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Der Dativ ist dem Genitiv sein Tod

Der Dativ ist dem Genitiv sein Tod is a series of books by Bastian Sick which deal in an entertaining manner with unappealing or clumsy use of the German language, as well as areas of contention in grammar, orthography, and punctuation. Origins The books are collections of the author’s column 'Zwiebelfisch', which appeared from 2003 to 2012 in Spiegel Online. Since February 2005 it also appeared in print in Der Spiegel'''s monthly culture supplement. The column's title, literally 'onion fish', is a printers' term for a single character with an incorrect font in a block of text.wissen.de-Wörterbuch: Zwiebelfisch The series consists of six volumes, all of which reached the top of the book sales lists, with the first volume selling more than 1.5 million copies within two years. The title, Der Dativ ist dem Genitiv sein Tod is a way of saying Der Dativ ist der Tod des Genitivs or Der Dativ ist des Genitivs Tod, a reference to a linguistic phenomenon in certain dialects of German where a noun in genitive case is replaced by a possessive adjective and noun in the dative case (see his genitive). Reception In several German states, articles from the books have been used officially as teaching materials, and—according to Sick's foreword of August 2005, the series has been added to the set text list for the Abitur in Saarland. The material in the book series has been adapted into a DVD, a board game, a computer game and into audiobooks. On the other hand, the linguists Vilmos Ágel, Manfred Kaluza and André Meinunger think that Sick's books are not useful for teaching German because they contain factual errors, often just deal with irrelevant nitpicking, and don't give sufficient proof of why something Sick deems wrong should be wrong.Manfred Kaluza: „Der Laie ist dem Linguisten sein Feind“. Anmerkungen zur Auseinandersetzung um Bastian Sicks Sprachkolumnen – Informationen Deutsch als Fremdsprache, 35. Jg, Heft 4, 2008, S. 432–442 Book titles Der Dativ ist dem Genitiv sein Tod – Ein Wegweiser durch den Irrgarten der deutschen Sprache. Kiepenheuer und Witsch, Köln 2004, (audio book: ) Der Dativ ist dem Genitiv sein Tod, Folge 2 – Neues aus dem Irrgarten der deutschen Sprache. Kiepenheuer und Witsch, Köln 2005, (audio book: ) Der Dativ ist dem Genitiv sein Tod. Folge 3 – Noch mehr aus dem Irrgarten der deutschen Sprache. Kiepenheuer und Witsch, Köln November 2006, (audio book: ) Der Dativ ist dem Genitiv sein Tod. Folge 4 – Das Allerneueste aus dem Irrgarten der deutschen Sprache. Kiepenheuer und Witsch, Köln 2009, Der Dativ ist dem Genitiv sein Tod. Folge 5. Kiepenheuer und Witsch, Köln 2013, (audio book: ) Der Dativ ist dem Genitiv sein Tod. Folge 6. Kiepenheuer und Witsch, Köln 2015, DVD title Der Dativ ist dem Genitiv sein Tod – Die Große Bastian Sick Schau. [sic] Sony BMG Music Entertainment GmbH, 2008, ASIN B000X1YDCC Game titles Der Dativ ist dem Genitiv sein Tod. KOSMOS, 2006, ASIN 3440690237 Der Dativ ist dem Genitiv sein Tod – Das PC-Spiel.'' (PC & Mac) United Soft Media Verlag GmbH, 2007, ASIN 3803228301 External links Der Spiegel ‘Zwiebelfisch’ column (German) German books German grammar

Prevention of mental disorders

Prevention of mental disorders are measures that try to decrease the chances of a mental disorder occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the disease burden." The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions." A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure". In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area. Methods Parenting Parenting may affect the child's mental health, and evidence suggests that helping parents to be more effective with their children can address mental health needs. Assessing parenting capability has been raised in child protection and other contexts. Delaying of potential very young pregnancies could lead to better mental health causal risk factors such as improved parenting skills and more stable homes, and various approaches have been used to encourage such behaviour change. Some countries run conditional cash transfer welfare programs where payment is conditional on behaviour of the recipients. Compulsory contraception has been used to prevent future mental illness. Pre-emptive CBT Use of cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. As of 2018, some health providers now advocate pre-emptive use of CBT to prevent worsening of mental illnesses. Mental silence meditation Sahaja meditators scored above control groups for emotional well-being and mental health measures on SF-36 ratings, leading to proposed use for mental illness prevention, although this result could be due to meditators having other characteristics leading to good mental health, such as higher general self care. Internet- and mobile-based interventions A review found that a number of studies have shown that internet- and mobile-based interventions can be effective in preventing mental disorders. Specific diseases Depression For depressive disorders, when people participated in interventions, some studies show the number of new cases is reduced by 22% to 38%. These interventions included CBT. Such interventions also save costs. Depression prevention continues to be called for. Anxiety For anxiety disorders, use of cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. Other interventions (parental inhibition reduction, behaviourism, parental modelling, problem-solving and communication skills) have also produced significant benefits. People with subthreshold panic disorder were found to benefit from use of CBT. for older people, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate of depression and anxiety disorders in a patient group aged 75 or older. for younger people, it has been found that teaching CBT in schools reduced anxiety in children, and a review found that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents. for university students mindfulness has been shown to reduce subsequent anxiety. Psychosis In those at high risk there is tentative evidence that psychosis incidence may be reduced with the use of CBT or other types of therapy. In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. There is also tentative evidence that treatment may help those with early symptoms. Antipsychotic medications are not recommended for preventing psychosis. For schizophrenia, one study of preventative CBT showed a positive effect and another showed neutral effect. Targeted vs universal There has been an historical trend among public health professionals to consider targeted programmes. However identification of high risk groups can increase stigma, in turn meaning that the targeted people do not engage. Thus policy recommends universal programs, with resources within such programs weighted towards high risk groups. Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials. History History of mental illness prevention strategies In 2020 a US paper identified the need for prevention, and led with focus on preventing traumatic events and adverse childhood experiences. A European paper highlighted "addressing both poor parenting and children's maladaptive personality traits and insufficient life skills." In 2018 the University of Birmingham Mental Health Policy Commission focused on prevention, including the challenges of funding given the shortness of political cycles versus the longer paybacks of prevention. In 2018 11 European researchers published a review of mental illness prevention stating that "Increasing evidence suggests that preventive interventions in psychiatry that are feasible, safe, and cost-effective could translate into a broader focus on prevention in our field." and that "Gaps between knowledge, policy, and practice need to be bridged." The US Substance Abuse and Mental Health Services Administration (SAMHSA) advocates a 5-step prevention framework. In 2016: the UK NGO Mental Health Foundation published a review of prevention approaches. the UK NGO Mind produced public mental health recommendations for more prevention. In 2015: the Hunter Institute of mental health in Australia published its "Prevention First" strategic framework for prevention. the UK NGO Mental Health Foundation published a review of prevention research, paving the way for prevention strategies. the official journal of the World Psychiatric Association included a survey of public mental health which concluded "the evidence base for public mental health interventions is convincing, and the time is now ripe to move from knowledge to action". In 2014 the UK Chief Medical Officer, Professor Dame Sally Davies, chose mental health for her major annual report, and included prevention of mental illness heavily in this. In 2013 the Faculty of Public Health, the UK professional body for public health professionals, produced its "Better Mental Health for All" resource, which aims at "the promotion of mental wellbeing and the primary prevention of mental illness". In 2012, Mind, the UK mental health NGO, included "Staying well; Support people likely to develop mental health problems, to stay well." as its first goal for 2012–16. The 2011 mental health strategy of Manitoba (Canada) included intents to (i) reduce risk factors associated with mental ill-health and (ii) increase mental health promotion for both adults and children. The 2011 US National Prevention Strategy included mental and emotional well-being, with recommendations including (i) better parenting and (ii) early intervention. Australia's mental health plan for 2009–14 included "Prevention and Early Intervention" as priority 2. The 2008 EU "Pact for Mental Health" made recommendations for youth and education including (i) promotion of parenting skills, (ii) integration of socio-emotional learning into education curricular and extracurricular activities, and (iii) early intervention throughout the educational system. The 2006 Canadian "Out of the Shadows at last" included a section on prevention. History of mental illness prevention programmes and research Historically prevention has been a very small part of the spend of mental health systems. For instance the 2009 UK Department of Health analysis of prevention expenditure did not include any apparent spend on mental health. The situation is the same in research. However more recently some prevention programmes have been proposed or implemented. Prevention programmes can include public health policies to raise general health, creating supportive environments, strengthening communities, developing personal skills, and reorienting services. In 2022 research showed the World Health Organization Self-Help Plus programme, at six-month follow-up, saw 22% incidence of mental disorder vs 41% in a control group, in Syrian refugees in Turkey. In 2016, the UK Education Policy Institute advocated prevention through increased mental health literacy, better parenting and improving children's resilience and digital world skills. In 2013 the UK NGO Mental Health Foundation and partners began to use Video Interaction Guidance (VIG) in an early years intervention to reduce later life mental illness. In 2013 in Australia the National Health and Medical Research Council supported a set of parenting strategies to prevent teenagers becoming anxious or depressed. In 2012 the UK Schizophrenia Commission recommended "a preventative strategy for psychosis including promoting protective factors for mental wellbeing and reducing risks such as cannabis use in early adolescence." In 2010 the European Union DataPrev database was launched. It states "A healthy start is crucial for mental health and wellbeing throughout life, with parenting being the single most important factor," and recommends a range of interventions. In 2009 the US National Academies publication on preventing mental, emotional, and behavioral disorders among young people focused on recent research and program experience and stated that "A number of promotion and prevention programs are now available that should be considered for broad implementation." A 2011 review of this by the authors said "A scientific base of evidence shows that we can prevent many mental, emotional, and behavioral disorders before they begin" and made recommendations including supporting the mental health and parenting skills of parents, encouraging the developmental competencies of children and using preventive strategies particularly for children at risk (such as children of parents with mental illness, or with family stresses such as divorce or job loss). In India the 1982 National Mental health Programme included prevention, but implementation has been slow, particularly of prevention elements. It is already known that home visiting programs for pregnant women and parents of young children can produce replicable effects on children's general health and development in a variety of community settings. Similarly positive benefits from social and emotional education are well proven. Research has shown that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. Issues in implementation Prevention programs can face issues in (i) ownership, because health systems are typically targeted at current cases, and (ii) funding, because program benefits come on longer timescales than the normal political and management cycle. Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding. References Mental disorders Medical prevention

