Search

This article, based on a talk given in November 2023, seeks to place contemporary Scotland in the context of broader social and political change. The last quarter of a century, marked by a devolved Parliament, has also seen the rise of increasingly aggressive individualism, a retreat from the social, and a populist right which threatens a crisis for democracy globally. Where, and how, does Scotland stand in these contexts?

Aims and methodWe aimed to estimate the costs of care for people with a personality disorder diagnosis and compare service use and costs for those receiving specialist input and those receiving generic care. Service use data were obtained from records and costs calculated. Comparisons were made between those who received care from specialist personality disorder teams and those who did not. Demographic and clinical predictors of costs were identified with regression modelling.ResultsMean total costs before diagnosis were £10 156 for the specialist group and £11 531 for the non-specialist group. Post-diagnosis costs were £24 017 and £22 266 respectively. Costs were associated with specialist care, comorbid conditions and living outside of London.Clinical implicationsReceiving increased support from a specialist service may reduce the need for in-patient care. This may be clinically appropriate and results in a distribution of costs.

The calls for reasoning and proof to have a prominent place in secondary mathematics classrooms raise the question of knowledge that teachers need to support student learning of reasoning and proof. Several conceptualizations of Mathematical Knowledge for Teaching Proof (MKT-P) have been proposed over the years, yet some key questions about the nature of MKT-P remain unclear, such as whether MKT-P is a special kind of knowledge specific to teaching or whether it is just common mathematics knowledge. Another question is whether MKT-P can be improved through targeted intervention. Our study attempts to respond to both questions. An MKT-P questionnaire was administered to in-service secondary teachers, undergraduate mathematics and computer science (M&CS) majors, and pre-service secondary teachers before and after taking a capstone courseMathematical Reasoning and Proving for Secondary Teachers. The results suggest that MKT-P is indeed a specialized type of knowledge, which can be improved through targeted intervention.

Gianfranco Poggi (1934–2023) was amongst the initial staff cohort at the formation of the University of Edinburgh’s Department of Sociology in 1964. Poggi’s recent death brought to an end almost six decades of thinking, arguing, and writing about Sociology: much of that time was spent in Scotland. Here Scottish Affairsmarks his passing through short memorials to him from his former student and colleague, David McCrone; and from his daughter, Maria Poggi Johnson.

The International Liaison Committee on Resuscitation has called for a randomised trial of delivery to a cardiac arrest centre. We aimed to assess whether expedited delivery to a cardiac arrest centre compared with current standard of care following resuscitated cardiac arrest reduces deaths.

Much has been made of the rise of English nationalism, reflected in the strong association of ‘being English’ and voting Leave in the Brexit referendum in 2016. This article examines recent books on Englishness, arguing that this is a complex and nuanced matter embedded in accreted myths. If there is a thoroughgoing ‘nationalism’ emerging in England, it requires not only significant and long-lasting shifts in national identity, but a conception of ‘England’ as an imagined community which is robust and relevant to modern social and cultural life. Furthermore, it requires a nationalism which is part of wider and ongoing political project, rather than a short-term political expedient such as Conservative mobilisation post-Brexit. The article argues that an older debate in the 1960s and 1970s, between Tom Nairn and E.P. Thompson sheds significant light on the origins and nature of Englishness, such that it has progressive rather than reactionary potential.

This obituary situates Tom Nairn (1932–2023) as a ‘Man With Qualities’, exploring his writing and thinking, not least through his critique of the British state.

Memristors have emerged as a viable component for developing neuromorphic hardware platforms, which can compete with biological systems in density, accuracy, and energy efficiency. Among contemporary memristive systems, intercalation-driven lithium niobite (LiNbO2) memristors have the advantage of inherent flux-driven large analog conductance tunability ( $\Delta {R}/{R} >89$ ), a wide resistance range (~10–1E $7 \Omega $ ) selected via geometry selection, and low-power (~100–150 mV) neuromorphic functionality resembling synaptic weight updates in the synaptic membrane. Emerging neural systems require nonstatic temporal responses to implement temporally diverse architectures, such as recurrent neural networks (RNNs), yet these temporally diverse memristors are rare. There is a gap in understanding of the frequency response of nonvolatile memristors, which is a fundamental characteristic in memristive systems and ultimately dictates the speed of adaptive learning in deployed neural networks and the memory windows available for designers in RNNs. Using both large and small signal characterization methods, these memristors demonstrate up to a decade of span in tunable frequency-dependent response, statically controlled via device geometry and scaling design rules, and dynamically tuned via channel lithium concentration. Thus, the tunable frequency dependence of resistance modulation in LiNbO2 memristors is evaluated, enabling future neural network design rules to be identified for scalable multifunctional memristive systems for neuromorphic computing applications.

