'Capable of being in uncertainties': applied medical humanities in undergraduate medical education.

Numerous medical schools have been updating and modernising their undergraduate curricula in response to the changing health needs of today's society and the updated General Medical Council competencies required for qualification. The humanities are sometimes seen as a way of addressing both of these requirements. Medical humanities advocates would argue that the humanities have a vital role to play in undergraduate medical education, allowing students to develop the critical tools required by the 21st-century clinician to deliver the best person-centred care. While we endorse this view, we contend that such training must be taught authentically to have maximal impact. This article arises from a collaboration between Imperial College London and Birkbeck, University of London, which aimed to embed the humanities into Imperial's undergraduate medical curriculum. Here, we use a teaching session on graphic medicine and narrative as a case study to illustrate how the humanities can be a powerful tool for students to explore professional clinical complexity and uncertainty when taught in a transdisciplinary way. In this session, uncertainty operated on several different levels: the introduction of unfamiliar concepts, materials, and methods to students, transdisciplinary approaches to teaching, and the complexities of real-life clinical practice. Further, we argue that to manage uncertainty, medical students must cross from a scientific training based on positivist understandings of evidence and knowledge, to one which foregrounds multiplicity, nuance, interpretive critical thinking, and which understands knowledge as contingent and contextually produced. In facilitating such learning, it is crucial that the teaching team includes experts from both medical and humanities fields to scaffold student learning in an intellectually dynamic way, drawing on their disciplinary knowledge and wide range of personal professional experiences.

A Home or a Gaol? Scandal, Secrecy, and the St James's Inebriate Home for Women.

In the 1880 s and 1890 s the operations of the St James's Home for Female Inebriates in Kennington, London, attracted the attention of both the Charity Organisation Society and the popular press when the proprietors of the Home were accused of mistreating women in their care. Such mistreatment, it was suggested, had been allowed to continue for many years due to the cloak of secrecy that surrounded the Home. Both medical and popular conceptions of the inebriate had functioned to legitimise institutionalisation as necessary for cure and-by implying a degree of moral culpability that aligned inebriate women with 'fallen women' more generally-to sanction the secrecy of such treatment. This article discusses the St James's case in detail in order to consider how the institutional culture of the private inebriate home could also be a culture of harm.

Adding access to a video magnifier to standard vision rehabilitation: initial results on reading performance and well-being from a prospective, randomized study.

PURPOSE: Both optical and electronic magnification are available to patients with low vision. Electronic video magnifiers are more expensive than optical magnifiers, but they offer additional benefits, including variable magnification and contrast. This study aimed to evaluate the effect of access to a video magnifier (VM) added to standard comprehensive vision rehabilitation (VR). METHODS: In this prospective study, 37 subjects with central field loss were randomized to receive standard VR (VR group, 18 subjects) or standard VR plus VM (VM group, 19 subjects). Subjects read the International Reading Speed Texts (IReST), a bank check, and a phone number at enrollment, at 1 month, and after occupational therapy (OT) as indicated to address patient goals. The Impact of Vision Impairment (IVI) questionnaire, a version of the Activity Inventory (AI), and the Depression Anxiety and Stress Scale (DASS) were administered at enrollment, 1 month, after OT, 1 month later, and 1 year after enrollment. Assessments at enrollment and 1 month later were evaluated. RESULTS: At 1 month, the VM group displayed significant improvement in reading continuous print as measured by the IReST (P = 0.01) but did not differ on IVI, AI, or DASS. From enrollment to 1 month all subjects improved in their ability to spot read (phone number and check; P < 0.01 for both). The VM group improved in their ability to find and read a number in a phone book more than the VR group at 1 month after initial consultation (P = 0.02). All reported better well-being (P = 0.02). CONCLUSIONS: All subjects reported better well-being on the IVI. The VM group read faster and was better at two spot reading tasks but did not differ from the VR group in other outcome measures.

Bloody technology: the sphygmograph in asylum practice.

The sphygmograph, an instrument to measure and visually chart the pulse, was used by a number of asylum researchers in the late nineteenth century in an attempt to better understand mental disease. In charting the use of such a medical technology in the asylum, this article explores the utility of a practice-oriented approach in the history of psychiatry - as a window onto the alienist profession and as a means of investigating how new medical technologies were assimilated into everyday practice.

Structurally optimised BODIPY derivatives for imaging of mitochondrial dysfunction in cancer and heart cells.

The structural features required for mitochondrial uptake of BODIPY-based optical imaging agents have been explored. The first derivatives of this class of dyes shown to have mitochondrial membrane potential-dependent uptake in both cancer and heart cells have been developed.