Professional identification

Professional Identification is a type of social identification and is the sense of oneness individuals have with a profession (e.g. law, medicine) and the degree to which individuals define themselves as profession members. Professional identity consists of the individual's alignment of roles, responsibilities, values, and ethical standards to be consistent with practices accepted by their specific profession. Sources of professional identification Researchers have found that a desire for quality (rather than profits) is associated with professional identification. Organizations tend to be concerned with efficiency and profitability, whereas professions care mainly about providing the highest-quality service (as defined by the professions), almost regardless of cost or revenue considerations (Freidson, 2001). Administrators are usually seen as promoting profitability at the expense of profession-defined quality (Freidson, 2001). In one notable study, practicing physicians viewed administrators with medical degrees (e.g., the M.D.) as “outsiders” to the medical profession because of what the physicians believed to be the administrators’ undue emphasis on organizational goals (Hoff, 1999: 336). Practicing physicians viewed administrators with MDs more negatively than those without MDs because the former were thought to have “betrayed” the medical profession by assuming administrative roles (Hoff, 1999: 344). Formation of professional identity Professional identity formation is a complex process through which the sense of oneness with a profession is developed, with some of the difficulty arising out of balancing personal identity with professional identity. Professional identity begins to form while individuals gain their educational training for their profession. Drawing on community of practice theory, transitions between communities can lead to the individual experiencing tension or conflict in how the distinct communities' values and expectations differ, causing the individual to restructure the boundaries between their professional, personal, and private spheres of identity. Recent research For over 50 years, researchers have studied whether professional employees' social identities influence their work behaviors. David R. Hekman and colleagues found that professional identification may conflict with organizational identification. Organizational identification may lead employees to believe that administrators are “like them” and “on their side", whereas professional identification leads employees to believe that administrators are “not like them” and “not on their side”. See also Acculturation Onboarding Socialization References Industrial and organizational psychology Occupations

Kolcaba's Theory of Comfort

Kolcaba's theory of comfort explains comfort as a fundamental need of all human beings for relief, ease, or transcendence arising from health care situations that are stressful. Comfort can enhance health-seeking behaviors for patients, family members, and nurses. The major concept within Katharine Kolcaba's theory is the comfort. The other related concepts include caring, comfort measures, holistic care, health seeking behaviors, institutional integrity, and intervening variables. Kolcaba's theory successfully addresses the four elements of nursing metaparadigm. Providing comfort in physical, psychospiritual, social, and environmental aspects in order to reduce harmful tension is a conceptual assertion of this theory. When nursing interventions are effective, the outcome of enhanced comfort is attained. This theory was derived from Watson's theory of human care and her own practice. Kolcaba was a head nurse asked to define her job as a nurse outside of specialized responsibilities. She realized the lack of written knowledge on the subject of comfort being important in patient care. The first publication was in 1994, then expanded in an article in 2001, and further developed in a book written in 2003. Kolcaba's theory became so popular that it was tested in multiple studies such as: women with early stage breast cancer going through radiation therapy conducted by Kolcaba and Fox in 1999, persons with urinary frequency and incontinence conducted by Dowd, Kolcaba, and Steiner in 2000, and persons near end of life conducted by Novak, Kolcaba, Steiner, and Dowd in 2001. References Psychological theories Nursing theory Positive psychology

Chinese Classification of Mental Disorders

The Chinese Classification of Mental Disorders (CCMD; ), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders. It is on its third version, the CCMD-3, written in Chinese and English. The current edition is very similar to the ICD-10, and is also influenced by the DSM-IV, the two main psychiatric typologies used in the rest of the world. However, it has a unique definition of some disorders, includes an additional 40 or so culturally-related diagnoses, and lacks certain conditions recognised in other parts of the world. History The first published Chinese psychiatric classificatory scheme appeared in 1979. A revised classification system, the CCMD-1, was made available in 1981 and was further modified in 1984 (CCMD-2-R), 1989, and 1995. The CCMD-3 was published in 2001. At launch, the CCMD-3 was supplemented with the companion book "Treatment and Nursing of Mental Disorders Relevant to CCMD-3". Many Chinese psychiatrists believed the CCMD had special advantages over other manuals, such as simplicity, stability, the inclusion of culture-distinctive categories, and the exclusion of certain Western diagnostic categories. The Chinese translation of the ICD-10 was seen as linguistically complicated, containing very long sentences, and awkward terms and syntax leading to lack of clarity in interpretation. A 2014 study found that the ICD-10 was more commonly used by Chinese psychiatrists than the CCMD-3 or DSM-IV. Diagnostic categories The diagnosis of depression is included in the CCMD, with many similar criteria to the ICD or DSM, with the core having been translated as 'low spirits'. However, neurasthenia is a more central diagnosis. Although also found in the ICD, its diagnosis takes a particular form in China, called 'shenjing shuairuo', which emphasizes somatic (bodily) complaints as well as fatigue or depressed feelings. Neurasthenia is a less stigmatizing diagnosis than depression in China, being conceptually distinct from psychiatric labels, and is said to fit well with a tendency to express emotional issues in somatic terms. The concept of neurasthenia as a nervous system disorder is also said to fit well with the traditional Chinese epistemology of disease causation on the basis of disharmony of Zungfu vital organs and imbalance of qi. The diagnosis of schizophrenia is included in the CCMD. It contains many similarities with its Western counterparts for diagnosis, like the duration of one month, as mentioned in the ICD-10. Some differences include two symptoms different from the ICD and DSM. These are improper affect and delusions, which can range in three different subcategories. It is applied quite readily and broadly in Chinese psychiatry. Some of the wordings of the diagnoses are different. For example, rather than borderline personality disorder, as in the DSM, or emotionally unstable personality disorder (borderline type), as in the ICD, the CCMD has impulsive personality disorder. Diagnoses that are more specific to Chinese or Asian culture, though they may also be outlined in the ICD (or DSM glossary section), include: Koro or Genital retraction syndrome: excessive fear of the genitals (and also breasts in women) shrinking or drawing back into the body. Zou huo ru mo psychosis/ fixation or qigong deviation: perception of uncontrolled flow of qi in the body. Mental disorders due to superstition or witchcraft. Travelling psychosis. The CCMD-3 lists several "disorders of sexual preference", including ego-dystonic homosexuality, but does not recognize pedophilia. Koro Koro or Genital retraction syndrome is a culture-specific syndrome from Southeast Asia in which the patient has an overpowering belief that the genitalia (or nipples in females) are shrinking and will shortly disappear. In China, it is known as shuk yang, shook yong, and suo yang. This has been associated with cultures placing a heavy emphasis on balance, or on fertility and reproduction. Zou huo ru mo Zou huo ru mo or "qigong deviation" is a mental condition characterized by the perception that there is an uncontrolled flow of qi in the body through incorrect cultivation practices including meditation. Other complaints include anxiety, psychosis, localized pains, headache, insomnia, and uncontrolled spontaneous movements and convolutions. See also International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association DSM-IV Codes Political abuse of psychiatry in China References External links CSP webpage about the CCMD Classification of mental disorders Healthcare in China Medical manuals

