bluuebunny/crossref_metadata_2025 huggingface dataset:
Narrative career therapy: From the problem-saturated story to a preferred story and career path
Authors: Shefer Tali
Published: August 2018

This article centres on the specific elaboration of the concept of ‘narrative’ in the philosophy and therapeutic techniques of Michael White, and on their application in narrative career therapy. The narrative career therapy model, developed by the author, aims to assist clients in their career deliberations through the life cycle. Various narrative approaches make use of the metaphor of narrative to describe the constructions that organise individual identities and reconstructing them in the counselling process through the addition of alternative, more optimistic and positive meanings. However, as this article seeks to demonstrate, while at times, the various narrative approaches adopt identical terminology, its meaning differs as applied in distinct models of career counselling and therapy. Initial outcome assessments of this model conducted by the author have been promising, with clients reporting an enhanced quality of life in the areas addressed in therapy and a satisfying career choice. This model features two additional tools adapted by the author: a qualitative questionnaire for clarifying career preferences and a narrative use of the career genogram. The article reviews White’s practices and their application to narrative career therapy as implemented with diverse populations in a range of therapeutic settings and in a training and supervision programme for psychologists and counsellors.
Narrative career counselling: A tension between potential, appeal, and proof. Introduction to the special issue
Authors: McMahon Mary
Published: August 2018

Narrative career counselling is becoming ubiquitous as its inherent appeal has seen it become more widely adopted in practice. A tension between its potential, popular appeal and proof has emerged. It is over 40 years since the need for a change in direction in theory and practice was first flagged, and it is timely to reflect on the past, present and future stories of narrative career counselling. This article considers the nature and purpose of narrative, the foundation for narrative approaches to career counselling. It overviews the relationship between narrative and identity, the philosophical underpinnings of narrative career counselling, the influence of narrative on career counselling and critiques of narrative career counselling. The article concludes that the potential and popular appeal of narrative career counselling have been realised, but that further supporting proof is needed. A possible future story could see researchers and practitioners working together more closely to build the evidence base for and stimulate theory development about narrative career counselling.
How can creative practice facilitate reflection on self-learning? Implications for narrative career counselling
Authors: Brammar Laura , Lezova Katarina
Published: August 2018

This study uses an individual case study to explore how creative practice can facilitate reflection on self-learning from a narrative career counselling perspective. The case study features the original creative output and associated writing task produced by a higher education student as part of a skills award. The study considers what is meant by creativity and the use of creative practices in narrative career counselling. Based on the case study, it considers the potential implications for narrative career counselling regarding the use of creative practice to facilitate both reflection and stimulate internal and external dialogues around self-learning.
Let’s Not “Taint” Stigma Research With Legitimacy, Please
Authors: Helms Wesley S. , Patterson Karen D. W. , Hudson Bryant Ashley
Published: August 2018

We propose that stigma and legitimacy are distinct constructs. Drawing from extant research, empirical observations, and the theoretical assumptions of both constructs we assert that, in spite of increasing efforts to equate stigma as illegitimacy, the opposite of legitimacy, that it is not. Specifically, we argue that organizations and their actors can be both stigmatized and legitimate at the same time. With this recognized, we propose a stigma-focused research agenda, separate from - and untainted by - legitimacy. Further, we propose an agenda that broadens conceptualizations of audiences and their dynamics, addresses how normal “deviants” take action in the face of stigma, and reconceptualises how audiences and the stigmatized interact.
Dynamic Alarm Systems for Hospitals (D.A.S.H.)
Authors: Greer Jasmine M. , Burdick Kendall J. , Chowdhury Arman R. , Schlesinger Joseph J.
Published: August 2018

Hospital alarms today indicate urgent clinical need, but they are seldom “true.” False alarms are contributing to the ever-increasing issue of alarm fatigue, or desensitization, among doctors and nurses. Alarm fatigue is a high-priority health care concern because of its potential to compromise health care quality and inflict harm on patients. To address this concern, we have engineered Dynamic Alarm Systems for Hospitals (D.A.S.H.), a dynamic alarm system that self-regulates alarm loudness based on the environmental noise level and incorporates differentiable and learnable alarms. D.A.S.H., with its ability to adapt to environmental noise and encode nuanced physiological information, may improve patient safety and attenuate clinician alarm fatigue.
Compression and low velocity impact response of sandwich panels with polyester pin-reinforced foam filled honeycomb core
Authors: Jayaram RS , Nagarajan VA , Vinod Kumar KP
Published: August 2018

