative and positive. The article suggests that there are a range of legislative, policy and funding drivers for these developments, from across homelessness, housing support and adult social care fields, which are distinctive to the English context. At the same time, debates about what complex needs are, and how best to respond to them, are evident in international debates about service delivery models with homeless service users in the Global Western North. ‘Complex needs’ is defined as a travelling concept, with affective qualities, which provides foundation for practice interventions, techniques and principles in different locations. The article conceptualises institutional machinations around the governance of complex needs as ‘new markets of vulnerability’. This term theorises new markets and new marketising strategies around complex needs in the context of a much larger reconfiguring of the mixed economies of welfare around markets and market mimicking devices and practices. It is argued that the intensification of activities around complex needs give insight into processes of neoliberalisation in contemporary modernized welfare ‘mixes’

Biomass offsets little or none of permafrost carbon release from soils, streams, and wildfire: an expert assessment

As the permafrost region warms, its large organic carbon pool will be increasingly vulnerable to decomposition, combustion, and hydrologic export. Models predict that some portion of this release will be offset by increased production of Arctic and boreal biomass; however, the lack of robust estimates of net carbon balance increases the risk of further overshooting international emissions targets. Precise empirical or model-based assessments of the critical factors driving carbon balance are unlikely in the near future, so to address this gap, we present estimates from 98 permafrost-region experts of the response of biomass, wildfire, and hydrologic carbon flux to climate change. Results suggest that contrary to model projections, total permafrost-region biomass could decrease due to water stress and disturbance, factors that are not adequately incorporated in current models. Assessments indicate that end-of-the-century organic carbon release from Arctic rivers and collapsing coastlines could increase by 75% while carbon loss via burning could increase four-fold. Experts identified water balance, shifts in vegetation community, and permafrost degradation as the key sources of uncertainty in predicting future system response. In combination with previous findings, results suggest the permafrost region will become a carbon source to the atmosphere by 2100 regardless of warming scenario but that 65%–85% of permafrost carbon release can still be avoided if human emissions are actively reduced

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Improving lesion localisation at colonoscopy: an analysis of influencing factors

Purpose: Colonoscopy detects colorectal cancer and determines lesion localisation that influences surgical planning. However, published work suggests that the accuracy of lesion localisation can be low as 60 %, with implications for both the surgeon and the patient. This work aims to identify potential influencing factors at colonoscopy that could lead to improved lesion localisation accuracy. Methods: A multi-centred, prospective, observational study was performed that identified patients who were undergoing planned curative resection for a colorectal lesion. Localisation of a lesion at colonoscopy was compared to the intra-operative lesion localisation to determine accuracy of colonoscopic localisation. Patient factors and colonoscopic factors were recorded to determine any influencing factors on lesion localisation at colonoscopy. Results: One hundred and eleven patients were analysed: mean age 67.4 years (range 27–89); male:female ratio 1.3:1; symptomatic referrals (n = 78, 70.3 %); and previous abdominal surgery in 27 patients (24.3 %). Complete colonoscopy was recorded in 78 patients (70.3 %). In 88 patients (79.3 %), colonoscopic lesion localisation matched the intra-operative location. Pre-operative CT imaging was unable to identify the tumour in 24 cases (21.8 %). Potential influencing patient and colonoscopic factors on accurate lesion localisation at colonoscopy found complete colonoscopy to be the only significant factor (p = 0.008). Conclusion: Colonoscopic lesion localisation was found to be inaccurate in 79.3 % cases, and with pre-operative CT unable to detect all lesions, this study confirms that accurate lesion localisation in the modern era is increasingly reliant on colonoscopy. Incomplete colonoscopy was the only significant factor that influenced inaccurate lesion localisation at colonoscopy