Health physics

Health physics, also referred to as the science of radiation protection, is the profession devoted to protecting people and their environment from potential radiation hazards, while making it possible to enjoy the beneficial uses of radiation. Health physicists normally require a four-year bachelor’s degree and qualifying experience that demonstrates a professional knowledge of the theory and application of radiation protection principles and closely related sciences. Health physicists principally work at facilities where radionuclides or other sources of ionizing radiation (such as X-ray generators) are used or produced; these include research, industry, education, medical facilities, nuclear power, military, environmental protection, enforcement of government regulations, and decontamination and decommissioning—the combination of education and experience for health physicists depends on the specific field in which the health physicist is engaged. Sub-specialties There are many sub-specialties in the field of health physics, including Ionising radiation instrumentation and measurement Internal dosimetry and external dosimetry Radioactive waste management Radioactive contamination, decontamination and decommissioning Radiological engineering (shielding, holdup, etc.) Environmental assessment, radiation monitoring and radon evaluation Operational radiation protection/health physics Particle accelerator physics Radiological emergency response/planning - (e.g., Nuclear Emergency Support Team) Industrial uses of radioactive material Medical health physics Public information and communication involving radioactive materials Biological effects/radiation biology Radiation standards Radiation risk analysis Nuclear power Radioactive materials and homeland security Radiation protection Nanotechnology Operational health physics The subfield of operational health physics, also called applied health physics in older sources, focuses on field work and the practical application of health physics knowledge to real-world situations, rather than basic research. Medical physics The field of Health Physics is related to the field of medical physics and they are similar to each other in that practitioners rely on much of the same fundamental science (i.e., radiation physics, biology, etc.) in both fields. Health physicists, however, focus on the evaluation and protection of human health from radiation, whereas medical health physicists and medical physicists support the use of radiation and other physics-based technologies by medical practitioners for the diagnosis and treatment of disease. Radiation protection instruments Practical ionising radiation measurement is essential for health physics. It enables the evaluation of protection measures, and the assessment of the radiation dose likely, or actually received by individuals. The provision of such instruments is normally controlled by law. In the UK it is the Ionising Radiation Regulations 1999. The measuring instruments for radiation protection are both "installed" (in a fixed position) and portable (hand-held or transportable). Installed instruments Installed instruments are fixed in positions which are known to be important in assessing the general radiation hazard in an area. Examples are installed "area" radiation monitors, Gamma interlock monitors, personnel exit monitors, and airborne contamination monitors. The area monitor will measure the ambient radiation, usually X-Ray, Gamma or neutrons; these are radiations which can have significant radiation levels over a range in excess of tens of metres from their source, and thereby cover a wide area. Interlock monitors are used in applications to prevent inadvertent exposure of workers to an excess dose by preventing personnel access to an area when a high radiation level is present. Airborne contamination monitors measure the concentration of radioactive particles in the atmosphere to guard against radioactive particles being deposited in the lungs of personnel. Personnel exit monitors are used to monitor workers who are exiting a "contamination controlled" or potentially contaminated area. These can be in the form of hand monitors, clothing frisk probes, or whole body monitors. These monitor the surface of the workers body and clothing to check if any radioactive contamination has been deposited. These generally measure alpha or beta or gamma, or combinations of these. The UK National Physical Laboratory has published a good practice guide through its Ionising Radiation Metrology Forum concerning the provision of such equipment and the methodology of calculating the alarm levels to be used. Portable instruments Portable instruments are hand-held or transportable. The hand-held instrument is generally used as a survey meter to check an object or person in detail, or assess an area where no installed instrumentation exists. They can also be used for personnel exit monitoring or personnel contamination checks in the field. These generally measure alpha, beta or gamma, or combinations of these. Transportable instruments are generally instruments that would have been permanently installed, but are temporarily placed in an area to provide continuous monitoring where it is likely there will be a hazard. Such instruments are often installed on trolleys to allow easy deployment, and are associated with temporary operational situations. Instrument types A number of commonly used detection instruments are listed below. ionization chambers proportional counters Geiger counters Semiconductor detectors Scintillation detectors The links should be followed for a fuller description of each. Guidance on use In the United Kingdom the HSE has issued a user guidance note on selecting the correct radiation measurement instrument for the application concerned . This covers all ionising radiation instrument technologies, and is a useful comparative guide. Radiation dosimeters Dosimeters are devices worn by the user which measure the radiation dose that the user is receiving. Common types of wearable dosimeters for ionizing radiation include: Quartz fiber dosimeter Film badge dosimeter Thermoluminescent dosimeter Solid state (MOSFET or silicon diode) dosimeter Units of measure Absorbed dose The fundamental units do not take into account the amount of damage done to matter (especially living tissue) by ionizing radiation. This is more closely related to the amount of energy deposited rather than the charge. This is called the absorbed dose. The gray (Gy), with units J/kg, is the SI unit of absorbed dose, which represents the amount of radiation required to deposit 1 joule of energy in 1 kilogram of any kind of matter. The rad (radiation absorbed dose), is the corresponding traditional unit, which is 0.01 J deposited per kg. 100 rad = 1 Gy. Equivalent dose Equal doses of different types or energies of radiation cause different amounts of damage to living tissue. For example, 1 Gy of alpha radiation causes about 20 times as much damage as 1 Gy of X-rays. Therefore, the equivalent dose was defined to give an approximate measure of the biological effect of radiation. It is calculated by multiplying the absorbed dose by a weighting factor WR, which is different for each type of radiation (see table at Relative biological effectiveness#Standardization). This weighting factor is also called the Q (quality factor), or RBE (relative biological effectiveness of the radiation). The sievert (Sv) is the SI unit of equivalent dose. Although it has the same units as the gray, J/kg, it measures something different. For a given type and dose of radiation(s) applied to a certain body part(s) of a certain organism, it measures the magnitude of an X-rays or gamma radiation dose applied to the whole body of the organism, such that the probabilities of the two scenarios to induce cancer is the same according to current statistics. The rem (Roentgen equivalent man) is the traditional unit of equivalent dose. 1 sievert = 100 rem. Because the rem is a relatively large unit, typical equivalent dose is measured in millirem (mrem), 10−3 rem, or in microsievert (μSv), 10−6 Sv. 1 mrem = 10 μSv. A unit sometimes used for low-level doses of radiation is the BRET (Background Radiation Equivalent Time). This is the number of days of an average person's background radiation exposure the dose is equivalent to. This unit is not standardized, and depends on the value used for the average background radiation dose. Using the 2000 UNSCEAR value (below), one BRET unit is equal to about 6.6 μSv. For comparison, the average 'background' dose of natural radiation received by a person per day, based on 2000 UNSCEAR estimate, makes BRET 6.6 μSv (660 μrem). However local exposures vary, with the yearly average in the US being around 3.6 mSv (360 mrem), and in a small area in India as high as 30 mSv (3 rem). The lethal full-body dose of radiation for a human is around 4–5 Sv (400–500 rem). History In 1898, The Röntgen Society (Currently the British Institute of Radiology) established a committee on X-ray injuries, thus initiating the discipline of radiation protection. The term "health physics" According to Paul Frame: "The term Health Physics is believed to have originated in the Metallurgical Laboratory at the University of Chicago in 1942, but the exact origin is unknown. The term was possibly coined by Robert Stone or Arthur Compton, since Stone was the head of the Health Division and Arthur Compton was the head of the Metallurgical Laboratory. The first task of the Health Physics Section was to design shielding for reactor CP-1 that Enrico Fermi was constructing, so the original HPs were mostly physicists trying to solve health-related problems. The explanation given by Robert Stone was that '...the term Health Physics has been used on the Plutonium Project to define that field in which physical methods are used to determine the existence of hazards to the health of personnel.' A variation was given by Raymond Finkle, a Health Division employee during this time frame. 'The coinage at first merely denoted the physics section of the Health Division... the name also served security: 'radiation protection' might arouse unwelcome interest; 'health physics' conveyed nothing.'" Radiation-related quantities The following table shows radiation quantities in SI and non-SI units. Although the United States Nuclear Regulatory Commission permits the use of the units curie, rad, and rem alongside SI units, the European Union European units of measurement directives required that their use for "public health ... purposes" be phased out by 31 December 1985. See also Health Physics Society Certified Health Physicist Radiological Protection of Patients Radiation protection Society for Radiological Protection The principal UK body concerned with promoting the science and practice of radiation protection. It is the UK national affiliated body to IRPA IRPA The International Radiation Protection Association. The International body concerned with promoting the science and practice of radiation protection. References External links The Health Physics Society, a scientific and professional organization whose members specialize in occupational and environmental radiation safety. - "The confusing world of radiation dosimetry" - M.A. Boyd, 2009, U.S. Environmental Protection Agency. An account of chronological differences between USA and ICRP dosimetry systems. Q&A: Health effects of radiation exposure, BBC News, 21 July 2011. Nuclear safety and security Medical physics Radiation health effects Health physicists

Institute of Mental Health and Hospital

The Institute of Mental Health and Hospital Agra, previously known as Agra Lunatic Asylum was established in 1859, in British Raj by State government of Uttar Pradesh. The Institute of Mental Health and Hospital spread over a campus of 172.8 acres in Agra in front of Bilochpura Railway Station near Sikendra. The institute is very famous in India for its treatment, research and training on human mental disorder. History The first asylum in India is founded by British Government in 1745 in Bombay and second in 1784 in Calcutta. Few more asylums are also founded by British Government in 1857 in big cities of India. In 1859, Agra asylum was also founded by British Government. The Institute of Mental Health and Hospital Agra was established in September 1859, and renamed to Mental Hospital Agra in 1925. Previously it was managed under the provisions of Indian Lunacy Act, 1912. Nowadays it is managed under the provisions of Mental Healthcare Act 2017. In 1994 it was again renamed to Agra Mansik Arogyashala by Honourable Supreme Court of India and made it an autonomous institution which aimed to improve treatment and care of mentally ill persons and provide professional education, training and research on mental health. On 8 February 2001 it again renamed as Institute of Mental Health and Hospital Agra. Professional courses The Institute offers MD Psychiatry, DNB Psychiatry, M.Phil Clinical Psychology, M.Phil Psychiatric Social Work, Post Basic Diploma in Psychiatric Nursing, Short term training programme in Psychiatry. References External links Official website National Health Portal (Available in English, Hindi, Gujarati, Bengali, Tamil and Punjabi) Psychiatric hospitals in India Hospitals in Uttar Pradesh Buildings and structures in Agra 1859 establishments in India Hospitals established in 1859