Hybridization of face, core and their combination is of great interest to develop high performance composite sandwich panels. In this regards, hybrid core of ‘polyester pin-reinforced foam filled honeycomb sandwich panels’ was fabricated and compared with unreinforced ‘foam filled honeycomb sandwich panels’ in terms of compressive and low velocity impact performances. MATLAB image processing techniques was applied to determine the impact damage area. Incorporating reinforcing pins for connecting faces and core is an effectual way to improve interfacial bonding, also imparts through thickness properties for sandwich panels. Compression tests performed on the sandwich panels revealed that the polyester pin reinforcement in foam filled honeycomb sandwich panel enhanced the load bearing capacity considerably. The low velocity impact properties such as load at initial damage, total absorbed energy were greatly improved and impact damage area reduced significantly by the addition of the pins.
The effect of European and global uncertainty on stock returns of travel and leisure companies
Authors: Ersan Oguz , Akron Sagi , Demir Ender
Published: August 2018

This article aims to evaluate the impact of economic policy uncertainty (EPU) on the STOXX Europe 600 Travel & Leisure Price Index by utilizing a monthly data set for 20 years through 1997–2016. It is found that both the European and the global EPU have significant negative effects on the stock returns of travel and leisure companies. We demonstrate the significantly superior forecasting power of EPU measures on tourism and leisure stock returns, relative to a rather weak forecasting power of various macroeconomic variables.
Investigating the ‘integration of theory and practice’ in examination physical education
Authors: Jones Andrew , Penney Dawn
Published: August 2018

This paper presents theoretical insights and empirical findings from research in Western Australia (WA) that explored the concept of ‘integrated theory and practice’ in the context of the introduction of a new examination physical education course. The lack of conceptual clarity associated with attempts to embed ‘integration’ into curriculum developments in examination physical education internationally provided a stimulus for this research. Focusing on a new Physical Education Studies course in WA, the research foregrounded the concept of policy enactment and used Arnold’s framework of learning in, through and about movement as a critical frame to investigate the specific notions of integration that were embedded in the official curriculum text and expressed in pedagogical practices in schools implementing the new course. The paper reports findings from the investigation of the pedagogic meanings that four teachers gave to ‘integrated theory and practice’. The data illustrate the varied meanings teachers gave to ‘integration’ and the differences consequently arising in their curriculum planning, teaching and assessment practices associated with the new Physical Education Studies course. Analysis of the data identified opportunistic, structured and investigative ‘integrated’ pedagogies. Data associated with each approach are presented and the expression of Arnold’s dimensions within each approach explored. Discussion pursues the conditions enabling different pedagogical practices to emerge from the new Physical Education Studies course and the learning opportunities provided to students by the different pedagogical approaches. The paper presents a case for further engagement with the pedagogical expression of Arnold’s framework by curriculum developers, researchers, teacher educators and teachers.
Exploring entrepreneurial roles and identity in the United Kingdom and China
Authors: Bell Robin , Liu Peng , Zhan Huirong , Bozward David , Fan Jing , Watts Helen , Ma Xiaoyu
Published: August 2018

This article examines entrepreneurial identity in both the United Kingdom and China through the lenses of identity theory and social identity theory to develop a deeper and more holistic understanding of the concept of entrepreneurial identity. By examining the entrepreneur as both a role and an identity, this article explores how an entrepreneur views the role of the entrepreneur, the counter-roles to the entrepreneur, and the “self-as-entrepreneur” and seeks to understand how entrepreneurs construct their identity as an entrepreneur. By looking at the role identity in different social constructs, a more nuanced view of entrepreneurial identity can be uncovered for entrepreneurs in both the United Kingdom and China. The study argues that entrepreneurs in the United Kingdom use counter-roles to bridge the disconnect between their understanding of the entrepreneur-as-role and the self-as-entrepreneur, whereas entrepreneurs in China have less conflict reconciling the two and use the counter-role as a way to paint entrepreneurship as a “calling,” justifying their abandonment of other identities.
Philanthropy and dementia care in Ireland
Authors: Carney Patricia , O’Shea Eamon
Published: August 2018

This paper examines The Atlantic Philanthropies investment in dementia in Ireland and its impact on the dementia landscape, particularly in relation to policy. Atlantic has directly invested €33 million in dementia in Ireland and leveraged a further €51 million from grantees, resulting in a total spend of €83 million between 2011 and 2016. The investment was broad and far reaching, encapsulating support for personalised community-based care, brain health, advocacy, education and training in dementia, culminating in support for the formulation and implementation of the first National Dementia Strategy in Ireland. Investing in the right people was a key feature of the Atlantic programme and one of the main drivers of its success. A close and credible relationship with government was also important for success. So too was an emphasis on evidence and evaluation, which has been a long-standing trait of Atlantic’s involvement in public policy in Ireland, as well as being influential in overall public service reform in the country. It is difficult to determine what the dementia landscape in Ireland might look like if Atlantic had not invested in the area, but even if one accepts the view that change would have come eventually, Atlantic ensured that it came much faster and in a more coherent manner.
Dementia caregiver intervention development and adaptation in the Vietnamese American community: A qualitative study
Authors: Meyer Oanh L , Fukurai Mihoka , Ho Janis , Limtiaco Pim , Nguyen Hedda Hieu , Dang Jennifer , Zane Nolan , Hinton Ladson
Published: August 2018

Objectives

The purpose of this study was to obtain input and feedback on a proposed intervention to reduce stress and enhance the health of Vietnamese dementia caregivers.