In the shadow of the asylum: the Stanley Royd Salmonella outbreak of 1984.

In August 1984, an outbreak of Salmonella at Stanley Royd Psychiatric Hospital in Yorkshire led to the deaths of 19 elderly residents. It was an incident that attracted a good deal of comment in both the local and national press, and one that had enduring relevance for ideas about psychiatric care, food handling and catering provisions, hospital management and the official inspection of medical institutions. This article examines the impact that the 1984 outbreak had on official and popular perceptions of these issues. As well as bringing to public attention the fact that large numbers of vulnerable elderly patients were long-term residents in psychiatric hospitals, the Salmonella outbreak highlighted the inadequacies of Victorian hospital buildings in modern healthcare. Throughout the press reports and official investigations examined here, the provenance of Stanley Royd was repeatedly emphasised; its Victorian fabric persistently interfered with cleaning regimes, cold storage facilities and the conveyance of food to patients. Within institutions like Stanley Royd, 'new' and 'old' risks came together--the microscopic bacterium and the crumbling nineteenth-century building--to create a strong critique of existing psychiatric care. The episode also highlighted broader problems within the NHS, such as systems of management and the status of psychogeriatrics as a specialism.

Feasibility of a web-based survey of hallucinations and assessment of visual function in patients with Parkinson's disease.

BACKGROUND: Patients with Parkinson's disease (PD) experience visual hallucinations, which may be related to decreased contrast sensitivity (ie, the ability to discern shades of grey). OBJECTIVE: The objective of this study was to investigate if an online research platform can be used to survey patients with Parkinson's disease regarding visual hallucinations, and also be used to assess visual contrast perception. METHODS: From the online patient community, PatientsLikeMe, 964 members were invited via email to participate in this study. Participants completed a modified version of the University of Miami Parkinson's disease hallucinations questionnaire and an online vision test. RESULTS: The study was completed by 27.9% (269/964) of those who were invited: 56.9% of this group had PD (153/269) and 43.1% (116/269) were non-Parkinson's controls. Hallucinations were reported by 18.3% (28/153) of the Parkinson's group. Although 10 subjects (9%) in the control group reported experiencing hallucinations, only 2 of them actually described formed hallucinations. Participants with Parkinson's disease with a mean of 1.75 (SD 0.35) and the control group with a mean of 1.85 (SD 0.36) showed relatively good contrast perception as measured with the online letter test (P=.07). People who reported hallucinations showed contrast sensitivity levels that did not differ from levels shown by people without hallucinations (P=.96), although there was a trend towards lower contrast sensitivity in hallucinators. CONCLUSIONS: Although more Parkinson's responders reported visual hallucinations, a significant number of non-Parkinson's control group responders also reported visual hallucinations. The online survey method may have failed to distinguish between formed hallucinations, which are typical in Parkinson's disease, and non-formed hallucinations that have less diagnostic specificity. Multiple questions outlining the nature of the hallucinations are required. In a clinical interview, the specific nature of the hallucination would be further refined to rule out a vague description that does not indicate a true, formed visual hallucination. Contrary to previous literature, both groups showed relatively good contrast sensitivity, perhaps representing a ceiling effect or limitations of online testing conditions that are difficult to standardize. Steps can be taken in future trials to further standardize online visual function testing, to refine control group parameters and to take steps to rule out confounding variables such as comorbid disease that could be associated with hallucinations. Contacting subjects via an online health social network is a novel, cost-effective method of conducting vision research that allows large numbers of individuals to be contacted quickly, and refinement of questionnaires and visual function testing may allow more robust findings in future research.

Developing a compassionate mind to enhance trauma-focused CBT with an adolescent female: a case study.

BACKGROUND: Shame and disgust are often associated with posttraumatic stress disorder (PTSD) following interpersonal traumas such as sexual assault. It has been suggested that individuals with high levels of shame might do less well in standard cognitive behavioural (CBT) interventions. AIMS: To see whether applying compassion-focused therapy and developing a compassionate mind can enhance trauma-focused CBT in an adolescent with high levels of shame and disgust the way it has been shown to within the adult population. METHOD: This single case study describes how trauma-focused CBT was enhanced by compassionate mind training. It details work using this approach with an adolescent female experiencing shame and disgust-based flashbacks. Treatment was provided for 20 sessions over 8 months. Symptoms of PTSD, depression and self-criticism, as well as the ability to self-soothe/reassure, were measured at assessment/start of treatment, mid- and end of treatment. RESULTS: Clinically significant reductions in PTSD, depressive, shame and self-attacking symptoms were found between assessment and completion of treatment. Clinically significant increases in self-reassurance were also reported. Following treatment, symptoms of PTSD and depression were sub-clinical. CONCLUSION: This case study suggests that developing a compassionate mind alongside trauma-focused CBT may be beneficial to adolescents experiencing shame and disgust with consideration for the young person's level of development and personal circumstances.