Process-oriented psychology

Process-oriented psychology, also called process work, is a depth psychology theory and set of techniques developed by Arnold Mindell and associated with transpersonal psychology, somatic psychology and post-Jungian psychology. Process oriented psychology has been applied in contexts including individual therapy and working with groups and organisations. It is known for extending dream analysis to body experiences and for applying psychology to world issues including socioeconomic disparities, diversity issues, social conflict and leadership. Origins and reception Process oriented psychology was originated in the 1970s by Arnold Mindell, an American Jungian analyst then living in Switzerland. It began as a development of Jungian psychology with the concept of a 'dreambody' that extended dream analysis to include work with people's body symptoms and bodily experiences. Jungian analyst June Singer commented that Mindell's work 'expands the scope of Jung's psychology to include not only the psyche but also the body, relationships and the total environment.' Stanislav Grof has described Arnold Mindell as one of the 'pioneers of transpersonal psychology'. Mindell's concepts of 'deep democracy' and 'worldwork' have been identified as part of a toolkit for transformational change which supports collective governance. In a critical exploration of the relationship between African Americans and C.G. Jung's analytical psychology, Fanny Brewster describes Mindell's dreambody work and his linking of body symptoms and psychological development. Brewster finds that Mindell's development of Jungian ideas is aligned with traditional African concepts of healing which link mind and body: ‘I believe that Mindell’s approach to dreamwork with its emphasis on body healing mirrors the African system of healing’s inclusiveness of body and mind in the process.’ Process Work is recognised within the field of body psychotherapy and somatic psychology with its emphasis on movement and body feeling. Mindell was one of five people honored in 2012 with a Pioneer Award from the US Association of Body Psychotherapy. Following the publication of his book Dreambody in 1982, it reportedly gained a 'worldwide following in the field of holistic healing' although remaining little known in 'traditional psychological circles'. Process Work is described as an integrative and holistic approach to understanding human behaviours. It is characterized as creative and improvisational: a 'fluid, flexible, playful approach, using some basic principles to improvise effective approaches to whatever comes its way, even-handedly weaving together the personal, political, the bodily, the relational and the spiritual aspects of existence.' It is considered to have similarities with Eugene Gendlin's Focusing and is identified with a focus on the unknown aspects of experience: 'Process Work ... seeks to encounter with the unknown and the irrational side of life. ... [It] appreciates symptoms and disturbances of any sort, not as pathologies to be healed or transcended or somehow got rid of, but as expressions of the very thing we need for our further growth, happiness, or enlightenment.' From its original 'dreambody' concept, Process Work developed a theory and method of working with altered states of consciousness including near death and coma, and with experiences given psychiatric diagnoses. Mindell's book on coma and palliative care inspired a UK theatre production performed in Edinburgh and London. Process Work and Arnold Mindell are also known for a theory and methods for working with conflict resolution and leadership issues, in groups and organisations. Process oriented psychology has been associated with alternative spirituality movements. It is considered an example of a modern Western eclectic adaptation of shamanism and has been taught at the Findhorn community in north-east Scotland. Fred Alan Wolf cites Mindell's 'dreambody' concept and the Institute of Noetic Sciences lists Mindell in their directory. Theory and practices Process The theory of process oriented psychology centres around the idea of 'process': a meaningful, connected pattern over time that can be observed and tracked through non-intentional signals (e.g. non-verbal communication, body symptoms, dreams, accidents, conflicts). It is claimed that becoming consciously aware of the 'dreaming process' may help to deal with disturbances including mental and physical distress, relationship troubles and social issues. The theory of a 'dreaming process' began with Arnold Mindell's concept of the 'dreambody', developed from Jungian dream analysis and the observation that dreams and body symptoms were meaningfully connected. Mindell asserted that a therapist could work with body experiences to reveal the unconscious just as they could work with dreams. Process Work's contention of a link between dreams and body symptoms is a viewpoint similar to shamanism, 'mankind's oldest medicinal doctrine, where illness reflects one's spiritual condition'. Mindell's theory has also been compared to another Jungian, Meredith Sabini, who similarly recognises a symbolic relationship between dream images and physical symptoms, and values their role in bringing awareness of a person's individuation process, the development of the Jungian Self. Mindell is recognised for providing a method of working psychologically with body symptoms using the technique of 'amplification'; this involves intensifying the experience of a symptom or a dream and following its expression through the various 'channels' of perception until the meaning of the 'dreambody' is revealed to the client. The idea of a 'dreambody' was generalised to the concept of a 'dreaming process': a potentially meaningful pattern within symptoms, dreams and other irrational or disturbing aspects of our experience. Totton explains that for process oriented psychology, 'dreaming' refers to any 'extra-conscious signals through which our process communicates itself'. The signals of a 'dreaming process' go beyond nighttime dreams and body symptoms to include 'daydreams, imagery and flickers of awareness that come and go'. For Process Work, 'dreaming' can be defined as 'the unconscious activity of the person, both when they are asleep and when they are awake'. Shafton comments that Mindell, along with Walter Bonime, Fritz Perls, Strephon Williams, Jeremy Taylor and Eugene Gendlin, makes the assumption that 'dreamlike symbolic processes occur in waking' and accordingly applies dreamwork techniques to aspects of conscious experience. The 'dreaming process' is believed to have a meaningful, purposeful direction of change, reflecting the influence of Taoism and Jungian psychology. The dreaming process can be understood as the Jungian unconscious 'seeking integration, and ... creating opportunities for the individual to grow in conscious awareness'. An important conceptual distinction for process oriented psychology is between the 'primary' (intended) and the 'secondary' (unintended) aspects of a given behaviour or experience: people at any given moment experienc[e] a 'primary process' — aspects of our experience with which we identify — and a 'secondary process' — aspects with which we find it hard to identify and which are trying insistently to enter our awareness. For an individual, the primary or intended aspects of communication and behaviour will be shaped by conscious norms and values, while secondary processes will include disturbing, challenging or irrational experiences that are further from awareness and often overtly marginalised. Process Work aims to integrate secondary processes into a person's primary, conscious awareness to reduce the disturbance and access its potential for meaning and growth. Process Work theory includes a framework of experiential 'channels' through which the dreaming process is expressed; these channels include the visual, auditory, movement (kinaesthetic), body feeling (proprioceptive), relationship and world channels. Like Gestalt therapy, Process Work tracks a person's experience as it shifts between different channels. Process Work is particularly known for using the channels of body awareness, movement and physical contact to explore psychological issues. The concept of a purposeful 'dreaming process' expressing itself through multiple 'channels' of experience is the theoretical basis for Process Work's 'far-reaching and flexible approach, which uses essentially the same capacious toolbox to work with everything from bodily symptoms to couple relationships to political conflicts'. The theory and contentions of process oriented psychology have been described as an alternative to mainstream psychology. Process Work proposes that disturbing feelings, symptoms and behaviours be interpreted as 'an underlying urge toward health, wholeness, and diversity rather than pathology'. The theory suggests understanding the meaning of symptoms and disturbances rather than only focusing on modifying or eliminating them. Worldwork and deep democracy The application of process oriented psychology to group issues is called 'worldwork' and a key concept is 'deep democracy'. Worldwork includes theory and practices for working with conflict, leadership and social issues. Brown and Harris (2014) explain: Deep democracy was developed as a means of approaching the relationships among individual, organisational and social transformational change which support collective governance. Amy and Arnold Mindell's world work framework draws on relativity concepts from physics to heighten awareness of the relationship element in all experience. A central concept is the validity of subjective inner and observable outer experience as two sides of the same coin. Process Work applications for groups have become known through Mindell's books: The Leader as Martial Artist: An Introduction to Deep Democracy (1992) and Sitting in the Fire: Large Group Transformation Using Conflict and Diversity (1995) Mindell's ideas of worldwork and deep democracy have been likened to the work of Danaan Parry. For process oriented psychology, the concept of 'deep democracy' refers to a 'belief in the inherent importance of all parts of ourselves and all viewpoints in the world around us'. It aims to broaden the idea of democracy to include not only cognitive, rational viewpoints but also emotional experiences and intuition: 'Deep democracy awareness welcomes inner voices and makes use of diversity and existing tensions to access subjective experience, deeper vision and tangible results of the participants.' Similarly, the author John Bradshaw explains: Deep democracy, as the psychologist Arnold Mindell points out in his book, The Leader as Martial Artist, is a timeless feeling of shared compassion for all living beings. It is a sense of the value and importance of the whole, including and especially our own personal reality. Deeply democratic people value every organ in their body as well as their inner feelings, needs, desires, thoughts and dreams. This use of the term 'deep democracy' is distinct from that of Arjun Appadurai and Judith M. Green in community development and that of Haider A. Khan in economic theory. Worldwork includes group techniques for developing awareness of social issues like racism and has been used to deal with post-conflict trauma. Worldwork has been described as the 'attempt to apply psychotherapy in the sphere of political conflict without privileging the therapeutic over the political', because it takes on the challenge of supporting all sides of a conflict while dealing with the real politics of inequality. Totton notes that 'so far worldwork has not resolved this problem—perhaps it cannot be resolved, but only held in continual tension'. Similarly, Worldwork has been described as 'group therapy in public': a group work technique aiming to bring awareness to 'the hidden emotional undercurrents surrounding social issues — like racism — that are rarely addressed publicly'. Totton comments that worldwork is 'difficult: experimental, stirring, demanding every ounce of flexibility and awareness from all the participants ... but also tremendously hopeful'. An example of 'worldwork' with social tensions in large groups was reported by the San Francisco Chronicle. In 1992, a racially diverse group of 200 people gathered in Oakland, CA to explore racial tensions, using Process Work techniques. This reportedly involved the expression of pain, anger and grief in a public forum with a focus on authentic, personal dialogue between individuals from opposing sides of a social issue. The Chronicle comments: Using role-playing exercises, body awareness and other techniques, Mindell tries to intensify the conflict under controlled situations — hoping that through some cathartic process, conflict will reconcile itself. The Chronicle reports that the group moved from angry heated conflict between a black and a white man, to a black man emotionally expressing his grief and pain, and finally the group 'melted into one giant, wailing, hugging mass of black and white humanity'. The Process Work approach to leadership and conflict facilitation is based on the idea of deep democracy; it tries to build awareness of the bigger picture and develop compassion for all sides in a conflict, an approach that Mindell refers to as 'eldership'. Process oriented psychology is known for a positive model of conflict, seeing it as an opportunity for growth and community; Mindell, like the authors Thomas Crum and Danaan Parry, suggests that dealing with personal conflicts better can create global change. The model of conflict resolution involves identifying the sides in the conflict as roles and having the conflicting parties experiment with expressing all roles, swapping sides until greater understanding is achieved. Conflict is understood as a sign that at least one viewpoint or experience within the group is not being adequately represented and Process Work aims to bring these 'ghosts' into conscious awareness and dialogue. Lewis Method of Deep Democracy Lewis Method of Deep Democracy is based on the work of Arnold Mindell. In the early 1990s two of Arnold Mindell’s students, Myrna Lewis and her late husband, Greg, began translating some of the tools. Lewis's Method of Deep Democracy is more flexible about the depth. Patricia A. Wilson's Deep Democracy Wilson has more focus on inner work and building the container for a culture of dialogue and connectedness. She summarizes essence of deep democracy as "the inner experience of interconnectedness". Judith M. Green's Deep Democracy Green describes "Deep Democracy would equip people to expect, to understand, and to value diversity and change while preserving and projecting both democratically humane cultural values and interactively sustainable environmental values in a dynamic responsive way." Research Process oriented psychology is one of eleven psychotherapeutic modalities examined in a Swiss longitudinal study of therapeutic effectiveness completed in 2012. There are published studies of the clinical application of Process Work to group therapy with people experiencing mental illness and to the care of elders with dementia. A Japanese case study has described the application of process oriented psychology to the treatment of a woman with symptoms including major depression and an eating disorder, concluding that the method can be effective in the resolution of psychosomatic problems. Process Work has been used to extend play therapy techniques and found to enrich therapeutic work with children experiencing parental separation issues. The process oriented psychology approach to clinical supervision has been documented and shown to offer experiential and phenomenological techniques to work with signals, roles and the "parallel dynamics" that occur within client-counsellor and counsellor-supervisor interactions. It has been suggested that the concept of ‘metaskills’ can be useful for the psychotherapist seeking to serve polyamorous clients. Connections have been established between process oriented psychology and dance movement therapy. The concept of ‘rank’ as defined and developed by Mindell has been taken up in a number of contexts including action learning, the analysis of international nongovernmental organization advocacy campaigns, and anti-racism diversity work. An Australian case study has considered the use of process oriented psychology for tackling the problems of intercultural communication in higher education; it finds that Process Work has a multidimensional concept of social rank (expanded beyond social status to include 'psychological' and 'spiritual' aspects) which promotes understanding of interpersonal communication issues and could be used to improve international student experience in Australia. Organisations Process oriented psychology is represented by a professional organisation called the International Association of Practitioners of Process Oriented Psychology (IAPOP). The Association recognises over 25 training centres around the world including the UK, Australia & New Zealand, Poland, Switzerland, Slovakia, Ireland, Japan, India, Greece, Israel, Palestine, Russia, Ukraine and the US. The first teaching organisation was founded in Zürich in 1982 and is now known as the Institute for Process Work (Institut für Prozessarbeit IPA), an accredited Training Institute for psychotherapy in Switzerland. The Research Society for Process Oriented Psychology in the UK (RSPOPUK)'s Training Programme is accredited by the United Kingdom Council of Psychotherapy, within the Humanistic and Integrative Psychotherapy Section. In the US, the first training centre was established in 1989 in Portland, Oregon, now known as the Process Work Institute, while the Deep Democracy Institute was founded in 2006. The newest Institute for Processwork was founded 2018 in Germany (Institut für Prozessarbeit Deutschland). Criticism and early controversy Criticisms of process oriented psychology include that the 'dreambody' concept and techniques are too subjective and overly positive. Mindell's concept of the meaningful 'dreambody' has been criticised for coming 'perilously close' to psychologising every illness; Shafton values 'dreambody work' but cautions that body symptoms are ambiguous and may be a product of stress or denial as much as a message for growth. Others have claimed that Process Work as a therapy is hard to define and has similarities with 'faith healing', raising hopes about the healing of physical illness (though it is reported that Mindell explicitly discourages this idea). Like other transpersonal psychologies, process oriented psychology has been identified by critics as a method having 'a mystical or supernaturalistic application, theory, significance, or pedigree.' In 1997, a Japanese scientist involved in deprogramming members of the Aum Shinrikyo cult mentioned process oriented psychology as an example of recent psychotherapeutic paradigms that draw on Asian philosophy, Gestalt, Jung and transpersonal psychology, and claimed that, while 'these programs are not substantively dangerous', the methods may be used adversely and have the potential to be a form of 'mind control'. He then clarified that process oriented psychology was not amongst those that were dangerous. Mindell's (1993) book, Leader as Martial Artist, has been critiqued as a use of Eastern belief systems to justify capitalist business practice. There has been controversy in the history of process oriented psychology in the US state of Oregon. In 1990, a Eugene newspaper, the Register-Guard, reported that a planning permit application for the coastal town of Yachats by the founder, Arnold Mindell, was met with initial apprehension and fears of 'another Bhagwan Shree Rajneesh' although these fears were subsequently allayed. Twenty-three years later, in 2013, The Yachats Academy of Arts and Sciences invited Arnold and his wife Amy Mindell to offer a keynote lecture on their work on conflict resolution around the world. In 2001, a Portland alternative newspaper, the Willamette Week guided by the complaint of a student, reported that an Oregon school of process oriented psychology, (one of 26 worldwide schools of process oriented psychology), the Process Work Center of Portland (now known as the Process Work Institute) was being investigated by the Oregon Office of Degree Authorization (ODA) due to a complaint by a student and an anonymous letter with the primary complaint that teachers in the Masters in Process Work shared student information inappropriately, and that relationship and sexual boundaries were not clear between students.' Some allegations were not verified while others were "substantially correct". ODA recommended improvements in privacy policies and dual relationship policies between students and faculty. PWI complied with changes requested during the investigation and the degree remained continuously authorized by the state of Oregon degree authorization office. The Process Work Institute does not have regional accreditation and does not participate in DOE Title IV lending. Small schools in the Pacific NW are not eligible for regional accreditation unless they have 300 or more active students. PWI is currently pursuing national accreditation which is allowed in the US for smaller schools. Other schools of Process Work internationally such as in Switzerland, Poland, the UK, and Australia have been able to become accredited either regionally, nationally, or by psychological professional accrediting boards. The ODA website shows that in 2014 the Process Work Institute is authorised as a degree offering institution and lists PWI as one of the unaccredited private colleges approved for students in Oregon. See also Body psychotherapy Depth psychology Somatic psychology Transpersonal psychology (Whiteheadian) Process psychology References Further reading Arnold Mindell Mindell, A. (2010) Processmind: A User's Guide to Connecting with the Mind of God. Quest Books. Mindell, A. (1995). Sitting in the fire: Large Group Transformation Using Conflict and Diversity. Portland, OR: Lao Tse Press. Mindell, A. (1993) Shaman's Body: A New Shamanism for Transforming Health, Relationships, and the Community. HarperSanFrancisco. Mindell, A. (1992) The Leader as Martial Artist: An Introduction to Deep Democracy (1st ed.). San Francisco: Harper. Other authors Audergon, A. (2005). The War Hotel: Psychological Dynamics in Violent Conflict. London and Philadelphia: Whurr Publishers. Bedrick, D. (2013). Talking Back to Dr. Phil: Alternatives to Mainstream Psychology. Santa Fe, NM: Belly Song Press. Diamond, J., & Jones, L. S. (2004). A path made by walking: Process Work in practice. Portland, OR: Lao Tse Press. Goodbread, J. (1987). The Dreambody Toolkit: A Practical Introduction to the Philosophy, Goals, and Practice of Process-Oriented Psychology. Routledge & Kegan Paul Ltd. Goodbread, J. (2009). Living on the edge: The mythical, spiritual and philosophical roots of social marginality. New York: Nova Science Publishers, Inc. Menken, D. (2013). Raising parents, raising kids: hands-on wisdom for the next generation. Santa Fe, NM: Belly Song Press. Mindell, Amy. (2001). Metaskills: The Spiritual Art of Therapy. Portland, OR: Lao Tse Press. Morin, P., & Reiss, G. (2010). Inside coma: a new view of awareness, healing, and hope. Santa Barbara, CA: Praeger Publishers. Reiss, G. (2006). Breaking the cycle of revenge in the Palestinian-Israeli conflict. In J. Kuriansky (Ed.), Terror in the Holy Land: Inside the anguish of the Israeli-Palestinian conflict. (pp. 107–116). Westport, CT US: Praeger Publishers/Greenwood Publishing Group. External links International Association for Process Oriented Psychology website The Journal of Process Oriented Psychology Whitehead Psychology Nexus Analytical psychology Body psychotherapy Dream Somatic psychology Transpersonal psychology