Methods

Sixteen semi-structured, in-depth interviews and two focus groups were conducted with a total of 21 key stakeholders (i.e., family caregivers, professionals, and community leaders).

Results

Several themes emerged from the data, and these themes fell into two major domains: the first domain was recruitment and engagement into the intervention: (1) importance of faith-based institutions, (2) inclusion of multiple family members in the intervention, (3) community empowerment/ownership, and (4) importance of credibility and trust. The second domain included themes on intervention content: (1) education about Alzheimer’s disease and dementias and (2) tailoring the intervention to caregivers’ needs.

Conclusions

Findings indicate that the proposed intervention could be very beneficial to caregivers, but slight modifications needed to be made.
A proposed model of transmission of Cantonese opera in Hong Kong higher education: From oral tradition to conservatoire
Authors: Leung Bo-Wah
Published: August 2018

Transmission of traditional art forms in the modern world has been a major issue in the field of arts education. Different issues have been raised on how to preserve the traditional art forms for further development. Cantonese opera is a representative Chinese opera popular in south China including Hong Kong. However, the genre has been experienced fluctuation since 1950s with the difficulties of transmission through oral tradition to conservatory tradition. While the Hong Kong Government promotes the genre to reserve the cultural tradition, great masters have been fading out and younger generation encounters difficulties in inheriting the genre. This article reports parts of a large-scale study on the nature and characteristics of oral tradition, learning in community settings, conservatory tradition, and proposes a model of transmission of Cantonese opera in Hong Kong. The model may shed light on preserving, inheriting, and further developing traditional performing arts in the modern world.
Structural health monitoring and fatigue damage estimation using vibration measurements and finite element model updating
Authors: Giagopoulos Dimitrios , Arailopoulos Alexandros , Dertimanis Vasilis , Papadimitriou Costas , Chatzi Eleni , Grompanopoulos Konstantinos
Published: August 2018

In this work, a computational framework is proposed for fatigue damage estimation in structural systems by integrating operational experimental measurements in a high-fidelity, large-scale finite element model. The proposed method is applied in a linear steel substructure of a lignite grinder assembly at a Public Power Corporation power plant. A finite element model of the steel base is developed and updated to match the dynamic characteristics measured in real operating conditions. This is achieved through coupled use of numerical and experimental methods for identifying, updating, and optimizing a high-fidelity finite element model. The full stress time histories of the complex mechanical assembly are estimated, at critical locations, by imposing operational vibration measurements from a limited number of sensors in the updated finite element model. Fatigue damage and remaining lifetime is subsequently estimated via commonly adopted engineering approaches, such as Palmgren–Miner damage rule, S–N curves, and rainflow cycle counting. Incorporation of a numerical model of the structure in the response estimation procedure permits stress estimation at unmeasured locations, thereby enabling the drawing of a complete and substantially dense fatigue map consistent with the vibration measurements. Fatigue predictions via the proposed framework are highly correlated to experimental fatigue results, proving the efficiency and applicability of the framework.
Nationalization in U.S. Senate and Gubernatorial Elections
Authors: Sievert Joel , McKee Seth C.
Published: August 2018

Since the 1970s, American politics has taken an impressive turn away from political dealignment and moved toward a more responsible party system. As a result, elections have become more nationalized, a process by which presidential and national politics exert greater influence over down-ballot contests. We evaluate nationalization in electoral contests for two high-profile offices—U.S. Senate and governor—that encompass the same constituencies but constitute markedly different job descriptions and mandated responsibilities. Our analysis utilizes both macro- and micro-level data (election returns and surveys, respectively) to assess patterns of nationalization in these elections. Although it is perhaps not surprising that the linkage between presidential and senatorial contests has tightened, it appears national political forces now also exert greater influence over gubernatorial contests. Nonetheless, we do find regional variation in the nationalization of senatorial and gubernatorial politics, which is more evident in the latter office.
Distributed beamforming algorithm based on game theory in device-to-device communications
Authors: Xie Xian-zhong , Li Chuan-wen , Cheng Shuang-guo , Yang He-lin , Tang Shu
Published: August 2018

In the device-to-device communication network, there is the interference problem when device-to-device users share the same spectrum with cellular users, a distributed beamforming scheme based on non-cooperative game is proposed to maximize weighted sum rate under the rated transmit power and the users’ quality of service. Since the optimization problem is non-concave, we first obtain the solution of the Karush-Kuhn-Tucher (KKT) condition for the downlink beamforming problem of each sender by dual decomposition. Second, a distributed beamforming algorithm based on the non-cooperative game is proposed, which can quickly converge to the Nash equilibrium point with a lower information exchange overhead. Finally, the simulation results show that the proposed algorithm has better performance in terms of system sum rate and fairness than the existing algorithms.
Ulnar Nerve Enlargement at the Medial Epicondyle Negatively Correlates With Nerve Conduction Velocity in Cubital Tunnel Syndrome
Authors: Luo T. David , Trammell Amy P. , Hedrick Luke P. , Wiesler Ethan R. , Walker Francis O. , Warburton Mark J.
Published: August 2018