Characterization of field loss based on microperimetry is predictive of face recognition difficulties.

PURPOSE: To determine how visual field loss as assessed by microperimetry is correlated with deficits in face recognition. METHODS: Twelve patients (age range, 26-70 years) with impaired visual sensitivity in the central visual field caused by a variety of pathologies and 12 normally sighted controls (control subject [CS] group; age range, 20-68 years) performed a face recognition task for blurred and unblurred faces. For patients, we assessed central visual field loss using microperimetry, fixation stability, Pelli-Robson contrast sensitivity, and letter acuity. RESULTS: Patients were divided into two groups by microperimetry: a low vision (LV) group (n = 8) had impaired sensitivity at the anatomical fovea and/or poor fixation stability, whereas a low vision that excluded the fovea (LV:F) group (n = 4) was characterized by at least some residual foveal sensitivity but insensitivity in other retinal regions. The LV group performed worse than the other groups at all blur levels, whereas the performance of the LV:F group was not credibly different from that of the CS group. The performance of the CS and LV:F groups deteriorated as blur increased, whereas the LV group showed consistently poor performance regardless of blur. Visual acuity and fixation stability were correlated with face recognition performance. CONCLUSIONS: Persons diagnosed as having disease affecting the central visual field can recognize faces as well as persons with no visual disease provided that they have residual sensitivity in the anatomical fovea and show stable fixation patterns. Performance in this task is limited by the upper resolution of nonfoveal vision or image blur, whichever is worse.

The bones of the insane.

This article examines alienist explanations for fracture among British asylum patients in the late nineteenth to early twentieth centuries. A series of deaths in asylums came to light in the 1870s which, in placing the blame for such incidents on asylum staff, called for a response from the psychiatric profession. This response drew upon other medical fields and employed novel pathological techniques to explain why fractures occurred among the insane, in many cases aligning bone fragility with particular forms of insanity (namely, General Paralysis of the Insane). Although such research aimed to provide a medical explanation for the 'fracture death', it also called into question the value of pathological research and the utility of quantitative measurement in understanding mental disease.

Face age and sex modulate the other-race effect in face recognition.

Faces convey a variety of socially relevant cues that have been shown to affect recognition, such as age, sex, and race, but few studies have examined the interactive effect of these cues. White participants of two distinct age groups were presented with faces that differed in race, age, and sex in a face recognition paradigm. Replicating the other-race effect, young participants recognized young own-race faces better than young other-race faces. However, recognition performance did not differ across old faces of different races (Experiments 1, 2A). In addition, participants showed an other-age effect, recognizing White young faces better than White old faces. Sex affected recognition performance only when age was not varied (Experiment 2B). Overall, older participants showed a similar recognition pattern (Experiment 3) as young participants, displaying an other-race effect for young, but not old, faces. However, they recognized young and old White faces on a similar level. These findings indicate that face cues interact to affect recognition performance such that age and sex information reliably modulate the effect of race cues. These results extend accounts of face recognition that explain recognition biases (such as the other-race effect) as a function of dichotomous ingroup/outgroup categorization, in that outgroup characteristics are not simply additive but interactively determine recognition performance.

What is narrative therapy and what is it not?: the usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy.

OBJECTIVE. 'What is narrative therapy and how do you do it?' is a question that is repeatedly asked of narrative therapy, with little consistent response. This study aimed to explore and distil out the 'common themes' of practitioner definitions of White and Epston's approach to narrative therapy. DESIGN. This was an Internet-based study involving current UK practitioners of this type of narrative therapy using a unique combination of a Delphi Panel and Q methodology. METHOD. A group of experienced practitioners were recruited into the Delphi Poll and were asked two questions about what narrative therapy is and is not, and what techniques are and are not employed. These data combined with other information formed the statements of a Q-sort that was then administered to a wider range of narrative practitioners. FINDINGS. The Delphi Panel agreed on a number of key points relating to the theory, politics and practice of narrative therapy. The Q-sort produced eight distinct accounts of narrative therapy and a number of dimensions along which these different positions could be distinguished. These included narrative therapy as a political stance and integration with other approaches. CONCLUSIONS. For any therapeutic model to demonstrate its efficacy and attract proponents, an accepted definition of its components and practice should preferably be established. This study has provided some data for the UK application of White and Epston's narrative therapy, which may then assist in forming a firmer base for further research and practice.