Getting It: The Psychology of est

Getting It: The Psychology of est, a non-fiction book by American clinical psychologist Sheridan Fenwick first published in 1976, analyzes Werner Erhard's Erhard Seminars Training or est. Fenwick based the book on her own experience of attending a four-day session of the est training, an intensive 60-hour personal-development course in the self-help genre. Large groups of up to 250 people took the est training at one time. In the first section of Fenwick's book, she recounts the est training process and the methods used during the course. Fenwick details the rules or "agreements" laid out by the trainers to the attendees, which include not talking to others or leaving the session to go to the bathroom unless during an announced break period. The second section is analytic: Fenwick analyzes the methods used by the est trainers, evaluates the course's potential effects, and discusses Erhard's background. Fenwick concludes that the program's long-term effects are unknown, the est training may not be appropriate for certain groups of people, and that a large proportion of participants report perceived positive effects. Writing in Library Journal, psychiatrist James Charney describes the book as "the only useful critical look" at the training. Zane Berzins of The New York Times Book Review characterizes the book as a "calm and professionally informed view". Hearings held in 1979 before the United States House of Representatives on a juvenile delinquents program depicted in Scared Straight! cited the book for background on the est training, as did psychologist Gidi Rubinstein in a 2005 study of the Landmark Forum published in the academic journal Psychology and Psychotherapy: Theory, Research and Practice. Background Werner Erhard (born John Paul Rosenberg), was originally from Pennsylvania and migrated to California. A former salesman, training manager and executive in the encyclopedia business, Erhard created the Erhard Seminars Training (est) course in 1971. est was a form of Large Group Awareness Training, and was part of the Human Potential Movement. est was a four-day, 60-hour self-help program given to groups of 250 people at a time. The program was very intensive: each day would contain 15–20 hours of instruction. During the training, est personnel utilized specialized vocabulary to convey key concepts, and participants agreed to rules which remained in effect for the duration of the course. Participants were taught that they were responsible for their life outcomes. Est had its critics and proponents. A year after Getting It was published, over 100,000 people completed the est training, including public figures and mental health professionals. In 1985, Werner Erhard and Associates repackaged the course as "The Forum", a seminar focused on "goal-oriented breakthroughs". By 1988, approximately one million people had taken some form of the trainings. In the early 1990s Erhard faced family problems, as well as tax problems that were eventually resolved in his favor. A group of his associates formed the company Landmark Education in 1991. Author Sheridan Fenwick, in her early thirties when Getting It was published, had graduated with a Bachelor of Arts degree from Goucher College and received a doctorate in psychopathology and social psychology from Cornell University. Her Ph.D. dissertation was published in 1975. Fenwick served as the director of social policy in the Department of City Planning of Chicago, Illinois, as assistant attending psychologist at Montefiore Medical Center, and as a faculty member of Columbia University's department of psychology. Fenwick writes that although she had been trained as a clinical psychologist, she avoided "consciousness" movements and never participated in transactional analysis or similar therapies, including Transcendental Meditation, Esalen, Arica, Gestalt therapy and Mind Dynamics. When she met with graduates of the est training and heard their testimonials and observed their level of self-confidence, she considered taking the training. After some preliminary research, Fenwick decided to take the training as a participant rather than as a professional observer. She paid the $250.00 course fee and enrolled in a four-day est program to examine its methods and its appeal. She reports that the training was an "extraordinary experience", but that she had "serious concerns about the implications of the est phenomenon", and that people should know more about it. The book was first published September 16, 1976, by J. B. Lippincott Company. A second edition was published by Penguin Books in 1977. Fenwick went on to work as director of the Behavioral Medicine Clinic at Abbott Northwestern Hospital in Minneapolis, before retiring in 1993 to set up Psybar, an online service to provide psychological experts for court cases. Contents The book comprises two sections. The first section describes Fenwick's own experiences of the training; the second analyzes the est program's methodology and effects. In her analysis of the course, she states: In the latter portion of the book Fenwick discusses comparisons of the est training to brainwashing and to psychotherapy, potential harmful effects of the course, and the extent that positive benefit from the course may be attributed to a self-fulfilling prophecy. Fenwick sees est as a form of psychotherapy that utilizes "in" therapies, and questions its suitability for certain individuals. Fenwick writes that the est training draws influences from Synanon, Gestalt therapy, encounter groups, and Scientology. She discusses the potential positive and negative psychological effects that can occur subsequent to taking the est training. She analyzes the rules of the training, and the behavioral tools used by the trainers, and points out that the est personnel are not qualified to assess psychopathology. Fenwick asserts that tactics including sensory deprivation and the large group setting of 250 people at a time help to make the training "work". She describes this as a "compression chamber effect", and asserts that it leads to the "hysterical confessions and the euphoric testimonials" she observed in the course. Fenwick cites the secrecy of the est organization as an impediment to meaningful study, and states that the studies cited by est itself are inadequate and inconclusive. Fenwick writes that a lack of "sophisticated research designs" limits the ability to properly determine long-term benefits or harm caused by the course and notes: "est uses techniques indiscriminately which, in a certain proportion of the population, are known to be harmful and potentially quite dangerous". She concludes that it is difficult to determine whether est "produces any more than a superficial catharsis, or whether it might be harmful to certain people", and states that the long-range effects of the training remain unknown. While reporting on testimonials of "perceived" changes as a result of the est training, Fenwick asks rhetorically: Reception Getting It received mixed, but generally positive, reviews. One positive evaluation came from psychiatrist James Charney, in a 1976 review for Library Journal. Charney calls the book "the only useful critical look at this essential issue", referring to the est training. He notes in particular that Fenwick's "analysis of the function of the group, the restrictive rules, and the enforced discomfort is convincing". In a 1977 review in Library Journal Edith Crockett and Ellis Mount highly recommended the book, commenting that "A plethora of newspaper and magazine reports, along with books written by graduates ... have attempted to explain the phenomenon of this self-help program, but none has done it as well or as objectively as this writer." Kirkus Reviews noted the precedent set by the analytical nature of the book, writing "Finally. Here's someone who is willing to disclose the details of Erhard Seminars Training, and then go on to analyze them from a psychological point of view." Zane Berzins, writing for The New York Times Book Review in 1977, describes Fenwick's work as a "calm and professionally informed view". Berzins describes the book as a "brave attempt" at an analysis of est's appeal, and concludes that "It's hardly an incendiary exposé, but Fenwick's open-minded scrutiny should deglamourize the est movement." William McGurk reviewed the book in Contemporary Psychology. Although McGurk praises the book's description of the est seminars, noting that it "present[s] a clear picture of the process", he also criticizes Fenwick's subsequent analysis, saying she "sounds like a different person" than in the first section. McGurk writes that "It's as though she put on her psychoanalytically oriented, professional hat and ran a tape that was far from being effective." A review in Publishers Weekly states that Fenwick's "inbred detachment may have kept her from the full impact of the 'experience' the training was meant to be (and is for many)". Even so, the review notes that Fenwick "scores heavily" in the section where she questions the nature of the est training and Erhard's background; it recommends that Getting It be read alongside Luke Rhinehart's The Book of est. The book is recommended by James R. Lewis and J. Gordon Melton's 1992 book Perspectives on the New Age, where they describe it as "a thorough discussion of est training methods and the psychology behind them". Other works that cite the book for background on est include Snapping: America's Epidemic of Sudden Personality Change, by Flo Conway and Jim Siegelman; and Evaluating a Large Group Awareness Training, a study commissioned by Erhard's successor company to est, Werner Erhard and Associates. Fenwick's work was cited in 1979 hearings before the United States House of Representatives on a controversial program for juvenile delinquents, which was depicted in the Academy Award-winning documentary film Scared Straight!. Getting It is cited in background discussion of the est training: "Fenwick has pointed out that sophisticated assessment of individual psychopathology is beyond the competence and training of the est personnel; it is also outside the est value system, since the training is held to be almost universally beneficial." Psychologist Gidi Rubinstein cites the book as a reference in a 2005 study of the Landmark Forum, a course descended from the est training, which he presented in the academic journal Psychology and Psychotherapy: Theory, Research and Practice. Notes References 1976 non-fiction books Psychology books J. B. Lippincott & Co. books English-language books Werner Erhard