Background: In cubital tunnel syndrome (CuTS), chronic compression often occurs at the origin of the flexor carpi ulnaris at the medial epicondyle. Motor nerve conduction velocity (NCV) across the elbow is assessed preoperatively to corroborate the clinical impression of CuTS. The purpose of this study was to correlate preoperative NCV to the direct measurements of ulnar nerve size about the elbow at the time of surgery in patients with clinical and/or electrodiagnostic evidence of CuTS. Methods: Data from 51 consecutive patients who underwent cubital tunnel release over a 2-year period were reviewed. Intraoperative measurements of the decompressed nerve were taken at 3 locations: at 4 cm proximal to the medial epicondyle, at the medial epicondyle, and at the distal aspect of Osborne fascia at the flexor aponeurotic origin. Correlation analysis was performed comparing nerve size measurements to slowing of ulnar motor nerve conduction velocities (NCV) below the normal threshold of 49 m/s across the elbow. Results: Enlargement of the ulnar nerve at the medial epicondyle and nerve compression at the flexor aponeurotic origin was a consistent finding. The mean calculated cross-sectional area of the ulnar nerve was 0.21 cm2 above the medial epicondyle, 0.30 cm2 at the medial epicondyle, and 0.20 cm2 at the flexor aponeurotic origin ( P < .001). There was an inverse correlation between change in nerve diameter and NCV slowing ( r = −0.529, P < .001). Conclusions: For patients with significantly reduced preoperative NCV and clinical findings of advanced ulnar neuropathy, surgeons can expect nerve enlargement, all of which may affect their surgical decision-making.
Intentionality of a co-actor influences sensorimotor synchronisation with a virtual partner
Authors: Mills Peta F , Harry Bronson , Stevens Catherine J , Knoblich Guenther , Keller Peter E
Published: August 2018

Interpersonal sensorimotor synchronisation requires individuals to anticipate and adapt to their partner’s movement timing. Research has demonstrated that the intentionality of a co-actor affects joint action planning, however, less is known about whether co-actor intentionality affects sensorimotor synchronisation. Explicit and implicit knowledge of a synchronisation partner’s intentionality may influence coordination by modulating temporal anticipation and adaptation processes. We used a computer-controlled virtual partner (VP) consisting of tempo-changing auditory pacing sequences to simulate either an intentional or unintentional synchronisation partner. The VP was programmed to respond to the participant with low or moderate degrees of error correction, simulating a slightly or moderately adaptive human, respectively. In addition, task instructions were manipulated so that participants were told they were synchronising with either another person or a computer. Results indicated that synchronisation performance improved with the more adaptive VP. In addition, there was an influence of the explicit partner instruction, but this was dependent upon the degree of VP adaptivity and was modulated by subjective preferences for either the human or the computer partner. Beliefs about the intentionality of a synchronisation partner may thus influence interpersonal sensorimotor synchronisation in a manner that is modulated by preferences for interacting with intentional agents.
Framing the war in the post war era: Exploring the counter-narratives in frames of an Iranian war photographer thirty years after the ceasefire with Iraq
Authors: Saramifar Younes
Published: August 2018

The battle between Iran and Iraq ended with a ceasefire being signed in 1988 but the war continued for most Iranians and their leadership. Even today after three decades, the war continues for Iranians who live in the borderlands as they struggle with the landmines and left-overs of the battles. Mehdi Monem, a celebrated Iranian war photographer, frames the pain of Iranians in the borderlands as the counter-narrative that challenges the mainstream frames of propaganda. He challenges the master narrative of the Islamic Republic of Iran that generates meanings for the frames of the war through notions of martyrdom and sacrifice. Hence, I follow his work in the context of the visual culture of martyrdom via an ethnography that explains how Iranians receive the pain of others 30 years after the war at home and abroad.
Smoking Selfies: Using Instagram to Explore Young Women’s Smoking Behaviors
Authors: Cortese Daniel K. , Szczypka Glen , Emery Sherry , Wang Shuai , Hair Elizabeth , Vallone Donna
Published: August 2018