Background: Dementia prevalence is increasing, with no cure at present. Drug therapies have potential side effects and risk of mortality. People with dementia are frequently offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services. Aims: The aims were to review published economic evaluations of community and nursing home non-pharmacological interventions for people with mild cognitive impairment or dementia and assess the usefulness of these evaluations for decision making in health services, for use by policy and local and national decision makers. Methods: We conducted a systematic review (PROSPERO CRD42021252999) of economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis. Exclusions: interventions for dementia prevention/early detection/end of life care. Databases searched: Academic Search Premier, MEDLINE, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Psychology and Behavioural Sciences Collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 1 January 2011–11 May 2023. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results: The review included 37 economic evaluations and four reviews worldwide across several distinct forms of care: physical activity, cognition, training, multicomponent, assistive technology and other (specialist dementia care, group living, home care vs care home). The intervention with the strongest evidence of cost-effectiveness was maintenance cognitive stimulation therapy. Case management, occupational therapy and dementia care management also showed good evidence of cost-effectiveness. Conclusion: More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency of methods and outcome measures. This could improve local and national decision makers’ confidence to promote future cost-effective dementia interventions.

This article is the first of two relating to an event at the University of Edinburgh to mark the coming retirement of Lindsay Paterson, Professor of Education Policy. Here three of Paterson’s close colleagues outline the very substantial contribution he has made to the study of Scotland, to understanding social inequality, and measuring the contribution of education to social mobility.

End-stage kidney disease is a significant burden on the healthcare systems of many countries, and this is likely to continue because of an increasingly aging and comorbid population. Multiple studies have demonstrated a significant clinical benefit in transplantation when compared with dialysis, however, there continues to be a shortage of donor kidneys available. This article provides an economic perspective on issues pertinent to living kidney donation and transplantation. Although ethics, equity, and cultural considerations often seem at odds with economic concepts around resource allocation, this article explains the situation around supply and demand for living kidneys and illustrates how this has been addressed in the economic literature. The article discusses different policy recommendations for resolving the imbalance between supply and demand in kidney donation, through policies under 3 main approaches: increasing supply, decreasing demand, and improving the allocation of kidney supply.

The SARS-CoV-2 Delta (Pango lineage B.1.617.2) variant of concern spread globally, causing resurgences of COVID-19 worldwide1,2. The emergence of the Delta variant in the UK occurred on the background of a heterogeneous landscape of immunity and relaxation of non-pharmaceutical interventions. Here we analyse 52,992 SARS-CoV-2 genomes from England together with 93,649 genomes from the rest of the world to reconstruct the emergence of Delta and quantify its introduction to and regional dissemination across England in the context of changing travel and social restrictions. Using analysis of human movement, contact tracing and virus genomic data, we find that the geographic focus of the expansion of Delta shifted from India to a more global pattern in early May 2021. In England, Delta lineages were introduced more than 1,000 times and spread nationally as non-pharmaceutical interventions were relaxed. We find that hotel quarantine for travellers reduced onward transmission from importations; however, the transmission chains that later dominated the Delta wave in England were seeded before travel restrictions were introduced. Increasing inter-regional travel within England drove the nationwide dissemination of Delta, with some cities receiving more than 2,000 observable lineage introductions from elsewhere. Subsequently, increased levels of local population mixing—and not the number of importations—were associated with the faster relative spread of Delta. The invasion dynamics of Delta depended on spatial heterogeneity in contact patterns, and our findings will inform optimal spatial interventions to reduce the transmission of current and future variants of concern, such as Omicron (Pango lineage B.1.1.529).

Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak—between 14 February and 19 June 2021—near the epicentre of the previous epidemic1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirusfrom samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirusfrom humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization.

The SARS-CoV-2 lineage B.1.1.7, designated variant of concern (VOC) 202012/01 by Public Health England1, was first identified in the UK in late summer to early autumn 20202. Whole-genome SARS-CoV-2 sequence data collected from community-based diagnostic testing for COVID-19 show an extremely rapid expansion of the B.1.1.7 lineage during autumn 2020, suggesting that it has a selective advantage. Here we show that changes in VOC frequency inferred from genetic data correspond closely to changes inferred by Sgene target failures (SGTF) in community-based diagnostic PCR testing. Analysis of trends in SGTF and non-SGTF case numbers in local areas across England shows that B.1.1.7 has higher transmissibility than non-VOC lineages, even if it has a different latent period or generation time. The SGTF data indicate a transient shift in the age composition of reported cases, with cases of B.1.1.7 including a larger share of under 20-year-olds than non-VOC cases. We estimated time-varying reproduction numbers for B.1.1.7 and co-circulating lineages using SGTF and genomic data. The best-supported models did not indicate a substantial difference in VOC transmissibility among different age groups, but all analyses agreed that B.1.1.7 has a substantial transmission advantage over other lineages, with a 50% to 100% higher reproduction number.

[18F]FDOPA PET imaging has shown dopaminergic function indexed as Kicerdiffers between antipsychotic treatment responders and non-responders. However, the theragnostic potential of this biomarker to identify non-responders has yet to be evaluated. In view of this, we aimed to evaluate this as a theragnostic test using linear and non-linear machine-learning (i.e., Bernoulli, support vector, random forest and Gaussian processes) analyses and to develop and evaluate a simplified approach, standardised uptake value ratio (SUVRc). Both [18F]FDOPA PET approaches had good test-rest reproducibility across striatal regions (KicerICC: 0.68–0.94, SUVRc ICC: 0.76–0.91). Both our linear and non-linear classification models showed good predictive power to distinguish responders from non-responders (receiver operating curve area under the curve for region-of-interest approach: Kicer= 0.80, SUVRc = 0.79; for voxel-wise approach using a linear support vector machine: 0.88) and similar sensitivity for identifying treatment non-responders with 100% specificity (Kicer: ~50%, SUVRc: 40–60%). Although the findings were replicated in two independent datasets, given the total sample size (n= 84) and single setting, they warrant testing in other samples and settings. Preliminary economic analysis of [18F]FDOPA PET to fast-track treatment-resistant patients with schizophrenia to clozapine indicated a potential healthcare cost saving of ~£3400 (equivalent to $4232 USD) per patient. These findings indicate [18F]FDOPA PET dopamine imaging has potential as biomarker to guide treatment choice.

How are Scottish elites educated? Is Scotland simply England writ small with Oxbridge and private schools predominating? Do private day schools mainly in the cities provide the core of elites? How important are education authority schools? How have patterns changed, if at all, between 1986 and 2019? Using ‘Who's Who in Scotland’, this article charts the changing composition of elites especially among the political, legal and administrative classes in Scotland in comparison with business and ‘traditional’ elites. Drawing comparisons with analysis of British elites more generally, it appears that Scottish elites are educationally more ‘Scottish’ and state-educated today than they were in 1986.

Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency.

The question ‘Which school did you go to?’ is an attempt to ‘place’ respondents in Edinburgh in terms of social status. This article examines the social and educational origins of fee-paying schools in a city with a significantly higher proportion of secondary pupils in such schools than elsewhere in Scotland. It asks what the perceived ‘pay-off’ is as regards social and educational mobility in the context of a significant decline since the 1960s in the numbers attending their ‘local’ university, and in a city with a much higher percentage of residents born furth of Scotland. The key question is to what extent being educated privately still makes a difference.

ObjectiveThe epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD.MethodsA three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40–74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention.ResultsAt 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI −288.00 to 147.90 and mean difference=7.24 steps, 95% CI −224.01 to 238.50, respectively), reducing weight (mean difference=−0.03 kg, 95% CI −0.49 to 0.44 and mean difference=−0.42 kg, 95% CI −0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds.ConclusionsEnhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.