Cognitive evaluation theory

Cognitive evaluation theory (CET) is a theory in psychology that is designed to explain the effects of external consequences on internal motivation. Specifically, CET is a sub-theory of self-determination theory that focuses on competence and autonomy while examining how intrinsic motivation is affected by external forces in a process known as motivational "crowding out." CET uses three propositions to explain how consequences affect internal motivation: External events set will impact intrinsic motivation for optimally challenging activities to the extent that they influence perceived competence, within the context of self-determination theory. Events that promote greater perceived competence will enhance intrinsic motivation, whereas those that diminish perceived competence will decrease intrinsic motivation (Deci & Ryan, 1985). Events relevant to the initiation and regulation of behavior have three potential aspects, each with a significant function. The informational aspect facilitates an internal perceived locus of causality and perceived competence, thus positively influencing intrinsic motivation. The controlling aspect facilitates an external perceived locus of causality (a person's perception of the cause of success or failure), thus negatively influencing intrinsic motivation and increasing extrinsic compliance or defiance. The amotivating aspect facilitates perceived incompetence, and undermining intrinsic motivation while promoting disinterest in the task. The relative salience and strength of these three aspects to a person determines the functional significance of the event (Deci & Ryan, 1985). 3. Personal events differ in their qualitative aspects and, like external events, can have differing functional significances. Events deemed internally informational facilitate self-determined functioning and maintain or enhance intrinsic motivation. Events deemed internally controlling events are experienced as pressure toward specific outcomes and undermine intrinsic motivation. Internally amotivating events make incompetence salient and also undermine intrinsic motivation (Deci & Ryan, 1985). Evidence for Many empirical studies have given at least partial support for the ideas expressed in CET. Some examples include: Vallerand and Reid (1984) found that college students' perceived competence and intrinsic motivation were increased by positive feedback and decreased by negative feedback. Further, a path analysis suggested that the effects of feedback on the students' intrinsic motivation were mediated by perceived competence. Kruglanski, Alon, and Lewis (1972) found that tangible rewards decreased fifth grade children's intrinsic motivation for playing various games. The authors also attempted to measure whether or not children who received the rewards had an external locus of causality. They asked rewarded and non-rewarded children 1 week after the treatment session for their reasons for playing the games. Of the 36 rewarded children, only 2 mentioned the reward as their reason. Goudas, Biddle, Fox, and Underwood (1995) tested this hypothesis with the use of different teaching styles in a physical education class. The students reported higher levels of intrinsic motivation when their track-and-field instructor offered them a number of choices throughout the lesson rather than controlling every class decision. Evidence against Many empirical studies have given at least partial support against the ideas expressed in CET. Some examples include: Many studies have found changes in intrinsic motivation without changes in perceived locus of causality or competence (Boal & Cummings, 1981; Harackiewicz, Manderlink, and Sansone, 1984). Phillips and Lord (1980) found changes in perceived competence following the receipt of rewards, but no changes in intrinsic motivation. Salancik (1975) found that college students rewarded with money reported internal attributions of control. Abuhamdeh, Csikszentmihalyi, & Jalal (2015) Found that participants chose to replay games in which they previously experienced high suspense but low perceived competence over games in which they previously experienced high perceived competence but low suspense. Alternative for undermining of intrinsic motivation Some behaviorist psychologists have offered up other explanations for the undermining of intrinsic motivation that has been found in support of CET. Dickinson (1989) proposed three explanations: That intrinsic motivation may decrease over time due to repetitive actions. This is to say that the motivation was not undermined by an external force but was decreasing because of doing the same action over and over. If the controlling actions (the reward) are negative it could negatively influence intrinsic motivation. Rewards can do this in several ways, including serving as a proxy for a punishment by withholding a reward as the reward stands as a means of coercion to complete an otherwise undesirable task. Culturally, intrinsically motivated acts that have no extrinsic reward are praised by society whereas actions that receive a tangible reward are not praised as highly, which would indicate that for actions that have a tangible reward they receive less praise and this undermines their intrinsic motivation to complete the task. Other explanations for the undermining effect include the "overjustification" effect, tested by Lepper, Greene, and Nisbett (1973). The "overjustification" effect claims that subjects will justify their actions later by investigating the causes for their own behavior, and if they were rewarded for that behavior they are likely to place an emphasis on the reward as opposed to any intrinsic motivation they might have had. Similarly, Lepper, Sagotsky, Dafoe, and Greene (1982) showed that children will develop beliefs that if they have to do one task prior to be allowing to engage in another (i.e., "clean up the dinner table before you can have dessert") that the first task is going to be uninteresting and that the second activity is preferable. Implications The primary implication for CET is that the consequences of a reward will be a decreased level of intrinsic motivation and satisfaction because the reward is perceived to negatively impact the autonomy and competence of the individual. Tangible rewards under most conditions will negatively impact the motivation and interest of employees. However, while expected tangible rewards negatively impact motivation and satisfaction, unexpected tangible rewards do not have a negative impact because they are unexpected and thus do not influence the motivation to engage in the act. Similarly, rewards that are not dependent upon the task and are given freely are also not detrimental to motivation and satisfaction (Deci, Koestner, & Ryan, 1999). Also, positive feedback is positively related to intrinsic motivation and satisfaction so long as the feedback is not relayed in a controlling manner. Word choice can negatively influence autonomy even under conditions of positive feedback if the feedback is given in a controlling manner, such as by indicating that someone is doing a good job and that they "should" continue the work, as opposed to simply indicating that they are performing well (Deci, Koestner, & Ryan, 1999). However, an important finding regarding positive feedback is that positive feedback is important for adults, but not for children. In their analysis of the literature, Deci et al. (1999) found that while adults had their intrinsic motivation significantly enhanced by positive feedback, children showed no such difference. Positive feedback for children neither significantly increased nor decreased their intrinsic motivation. Despite this, perceived satisfaction with tasks was still positively impacted by positive feedback for both children and adults. It is important to note that the findings of CET are usually based on the premise that the task is an interesting one so that the employee/student will want to engage in the task of their own volition, but when the task is not interesting the findings indicate that the use of rewards does not damage the intrinsic motivation or satisfaction of the employees/student to a significant degree (Deci, Koestner, & Ryan, 1999). This might indicate that under certain situations, such as when a boring task is used, tangible rewards might be appropriate. Taken together, CET implies that under conditions involving interesting tasks positive feedback is generally a positive force on intrinsic motivation and that tangible and expected rewards are a negative force. This would indicate that when tangible rewards are to be used that they should not be made known beforehand (and therefore linked to the behavior) and that positive verbal feedback is only good when it is applied in a manner that does not threaten the autonomy of the individual. The implications of this theory have been noted in the field of economics due to its implications for incentives (Fehr & Falk, 2002) and in educational settings (Hattie & Timperley, 2007). In the educational field, the difference between children and adults in how important positive feedback is to their feelings of intrinsic motivation is an important one and will alter the application of CET between the workplace and the classroom. Future research Future research on CET will likely look to the effect of rewards on long-term tasks as opposed to short-term tasks as this might affect the relationship between rewards and motivation; complicated and interesting tasks that occur over time might display different relationships regarding rewards and intrinsic motivation (as suggested by Hidi & Harackiewicz, 2000). Other elements to consider for future research include investigating how intrinsic versus extrinsic rewards might alter the relationship between rewards and intrinsic motivation, as the expected payoff between learning a new skill (such as learning to play the guitar) and being compensated monetarily could have different effects on intrinsic motivation (Vansteenkiste, Lens, & Deci, 2006). References Motivational theories Management cybernetics

Socioeconomic status and mental health

Numerous studies around the world have found a relationship between socioeconomic status and mental health. There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model. Social causation The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one's socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, "members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder". The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness. Research The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model. Faris and Dunham (1939) Faris and Dunham analyzed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the center. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighborhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory. Hollingshead and Redlich (1958) Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalized or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis. Midtown Manhattan Study (1962) The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to "uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike". The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33 percent of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18 percent of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47 percent of inhabitants in the lowest SES showed signs of weakening mental functions while only 13 percent of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders. Downward drift In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to "a drift down into or fail to rise out of lower SES groups". This means that a person's SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia. Research Weich and Lewis (1998) The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break. Isohanni et al. (2001) In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalized at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant. Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalized had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness. Wiersma, Giel, De Jong and Slooff (1983) The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset. Debate Many researchers argue against the downward drift model, because unlike its counterpart, "it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance". Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one's life. Those in lower SES have a minimal sense of control over the events that occur in their lives. They argue that lack of control does not only stem from jobs with low income, but that "minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities". The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia. According to a 2009 meta-analysis by Paul and Moser, countries with high income inequality and poor unemployment protections have worse mental health outcomes among the unemployed. Implications for schizophrenia Although social causation can explain some forms of mental illnesses, downward drift "has the greatest empirical support and is one of the cardinal features of schizophrenia". The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards. Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, "individuals with this diagnosis often experience cycles of remission and relapse throughout their lives". This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because "it often starts in early adult life and becomes chronic". Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible. Another possible explanation discussed in literature regarding the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavorably stigmatized. As Livingston explains, "stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create...a decline in social class". Individuals who develop schizophrenia cannot function at the level they are used to, and "are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses." The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma. While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated. See also Causes of mental disorders Causes of poverty Culture Culture of poverty Homelessness and mental health Identity performance Marx's theory of alienation Mental health inequality Poverty Occupational burnout Racism Sexism Social determinants of mental health Social rejection Social stigma Social stress Socioeconomic status and memory Unemployment References Causes of mental disorders Social status