Our research provides social scientists with areas of inquiry in tobacco-related health disparities in young adult women and opportunities for intervention, as Instagram may be a powerful tool for the public health surveillance of smoking behavior and social norms among young women. Social media has fundamentally changed how to engage with health-related information. Researchers increasingly turn to social media platforms for public health surveillance. Instagram currently is one of the fastest growing social networks with over 53% of young adults (aged 18-29) using the platform and young adult women comprise a significant user base. We conducted a content analysis of a sample of smoking imagery drawn from Instagram’s public Application Programming Interface (API). From August 2014 to July 2015, 18 popular tobacco- and e-cigarette-related text tags were used to collect 2.3 million image posts. Trained undergraduate coders (aged 21-29) coded 8,000 images ( r = .91) by type of artifact, branding, number of persons, gender, age, ethnicity, and the presence of smoke. Approximately 71.5% of images were tobacco-relevant and informed our research. Images of cigarettes were the most popular (49%), followed by e-cigarettes (32.1%). “Selfies while smoking” was the dominant form of portrait expression, with 61.4% of images containing only one person, and of those, 65.7% contained images of women. The most common selfie was women engaged in “smoke play” (62.4%) that the viewer could interpret as “cool.” These “cool” images may counteract public health efforts to denormalize smoking, and young women are bearing the brunt of this under-the-radar tobacco advertising. Social media further normalizes tobacco use because positive images and brand messaging are easily seen and shared, and also operates as unpaid advertising on image-based platforms like Instagram. These findings portend a dangerous trend for young women in the absence of effective public health intervention strategies.
Patients’ Satisfaction With Inpatient Orthopedic Physiotherapy Services at a Tertiary Hospital in Ghana
Authors: Ampiah Paapa Kwesi , Ahenkorah Josephine , Karikari Margaret
Published: August 2018

Background:

Although assessing patient satisfaction ensures quality assurance, compliance, and better effects of therapy, patient satisfaction studies are lacking within the Ghanaian physiotherapy domain.

Objective:

To ascertain patients’ satisfaction with physiotherapy services and evaluate factors that influence satisfaction levels at the trauma and orthopedic directorate of Komfo Anokye Teaching Hospital.

Method:

A cross-sectional survey was done, and systematic random sampling was used to recruit participants. One-hundred twenty (120) patients participated in the study. Data were collected using an adapted structured patient satisfaction questionnaire. Data obtained were analyzed using SPSS version 24. Descriptive statistics and nonparametric tests were performed.

Results:

The mean age of participants was 39.9 ± 15.8 years. They comprised 48 (40%) females and 72 (60%) males. The most common cause of patient admission was road traffic accident (71.7%). All dimensions of satisfaction assessed were highly rated (>90%). Majority of the participants reported that they were satisfied (95.7%) and compliant (91.6%) with the physiotherapy treatment. Respect shown by therapist (98%) and courtesy and friendliness (97%) were the most rated indices; however, some respondents had uncertainties pertaining to patient involvement in decision-making. The majority of participants also reported that due to their satisfaction, compliance came naturally (75.9%) and reported compliance had a significant association with satisfaction ( P = .02). Age was also found to influence satisfaction ( P = .04).

Conclusion:

Patient satisfaction with physiotherapy services rendered at the inpatient facility was high, and satisfaction reportedly translated into ease with compliance.
Reconciling the Views of Project Success
Authors: Davis Kate
Published: August 2018

This article presents a new model encompassing all the important critical attributes needed to measure project success across different stakeholder groups. The study investigates the possibility that project failure is a result of the interpretations of the criteria and factors used for success by multiple stakeholder groups. Unique projects must have their outcome parameters monitored and controlled to minimize the chances of failure and the likely major financial and managerial ramifications for the organization. Early testing of the model supports its use to increase the shared, multiple stakeholder perception of project success, leading to more informed decision making and motivation of employees.
Technical examination of the Emerson-White Book of Hours: observations on pigment preferences and media application in a Flemish manuscript
Authors: Mayer Debora D. , Mayo Hope , Mysak Erin , Smith Theresa J. , Eremin Katherine
Published: August 2018

The Emerson-White Hours (MS Typ 443–443.1, Houghton Library, Harvard University) is a book of hours and missal produced in Valenciennes, Bruges, and Ghent in the late 1470s or early 1480s. There are seven full-page miniatures (many more have been removed), fourteen historiated borders, 28 historiated initials, and 24 calendar illustrations in tempera and gold. Text pages have shell gold trompe-l’oeil borders. The illuminators include Simon Marmion, the Master of the Houghton Miniatures (named for this manuscript), the Master of the Dresden Prayerbook, and one of the Ghent Associates. The goal of analysis was to determine if identification of palettes supported previous stylistic attributions. Focusing on the illuminations attributed to Simon Marmion and the Houghton Master, we demonstrate that technical analysis can support attribution by identifying differences in artists’ pigment preferences, pigment blending, and technique of paint application, particularly how the artists render shadows.
Negative Symptoms: Relationship to Other Schizophrenic Symptom Classes
Authors: McKenna P.J. , Lund C.E. , Mortimer Ann M.
Published: August 2018

If negative symptoms represent a distinct class of schizophrenic symptoms, they should, to paraphrase Bleuler (1911), be more closely related to each other than they are to other schizophrenic symptoms. The first part of this statement, that negative symptoms are intrinsically related to each other, has received considerable experimental support (Andreasen, this volume; Mortimer et al, this volume). The second, that negative symptoms are unrelated to other schizophrenic symptoms, has been somewhat more unevenly investigated.
Obsessive—Compulsive Disorder as a 5-HT Subsystem-Related Behavioural Disorder
Authors: Murphy D. L. , Zohar J. , Benkelfat C. , Pato M. T. , Pigott T. A. , Insel T. R.
Published: August 2018