The Life-Space Assessment (LSA) has demonstrable validity and reliability among people sampled from nonclinical settings. Its properties in clinical settings, especially physical therapy services, are less well established.

Irritable bowel syndrome (IBS) is common, affecting 10–20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT for patients with refractory IBS. ACTIB results showed that, at 12 months, both forms of CBT for IBS were significantly more effective than treatment as usual at reducing IBS symptom severity in adults with refractory IBS. This follow-up study aimed to evaluate 24-month clinical outcomes of participants in the ACTIB trial.

Frank Bechhofer (1935–2018) made a remarkable contribution to sociology and the wider social sciences as a researcher, a teacher, and a writer. In this article three of his academic collaborators sketch out several areas in which he enriched intellectual life in Scotland.

How did Edinburgh become ‘festival city’? Despite appearances, it was not always so, and it acquired the accolade by happenstance; in the view of one observer, a ‘strange amalgam of cultural banditry, civic enterprise and idealism’. The official Festival's survival was down to the City Council, and it was funded almost entirely by public bodies. This was the central structure around which The Fringe developed, and The Traverse prospered, along with smaller festivals and events to become Festival City. The story sheds considerable light on how Edinburgh ‘works’, its strengths and weaknesses combined.

AimsThe aim of the Scaphoid Magnetic Resonance Imaging in Trauma (SMaRT) trial was to evaluate the clinical and cost implications of using immediate MRI in the acute management of patients with a suspected fracture of the scaphoid with negative radiographs.Patients and MethodsPatients who presented to the emergency department (ED) with a suspected fracture of the scaphoid and negative radiographs were randomized to a control group, who did not undergo further imaging in the ED, or an intervention group, who had an MRI of the wrist as an additional test during the initial ED attendance. Most participants were male (52% control, 61% intervention), with a mean age of 36.2 years (18 to 73) in the control group and 38.2 years (20 to 71) in the intervention group. The primary outcome was total cost impact at three months post-recruitment. Secondary outcomes included total costs at six months, the assessment of clinical findings, diagnostic accuracy, and the participants’ self-reported level of satisfaction. Differences in cost were estimated using generalized linear models with gamma errors.ResultsThe mean cost up to three months post-recruitment per participant was £542.40 (sd£855.20, n = 65) for the control group and £368.40 (sd£338.60, n = 67) for the intervention group, leading to an estimated cost difference of £174 (95% confidence interval (CI) -£30 to £378; p = 0.094). The cost difference per participant increased to £266 (95% CI £3.30 to £528; p = 0.047) at six months. Overall, 6.2% of participants (4/65, control group) and 10.4% of participants (7/67, intervention group) had sustained a fracture of the scaphoid (p = 0.37). In addition, 7.7% of participants (5/65, control group) and 22.4% of participants (15/67, intervention group) had other fractures diagnosed (p = 0.019). The use of MRI was associated with higher diagnostic accuracy both in the diagnosis of a fracture of the scaphoid (100.0% vs93.8%) and of any other fracture (98.5% vs84.6%).ConclusionThe use of immediate MRI in the management of participants with a suspected fracture of the scaphoid and negative radiographs led to cost savings while improving the pathway’s diagnostic accuracy and patient satisfaction.Cite this article: Bone Joint J2019;101-B:984–994.

Twenty years of the Scottish Parliament requires assessment of its impact. What do people in Scotland think of it so far? Has it fulfilled their expectations and needs? This article focuses on evidence from Scottish Social Attitudes surveys over the period, and in particular how the performances of Scottish Government vis-à-vis UK Government are judged by public opinion. To what extent has the devolution conundrum, identified in the first session of the parliament, namely, that the Scottish tier of government gets the credit for any successes, and the UK government the blame for failures been reversed? How do people rate the respective tiers of government In terms of willingness to listen, and trust in governments to work in Scotland's long-term interests and judgements about fairness? How are these differences best explained in terms of people's social and demographic characteristics as well as their political and constitutional views? The article concludes that Scottish Government has maintained early expectations, and established itself as the premier tier of government despite its constitutional position as a devolved institution. It has become, in the eyes of people in Scotland, the main framework through which politics and policy-making in Scotland are carried out.