Critical social work

Critical social work is the application to social work of a critical theory perspective. Critical social work seeks to address social injustices, as opposed to focusing on individualized issues. Critical theories explain social problems as arising from various forms of oppression and injustice in globalized capitalist societies and forms of neoliberal governance. This approach to social work theory is formed by a polyglot of theories from across the humanities and social sciences, borrowing from various schools of thought, including anarchism, anti-capitalism, anti-racism, Marxism, feminism, and social democracy. Introduction Social workers have an ethical commitment to working to overcome inequality and oppression. For radical social workers, this implies working towards the transformation of capitalist society towards building social arrangements which are more compatible with these commitments. Mullaly & Keating (1991) suggest three schools of radical thought corresponding to three versions of socialist analysis; social democracy, eurocommunist, and revolutionary Marxism. However, they work in institutional contexts which paradoxically implicates them in maintaining capitalist functions. Social work theories have three possible strategies of analysis, as identified by Rojek et al. (1986). These are: The progressive position. Social work is seen as a catalyst for social change. Social workers work with the oppressed and marginalized and so are in a good position to harness class resistance to capitalism and transform society into a more social democracy or socialist state. ( Bailey & Brake, 1975, Galper, 1975, Simpkin, 1979, Ginsberg, 1979) The reproductive position. Social work is seen as an indispensable tool of the capitalist social order. Its function is to produce and maintain the capitalist state machine and to ensure working class subordination. Social workers are the ‘soft cops’ of the capitalist state machine. (Althusser, 1971, Poulantzas, 1975, Donzelot, 1976, Muller & Neususs, 1978, Webb, 2016) The contradictory position. Social work can undermine capitalism and class society. While it acts as an instrument of class control it can simultaneously create the conditions for the overthrow of capitalist social relations. (Corrigan & Leonard, Phillipson, 1979, Bolger, 1981) History Critical social work is heavily influenced by Marxism, the Frankfurt School of Critical Theory and by the earlier approach of Radical social work, which was focused on class oppression. Critical social work evolved from this to oppose all forms of oppression. Several writers helped codify radical social work, such as Jeffry Galper (1975), Mike Brake (1975) and Harold Throssell (1975). They were building on the views expounded by earlier social workers such as Octavia Hill, Jane Addams & Bertha Reynolds, who had at various points over the previous 200 years sought to make social work & charity more focused on structural forces. More recently writers such as Stephen A. Webb, Iain Ferguson, Susan White, Lena Dominelli, Paul Michael-Garrett, and Stan Houston have further developed the paradigm by incorporating inter-disciplinary ideas from contemporary political philosophy, anthropology and social theory. These include the ideas of Michel Foucault, Jacques Donzelot, Gilles Deleuze, Judith Butler, Pierre Bourdieu and Jürgen Habermas. More recently the writings of Italian political philosophers such as Giorgio Agamben and Roberto Esposito, especially their theorizing about community and governance have come to the fore in critical social work. A new journal published by Policy Press called Critical and Radical Social Work: An international journal promotes debate and scholarship around a range of engaged social work themes and issues. The journal publishes papers which seek to analyze and respond to issues, such as the impact of global neo-liberalism on social welfare; austerity and social work; social work and social movements; social work, inequality and oppression. Stephen A. Webb was commissioned by Routledge to edit a major international reference work 'A Handbook of Critical Social Work' (due for publication 2018). Webb published 'The New Politics of Social Work' in 2013 written closely in the tradition of critical social work. Focus Major themes that critical social work seeks to address are: Poverty, unemployment and social exclusion Racism and other forms of discrimination relating to disability, age and gender. Inadequacies in housing, health care and education and workplace opportunities Crime and social unrest (although the critical approach would be more focused on the structural causes than the behaviour itself) Abuse and exploitation The inhumane impacts of neoliberalism and austerity capitalism such as the introduction of food banks and precarious zero hours work. Sub-theories As critical social work grew out of radical social work, it split into various theories. They are listed below, with a selection of writers who have influenced the theory. Structural social work theory ( Ann Davis, Maurice Moreau, Robert Mullaly) Anti-discriminatory and anti-oppressive social work theory (Neil Thompson, Dalrymple & Burke) Postcolonial social work theory (Linda Briskman) New structural social work theory (Robert Mullaly) Critical social work theory (Jan Fook, Karen Healy, Stephen A. Webb, Bob Pease, Paul Michael Garrett) Radical social work theory (Mike Brake, Iain Ferguson) Structural and Dialectic critiques of human agency While critical social work has a strong commitment to structural change, it does not discount the role of agency, albeit a constrained form of potential. Critical analysis in social work looks at competing forces such as the capitalist economic system, the welfare state as all affecting individual choices. Therefore, according to the critical theory, the aim of social work is to emancipate people from oppression and allow a critique of the ideology of "operativity", State law and governance. Critical social work takes a stance against common assumptions about the necessity of work, capitalist labor and managerial systems of control. "A dialectical approach to social work avoids the simplistic linear cause-effect notion of historical materialism and the naïve romanticism associated with the notion of totally free human will." (Mullaly and Keating, 1991). "Dialectical analysis helps to illuminate the complex interplay between people and the world around them and to indicate the role of social work within society" (Mullaly, 2007:241). Critical Practice models Various practice theories influence critical social work including: Working collectively and recognizing that "community" emerges temporarily around issues and matters of concern. Relationship based social work (Sue White and Brigid Featherstone) Finding ways in which community, cooperation and consciousness can empower disadvantaged people Helping people to understand the social consequences of the market system, neo liberalism and the economisation of life Helping people deal collectively with social issues rather than individualising them Making alliances with working class organisations and recognise social workers as 'workers' themselves Civil disobedience, such as the intentional and surreptitious violation of agency policies that perpetuate capitalist oppression References External links Interprofessional and inter-agency collaboration Exploring Stress Resilience in Trainee Social Workers Identifying ‘the critical’ in a relationship-based model of reflection Social work Critical theory

Inclusion and exclusion criteria

In a clinical trial, the investigators must specify inclusion and exclusion criteria for participation in the study. Inclusion and exclusion criteria define the characteristics that prospective subjects must have if they are to be included in a study. Although there is some unclarity concerning the distinction between the two, the ICH E3 guideline on reporting clinical studies suggests that Inclusion criteria concern properties of the target population, defining the population to which the study's results should be generalizable. Inclusion criteria may include factors such as type and stage of disease, the subject’s previous treatment history, age, sex, race, ethnicity. Exclusion criteria concern properties of the study sample, defining reasons for which patients from the target population are to be excluded from the current study sample. Typical exclusion criteria are defined for either ethical reasons (e.g., children, pregnant women, patients with psychological illnesses, patients who are not able or willing to sign informed consent), to overcome practical issues related to the study itself (e.g., not being able to read, when questionnaires are used for assessment of outcomes), or to eliminate factors that may limit the interpretability of study results (e.g., comorbidities). Exclusion criteria may lead to biases in the study's results. Exclusion criteria Poorly Justified Reasons for Exclusion: Any criteria unless the condition or intervention is specific to the criterion, or the criterion has a direct bearing on condition/intervention/results. Strongly Justified Reasons for Exclusion: Unable to provide informed consent Placebo or intervention would be harmful Lack of equipoise (intervention harmful) Effect of intervention difficult to interpret Potentially Justified Reasons for Exclusion Individual may not adhere Individual may not complete follow up Individuals do not have reliable information Example of inclusion and exclusion criteria Coronary Heart Disease Include criteria: Minimum outcomes: coronary deaths & non-fatal myocardial infarction Appropriate measures of Framingham variables (Age, sex, LDL, HDL, total cholesterol, diabetes, smoking status, hypertension) Cohort, nested case-control, cardiovascular trial follow-up study (or systematic review or meta-analysis of these study types) that measures a novel risk factor and estimates its predictive value after adjusting for Framingham variables Exclude criteria: No data Population or sub-population with known coronary disease or coronary disease equivalent (e.g., diabetes) Does not include minimum outcomes Does not measure Framingham variables appropriately Wrong study design/article format A lesser studied form of exclusion criteria involves an absence of racial, ethnic, or sexual diversity that results in clinical trials that do not reflect the US population. A recent systematic review of the literature of hearing loss in adults, while representative of the US population in terms of sex, does not adequately represent racial or ethnic diversity. See also Drug development U.S. Food and Drug Administration (FDA) European Medicines Agency References External links ICH Website: Guidelines for Clinical Trial Management FDA Website Careers in Clinical Research Clinical Research Services Clinical Trial Management Companies Listings Clinical research Clinical trials

The Seven Pillars of Life

The Seven Pillars of Life are the essential principles of life described by Daniel E. Koshland in 2002 in order to create a universal definition of life. One stated goal of this universal definition is to aid in understanding and identifying artificial and extraterrestrial life. The seven pillars are Program, Improvisation, Compartmentalization, Energy, Regeneration, Adaptability, and Seclusion. These can be abbreviated as PICERAS. The Seven Pillars Program Koshland defines "Program" as an "organized plan that describes both the ingredients themselves and the kinetics of the interactions among ingredients as the living system persists through time." In natural life as it is known on Earth, the program operates through the mechanisms of nucleic acids and amino acids, but the concept of program can apply to other imagined or undiscovered mechanisms. Improvisation "Improvisation" refers to the living system's ability to change its program in response to the larger environment in which it exists. An example of improvisation on earth is natural selection. Compartmentalization "Compartmentalization" refers to the separation of spaces in the living system that allow for separate environments for necessary chemical processes. Compartmentalization is necessary to protect the concentration of the ingredients for a reaction from outside environments. Energy Because living systems involve net movement in terms of chemical movement or body movement, and lose energy in those movements through entropy, energy is required for a living system to exist. The main source of energy on Earth is the sun, but other sources of energy exist for life on Earth, such as hydrogen gas or methane, used in chemosynthesis. Regeneration "Regeneration" in a living system refers to the general compensation for losses and degradation in the various components and processes in the system. This covers the thermodynamic loss in chemical reactions, the wear and tear of larger parts, and the larger decline of components of the system in ageing. Living systems replace these losses by importing molecules from the outside environment, synthesizing new molecules and components, or creating new generations to start the system over again. Adaptability "Adaptability" is the ability of a living system to respond to needs, dangers, or changes. It is distinguished from improvisation because the response is timely and does not involve a change of the program. Adaptability occurs from a molecular level to a behavioral level through feedback and feedforward systems. For example, an animal seeing a predator will respond to the danger with hormonal changes and escape behavior. Seclusion "Seclusion" is the separation of chemical pathways and the specificity of the effect of molecules, so that processes can function separately within the living system. In organisms on Earth, proteins aid in seclusion because of their individualized structure that are specific for their function, so that they can efficiently act without affecting separate functions. Criticism Y. N. Zhuravlev and V. A. Avetisov have analyzed Koshland's seven pillars from the context of primordial life and, though calling the concept "elegant," point out that the pillars of compartmentalization, program, and seclusion don't apply well to the non-differentiated earliest life. See also Artificial life Extraterrestrial life Non-cellular life Organism References External links "The Seven Pillars of Life" in Science Magazine "Biochemist suggests '7 pillars' to define life" in USA Today Life Biological concepts Philosophy of biology