Involvement of the brain serotonin (5-HT) neurotransmitter system in obsessive-compulsive disorder (OCD) was originally suggested on the basis of therapeutic effects found with the semi-selective serotonin uptake inhibitor, clomipramine. More recent studies directly comparing clomipramine with non-selective or norepinephrine-selective uptake inhibitors, such as desipramine or nortriptyline, as well as studies with new, more selective serotonin uptake inhibitors, including fluvoxamine and fluoxetine, have supported that hypothesis. Clomipramine's antiobsessional effect has been augmented with the serotonin precursor, L-tryptophan, or with lithium, which has prominent serotonergic effects. Patients whose OCD symptoms improved on clomipramine worsened when the drug was discontinued (regardless of duration of therapy) and improved when clomipramine was reinstituted. OCD symptoms also worsened when metergoline, a 5-HT antagonist, was given to patients who had improved with clomipramine. Metergoline given alone had no effect. Administration of m-chlorophenylpiperazine (m-CPP), a 5-HT receptor agonist, to untreated OCD patients increased their anxiety, depression, and dysphoria, and exacerbated their OC symptoms. After 4 months of clomipramine therapy, m-CPP failed to produce the same behavioural effects, suggesting an alteration of a 5-HT subsystem (possibly downregulation of some 5-HT receptors). The data reviewed suggest an important role for an abnormal brain 5-HT subsystem in patients with OCD.
Diagnosing Childhood Depression. Who Should be Interviewed - Parent or Child?
Authors: Barrett M. L. , Berney T. P. , Bhate S. , Famuyiwa O. O. , Fundudis T. , Kolvin I. , Tyrer S.
Published: August 2018

The extent of the similarities and discrepancies in the reporting of depressive symptomatology by children and their mothers was examined. Child-parent agreement was not always impressive, particularly for more subjective symptoms. It is suggested that direct psychiatric assessment of children provides a more accurate picture of their mental state regardless of presenting disorder, but particularly where depression is suspected.
The TAPS Project. 11: The Selection of Patients for Reprovision
Authors: Jones David
Published: August 2018

The selection of patients for community reprovision during the first three years of an active closure programme at two large mental hospitals in the North East Thames Regional Health Authority was studied. It was found that a strong selection bias was operating: the patients selected were significantly younger, had spent less time in full-time psychiatric care, were less likely to have a diagnosis of schizophrenia, had larger social networks, and were more likely to want to leave hospital.
Comparisons of Clinical Efficacy
Authors: Ferrier I. N.
Published: August 2018

This paper does not attempt to review the whole topic of clinical efficacy but will consider general concepts, particularly in the light of the advent of the serotonin (5-HT) uptake inhibitors (SSRIs).

The aetiology of depression is complex. In most cases there is some form of predisposition based on problematical family dynamics, disordered family communication and/or genetic factors; each may be present to a variable extent. On top of this predisposition, some form of stimulus - ‘stress’, an external problem, loss of control, a physical disorder, adverse life circumstances - appears to affect those who are already primed. There are a variety of possible outcomes from this combination of predisposition and stimuli: low mood, depression in the full syndromic sense, and depression with biological features. It seems likely that, particularly with severe depressions (the major syndromic forms and those with biological features), there are neuroendocrine and neurochemical changes to mediate the effects of stress into those of the clinical symptoms and signs. It has been hypothesised that stressors induce adaptive neurochemical changes, failure of which may engender behavioural disturbances (Anisman & Zacharko, 1992). However, there are also many individuals who may not undergo this process, but who probably have some cognitive or learned change leading to dysphoria; this aspect needs to be considered carefully in relation to efficacy.
Implications of Positron Emission Tomography Research for the Investigation of the Actions of Antipsychotic Drugs
Authors: List Stephen J. , Cleghorn John M.
Published: August 2018

Positron emission tomography studies of regional brain metabolic activity, cerebral blood flow and D2 dopamine receptor binding in schizophrenics and controls are reviewed. Methodological influences on the validity of the data generated by these technologies include problems with measurement as well as clinical and anatomical heterogeneity. Work in these fields to date, however, has produced strong support for the role of D2 dopamine receptor blockade in antipsychotic efficacy. Neuroleptic-induced changes in regional brain metabolism over time have also been observed; however, the relationship between such actions and symptomatic change needs to be further clarified. Future studies on time-course of neuroleptic-associated changes in regional brain metabolism, blood flow and dopamine receptor binding in schizophrenics have the potential to provide greater insight into the relationship of these actions to symptomatic changes and drug-induced side-effects.
Comparison of Standard Locked-Ward Treatment Versus Open-Ward Rehabilitation Treatment for Chronic Schizophrenic Patients
Authors: Fan Zhanhuai , Huang Jingkang , Wu Qihui , Jiang Shaxi
Published: August 2018