Why, if few people in Scotland give priority to being ‘European’, vis-à-vis being ‘Scottish’ or being ‘British’, did a significant majority vote Remain in the 2016 Brexit referendum? Much depends on how questions on territorial identities are asked in surveys. Employing a 7-point scale ranging from ‘weakly European’ to ‘strongly European’ we find that as many as 45% put themselves at the strongly European end of the scale in Scotland. Furthermore, and contrary to expectations, being European correlates more strongly with being British than with being Scottish north of the border. Using linear regression analysis, four variables contribute significantly to being strongly European: having liberal (‘libertarian’) values, high levels of education, supporting the SNP and Independence, and feeling ‘British’. Being ‘Scottish’ has lesser effect because it is ubiquitous across the social spectrum, and, in any case, national identity in Scotland, in contrast with England, did not account significantly for the 2016 Brexit vote in Scotland. There is evidence, however, that, post-Brexit, being ‘European’ has taken on more political-constitutional meanings, even though the binary divide between Remain and Leave does not properly reflect the range of policy preferences people adopt concerning the European Union.

ObjectiveTo evaluate the clinical effectiveness of two modes of cognitive–behavioural therapy (CBT) for IBS compared with treatment as usual (TAU) in refractory IBS.DesignA three-arm randomised controlled trial assessing telephone-delivered CBT (TCBT), web-based CBT (WCBT) with minimal therapist support, and TAU. Blinding participants and therapists was not possible. Chief investigator, assessors and statisticians were blinded. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and South of England between May 2014 to March 2016. Co-primary outcomes were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS) at 12 months.Results558/1452 (38.4%) patients screened for eligibility were randomised: 76% female: 91% white: mean age 43 years. (391/558) 70.1% completed 12 months of follow-up. Primary outcomes: Compared with TAU (IBS-SSS 205.6 at 12 months), IBS-SSS was 61.6 (95% CI 33.8 to 89.5) points lower (p<0.001) in TCBT and 35.2 (95% CI 12.6 to 57.8) points lower (p=0.002) in WCBT at 12 months. Compared with TAU (WSAS score 10.8 at 12 months) WSAS was 3.5 (95% CI 1.9 to 5.1) points lower (p<0.001) in TCBT and 3.0 (95% CI 1.3 to 4.6) points lower (p=0.001) in WCBT. All secondary outcomes showed significantly greater improvement (p≤0.002) in CBT arms compared with TAU. There were no serious adverse reactions to treatment.ConclusionBoth CBT interventions were superior to TAU up to 12 months of follow-up.Trial registration numberISRCTN44427879.

The absence of economic evidence hinders current reforms of hospital-based mental health systems in central and eastern Europe. We aimed to assess the cost-effectiveness of discharge to community care for people with chronic psychoses compared with care in psychiatric hospitals in the Czech Republic.

READER FEEDBACK I also went through hours of unsuccessful phone calls and callbacks about Social Security issues that could not be resolved on the phone ("From the Editor", March). I chose to itemize on my federal return even though my deductions were below the standard deduction because my state tax liability was decreased by more than my increase in federal taxes. All the subsequent share prices are lower than the beginning price of $25, so of course the average price per share is lower. [Extracted from the article]

The saga of the Edinburgh Trams, and ensuing Public Inquiry, sheds light on systems of power and influence in the city. Drawing mainly upon Inquiry evidence, this article gives an account of why the project was over-budget, curtailed in length, and failed to meet the original timetable. It examines how blame was apportioned by key actors. In terms of analysis, the article explores the Trams as a ‘mega-project’, and locates it in the context of outsourcing the state, both national and local. More generally, it treats Edinburgh as an example of the ‘calculable city’, in which assets are treated as future forms of revenue rather than as public resources.

The Scottish press and media have been credited with keeping alive and amplifying Scottish national identity, and with it, the Scottish Home Rule project. And yet, the Scottish press has undergone a massive decline in sales and readership in the last fifty years. This brief commentary addresses the apparent anomaly that the press, the ostensible carriers of the Scottish political project, are no longer vital to its development in the 21stcentury.