A priority for psychiatric rehabilitation workers in China is to develop less-restrictive methods for managing the estimated 2500 chronically institutionalised patients who are symptomatically stable and have adequate psychosocial functioning but have no family members who are able or willing to take them home. We transferred 45 chronic schizophrenic male in-patients to an open-door rehabilitation ward where they were given as much freedom as possible and encouraged to take part in occupational, social, and recreational activities. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used to compare the psychosocial functioning of the 43 patients who completed the year-long trial with that of 43 similar patients who received standard in-patient treatment on a locked ward. Over the year, the experimental group showed a significant improvement in overall functioning, whereas the control group showed no improvement. These findings suggest that open-door rehabilitation wards situated within the hospital can mobilise latent psychosocial functioning and may be a good method for re-introducing chronic schizophrenic patients in China back into the community.
Community Mental Health Care for Former Hospital In-Patients: Predicting Costs from Needs and Diagnoses
Authors: Knapp Martin , Beecham Jennifer , Fenyo Andrew , Hallam Angela
Published: August 2018

Background. In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs.

Method. Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients.

Results. Although clinical diagnosis was not a useful predictor of either service utilisation or costs, more than a third of the variation in community care costs could be explained by symptoms, behaviour and personal characteristics at least one year earlier.
Cognitive deficit in schizophrenia and its neurochemical basis
Authors: Breier Alan
Published: August 2018

Cognitive impairment is a central feature of schizophrenia and has been correlated with negative symptoms and impaired social functioning. There is a growing body of data suggesting that the so-called atypical antipsychotic drugs (e.g. clozapine, risperidone, and olanzapine) are better at enhancing cognitive function than traditional neuroleptics. Preclinical studies of information processing using a pre-pulse inhibition model show that the mechanism of action of both olanzapine and clozapine for cognitive enhancement may involve glutamatergic/N-methyl-D-aspartate (NMDA) antagonism. Using positron emission tomography, we have described the metabolic and neurochemical correlates of cognitive impairment induced by glutamatergic/ NMDA antagonism. A better understanding of the underlying causes of cognitive impairment may contribute to elucidating the pathophysiology of schizophrenia and the development of more efficacious treatments for this disorder.
Acknowledgements
Authors: Sartorius N.
Published: August 2018

The proposals for the chapter dealing with mental, behavioural and developmental disorders in the tenth revision of the International Classification of Diseases (ICD) are in the true sense a product of many minds. In their development WHO has called on and received the generous advice and support of its network of collaborating centres, of the members of Expert Advisory Panels on Mental Health, Neurosciences and Drug Dependence and Alcohol Problems from some 60 countries, and of the non-governmental organizations with whom WHO is in official relations. Among the latter, the collaboration with the World Psychiatric Association has been particularly useful; this Association sent the text of the ICD to all of its member societies, assembled their views and comments and worked closely with WHO in incorporating these comments into the text of the ICD. The WPA has created a special committee under the chairmanship of Professor E. Stromgren which summarised all the views received, and maintained collaboration with WHO throughout the development of the proposals.
Electrodermal Activity, Expressed Emotion and Outcome in Schizophrenia
Authors: Tarrier Nicholas
Published: August 2018

This paper attempts to describe some of our electrodermal data and its relationship with environmental factors and the outcome of a psychosocial intervention study with families of schizophrenics. In the context of the heuristic vulnerability/stress model of the development and course of schizophrenic episodes described by Nuechterlein & Dawson in 1984, there is an interaction between individual vulnerability factors and external environmental stressors with resulting effects on the hypothesised transient intermediate states of: processing capacity overload, autonomic hyperarousal and a deficient processing of social stimuli. Accelerating dysfunctions in these systems result in the reappearance of characteristic schizophrenic psychotic symptoms. The purpose of our work has been to investigate the interface between the individuals' biological and environmental systems.
Computerised Life Chart Methods to Map Domains of Function and Illustrate Patterns of Interactions in the Long-Term Course Trajectories of Patients Who Once Met the Criteria for DSM-III Schizophrenia
Authors: Harding Courtenay M. , McCormick Rodney V. , Strauss John S. , Ashikaga Takamaru , Brooks George W.
Published: August 2018

The research question of which mediating factors influence the long-term course of schizophrenia was not asked until recently because the expectation has been of uniformly poor outcome (Kraepelin, 1902; American Psychiatric Association, 1980). However, anecdotal clinical knowledge about heterogeneity in the long-term course of this severe illness has been firmly supported in the last 15 years by six recent longitudinal studies in Europe, Asia, and the USA (Blueler, 1972; Ciompi & Müller, 1976; Huber et al, 1979; Tsuang et al, 1979; Harding et al, 19876; Ogawa et al, 1987). Each of these studies, more methodologically rigorous than those of the past, has found multiple indices of wide heterogeneity in the long-term outcome of schizophrenia with trends toward significant improvement or recovery demonstrated in over half of each cohort.
Family Discourse: Physiological Correlates of Different Degrees of Stress
Authors: Käsermann Marie-Louise , Altorfer Andreas
Published: August 2018

An important basis for this work is the vulnerability model proposed by Zubin & Spring (1977). They integrated findings on schizophrenia in a second-order model showing the relationship between vulnerability to schizophrenia and stress, adaptation to stress, and especially coping breakdown, i.e. the incapacity to adapt in the shorter or longer term. Thus, given a certain degree of vulnerability, stress, and how the affected individual copes with it are the critical factors for the occurrence of a schizophrenic episode. The work presented here describes an empirical investigation of these two components.
Reasoning and Delusions
Authors: Garety Philippa
Published: August 2018

Delusions are among the most common psychiatric symptoms, but the psychological processes involved in their formation and maintenance remain a matter of controversy. This paper briefly reviews competing theories, particularly those involving abnormalities of perception and reason. An investigation of reasoning in deluded schizophrenic and paranoid subjects is presented, followed by a tentative model of belief formation in which abnormalities or biases in reasoning and perception, implicated in the formation of some delusions, are highlighted.
Schizoaffective States: Understandability and Outcome
Authors: Varghese Francis T.
Published: August 2018

According to Kendell (Kendell, 1975) the classification of psychiatric disorders should “cleave nature at its joints”. The central task of nosology then is to discover ‘nature's joints‘. There are, generally speaking, two major approaches to this task, which as Kendell has outlined, trace their origins to the epistemological debates between Platonic and Aristotelian schools. The first is the empirical approach from Locke and Hume, which is currently in ascendancy as exemplified by DSM—III and DSM—III—R, (American Psychiatric Association, 1980, 1987) while the second can be regarded as the ‘rational‘ approach deriving from the philosophy of Kant (Varghese, 1988). Table 1 outlines the differences between nosological approaches.
Phenomenological Aspects of Monodelusional Disorders
Authors: Munro Alistair
Published: August 2018

The monodelusional disorders correspond closely to the Kraepelinian description of paranoia (Kraepelin, 1921), and to the DSM—III—R category of “delusional (paranoid) disorder” (American Psychiatric Association, 1987). The essential feature is a stable delusional system, and the encapsulated quality of the delusion is characteristic. The rest of the personality is notably well preserved, but the delusional system, despite its encapsulation, takes over much of the individual's way of life. There are profound and striking secondary changes in affect, attitude and logic when the patient switches from the normal to the delusional mode or vice versa.
The Origins of Psychosis and “The Descent of Man”
Authors: Crow T. J.
Published: August 2018

In 1871, Charles Darwin published The Descent of Man and Selection in Relation to Sex. The first part of this volume made explicit the conclusion that had been implicit in the Origin of Species published 12 years earlier, that man indeed was descended from the great apes.
Delusion: What Did Jaspers Really Say?
Authors: Walker Chris
Published: August 2018

“Since time immemorial, delusion has been taken as the basic characteristic of madness. To be mad was to be deluded” (Jaspers, 1963, p. 93).
III. Profile and Prevalence of the Brain Fag Syndrome: Psychiatric Morbidity in School Populations in Africa
Authors: Guinness E. A.
Published: August 2018

The profile and prevalence of a syndrome of somaticised anxiety associated with education in Africa was explored by survey of 2040 senior secondary school students in different types of school: rural, urban, and elite. Response to two different screening methods, an open question to elicit symptoms spontaneously, and the SRQ-24, was compared. Symptom prevalence was higher in rural schools, 34%, than periurban, 22%, and elite, 6%, but the central urban school serving a shanty town was also high at 35%. Three categories of the culturally relevant symptoms were identified - somatic, cognitive and ‘spiritual’ - with affective symptoms sparsely represented in the cultural idiom. The SRQ-24 items screening for psychosis were associated with a range of spontaneous symptoms representing anxiety. This ‘spiritual’ expression of neurosis reflects the world views and beliefs of the culture. Intensification under stress could produce the picture of transient reactive psychosis.
The Importance of Serotonin-Dopamine Interactions in the Action of Clozapine
Authors: Meltzer Herbert Y.
Published: August 2018

Clozapine has an affinity for the dopamine (DA) D2 receptor which is relatively weak but is in line with its average clinical dose when compared with typical neuroleptic drugs. A few atypical antipsychotic drugs may have high absolute affinities for the D2 receptor, but most are weak D2 blockers. The atypical antipsychotic drugs also differ from the typical antipsychotic drugs by a relatively high affinity for the serotonin (5-HT2) receptor. This is evident on both in vitro and in vivo binding to cortical 5-HT2 receptors. The atypical antipsychotics are best distinguished from the typical antipsychotics on the basis of the relationship between strong 5-HT2 and weak D2 affinities. High D1 receptor binding is not characteristic of the group of atypical drugs. A new group of putative atypical antipsychotic drugs with high affinities for 5-HT2 compared to D2 receptors is under study.