Preventive and social medicine

Preventive and social medicine is a branch of medicine dealing with providing health services in areas of prevention, promotion and treatment of rehabilitative diseases. Studies in preventive healthcare and social medicine are helpful in providing guided care, medicine in environmental health, offering scholarly services, formulating legal policy, consulting, and research in international work. While other fields of medicine deal primarily with individual health, preventive medicine focuses on community health, with individual efforts directed toward small groups, entire populations, and any size of group in between. History and objectives Preventive and social medicine primarily deals with providing a complete health service in the fields of rehabilitation, curative medicine, preventive medicine, as well as health promotion. Preventive and social medicine operates at the community level unlike other fields of medicine that are concerned with individuals. This branch of medicine often deals with improving public health. Responsibilities The practice of preventive and social medicine frequently involves managing and assessing surroundings. The main responsibilities of a preventative medicine practitioner include: Offering specialized services for people's health in defined populations Helping to prevent disease through protection and maintenance of health Assisting in preventing disability and premature death Managing and assessing health related to environmental or occupational factors The field of preventive medicine covers a wide range of medical practices. Education Preventative medicine physicians must acquire a doctoral degree in medicine - MD, DO, or MBBS. A preventative medicine physician undergoes a multi-year residency program similar to physicians specializing in other fields, such as surgery or radiology. Other professionals in preventative and social medicine may have a bachelor's degree, master's degree, or other form of doctoral degree. The field is multi-disciplinary, and thus has a mixture of specialists and roles, such as forensic medicine specialists. See also Preventive healthcare Public health References Further reading 766 pages. Public health Medical humanities

Medical case management

Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates. It refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results. Medical case management requires the evaluation of a medical condition, developing and implementing a plan of care, coordinating medical resources, communicated healthcare needs to the individual, monitors an individual's progress and promotes cost-effective care. The term also has usage in the USA health care system, referring to the case management coordination in the managed care environment. See also Case management (mental health) Disease management (health) Case management (US healthcare system) References External links Medical terminology Health care management Health economics

Childhood dementia

Childhood dementia is an umbrella group consisting of over 100 rare neurodegenerative conditions. These are typically genetic, that cause progressive cognitive decline and the loss of previously acquired skills (e.g: talking, walking, reading/writing, etc). The group of conditions has a very poor prognosis on average, as the progression of cognitive decline and other symptoms/complications have a very significant impact on the life expectancy and quality of those affected. Neuronal ceroid lipofuscinoses, a group of lysosomal storage disorders, are the most common cause of childhood dementia. Classification and terminology Childhood dementias are a heterogenous group of genetic neurodegenerative disorders, that present symptoms before the age of 18. They are typically monogenic (caused by mutations of a single gene). Their main characteristics are chronic and widespread cognitive decline; loss of previously acquired developmental skills after a period of typical development; and behaviours and psychological symptoms of dementia (BPSD). Childhood dementias are distinct from sources of intellectual disability in childhood that are non-progressive (e.g traumatic brain injury) or acquired (e.g nutritional deficiencies or encephalitis). Prognosis The prognosis for childhood dementia is generally poor, with most children experiencing a significant decline in cognitive and motor function. Life expectancy varies depending on the underlying cause, but it is often significantly reduced. Studies show that only 25–29% of affected individuals survive to adulthood, and only 10% reach the age of 50. The median life expectancy is around 9 years, whereas the average life expectancy is 16.3 years. Signs and symptoms By their usual definitions, childhood dementias always cause global neurocognitive decline, typically beginning after a period of seemingly normal development. This progressive decline causes difficulty concentrating, memory loss, confusion, and learning difficulties, in addition to the loss of developmental skills acquired previously, such as: walking, talking, writing, reading, and playing. Eventually the body loses its ability to function, leading to an early death. Other symptoms and complications can occur depending on the subtype. Other symptoms: Behavioral changes: Changes in one's personality, aggression, and hyperactivity. Motor decline: Loss of coordination, balance, and movement abilities. Seizures: Frequent in many forms of childhood dementia. Other complications: Loss of vision or hearing. Cardiovascular, respiratory, and/or digestive problems Bone or joint problems. Causes The majority of childhood dementia cases are caused by genetic mutations that lead to neurodegenerative diseases. The most frequent cause is neuronal ceroid lipofuscinoses (NCL), a family of lysosomal storage disorders. Other causes include mitochondrial diseases, peroxisomal disorders, and other genetic disorders affecting brain function. Diagnosis Diagnosis typically involves a combination of biochemical testing and genetic testing, often performed around the age of four. Early diagnosis is crucial for managing symptoms and improving the quality of life for those affected. In most cases, childhood dementia is diagnosed after developmental regression is observed. Management There is no treatment for most forms of childhood dementia. For these untreatable conditions, treatment focuses on managing symptoms and improving quality of life. This can include: Medications: Anti-seizure medications, behaviour-modifying drugs, and muscle relaxants. Therapies: Physiotherapy, occupational therapy, and speech therapy are used to maintain physical function for as long as possible. Supportive care: This includes comprehensive care to address complications related to mobility, feeding, breathing, and communication. Supportive care measures are customized for each patient and may include: Respiratory support, to manage breathing difficulties in advanced stages. Nutritional support, including the use of feeding tubes when swallowing becomes difficult. Palliative care to ensure comfort and quality of life as the disease progresses. Epidemiology Current estimates place the incidence of childhood dementias at 1 in 1186 births. This is higher than the incidence of some diseases with more widespread awareness, such as cystic fibrosis (affecting around 1 in 3000-4000 births) and spinal muscular atrophy (around 1 in 11000 births). Meanwhile, the estimates for the prevalence are lower, at 1 in 3484 people in the general population and 1 in 1715 among children. History The concept of childhood dementia gained recognition in the early 20th century with the identification of Batten disease, one of the first known forms of childhood dementia, by British neurologist Frederick Batten in 1903. See also Neuronal ceroid lipofuscinosis Batten disease Lysosomal storage disease Neurodegenerative disease References External links Dementia Australia: Childhood Dementia Childhood Dementia Initiative Neurodegenerative disorders Neurological disorders in children Rare diseases Lipid storage disorders Disorders causing seizures

Health Education England

Health Education England (HEE) is an executive non-departmental public body of the Department of Health and Social Care. Its function is to provide national leadership and coordination for the education and training within the health and public health workforce within England. It has been operational since June 2012. In November 2021 it was announced that the organisation would be merged with NHS England by April 2023. It was suggested that this would make responsibilities for workforce planning much clearer and make it easier to develop the workforce strategy needed to meet current and future demand for services. The merger was completed in April 2023, and HEE become the new Workforce, Training and Education Directorate within the national NHS England organisation. Functions Key functions of HEE include: providing leadership for the new education and training system. ensuring that the workforce has the right skills, behaviours and training, and is available in the right numbers, to support the delivery of excellent healthcare and drive improvements supporting healthcare providers and clinicians to take greater responsibility for planning and commissioning education and training through the development of Local Education and Training Boards (LETBs), which are statutory committees of HEE ensuring that the shape and skills of the health and public health workforce evolve with demographic and technological change History HEE was one of the new bodies set out in the NHS reforms of April 2012. Originally established as a special health authority on 28 June 2012, it became a non-departmental public body (NDPB) on 1 April 2015 under the provisions of the Care Act 2014. Dr Navina Evans, Chief Executive of East London NHS Foundation Trust, a psychiatrist, was appointed Chief Executive in March 2020, succeeding Prof Ian Cumming. In August 2020, Dr Harpreet Sood was appointed as Health Education England (HEE) Non-Executive Director. In November 2021, it was announced that HEE would merge with NHS England. Plans Its third national workforce plan, published in December 2015, provides for an increase of nearly 15% in nurses and doctors trained by 2020. This is planned to lead to an increase of 21,133 qualified adult nurses, 6039 hospital consultants and 5381 General Practitioners after allowing for retirement and staff turnover. NHS knowledge and library services HEE leads on the strategic development of NHS knowledge and library services. The national NHS knowledge and library services team at HEE is responsible for procuring core digital knowledge resources on behalf of the health and care workforce and trainees. National Health Service (England) has 177 autonomous library services largely based in acute hospitals, but also in mental health and community health services. These deliver knowledge services to trainees and staff. In large cities, particularly in London, a small number of universities offer knowledge services to NHS staff as well as to students. In 1997, national guidance on NHS library and information services observed duplication and lack of co-ordination, partly arising from complex funding arrangements. Health Service Guideline HSG (97) 47 concentrated on enabling equitable access to the knowledge base for all healthcare professionals irrespective of their discipline, by requiring the development of multi-professional library and information services. It required that each Hospital Trust in England draw up a library and information strategy. A digital library service for the NHS in England called the National electronic Library for Health (NeLH) was launched in 1998, later becoming the National Library for Health (NLH). Management of this service was transferred to NICE, the National Institute for Health and Care Excellence in 2008. In 2012, organisational changes saw the transfer of the regional leads responsible for NHS libraries, and their budgets, into HEE, for the first time bringing all of them together within a single organisation. Knowledge for Healthcare The first five-year strategy, “Knowledge for Healthcare: a development framework 2015-2020” was published in December 2014 and envisioned by planners to be a 15-year programme of work. A programme manager was appointed for one year following publication to establish a programme and project management infrastructure through which the work could be effectively progressed and reviewed. Following successes, the regional teams were formed into a single national team and the decision was made to appoint a national lead. The programme manager is now a full-time and permanent post, and the postholder is responsible for leading and sustaining a coherent national approach. Through 2019–20, the HEE reviewed their strategy. The Carter review of operational productivity and performance in English NHS Acute hospitals in 2016 signalled the need for greater use of evidence and data to engage business managers and clinical leaders.[Varela] The Long-Term plan, published in 2019, spoke of the “strong scientific tradition of evidence-based decisions about care” and the need for ready access to decision support. It featured several workstreams, including mobilising evidence and organizational knowledge; patients, carers and the public; resource discovery; quality and impact; and workforce planning and development. The second five-year strategy was published in January 2021. HEE's aim in developing and continuing to publish iterations of the national strategy for NHS knowledge and library services is to: Set direction, articulate a clear ambition and establish priorities Invite key stakeholders to partner work with us in order “to transform and optimise healthcare library and knowledge services, harness new technologies, and champion service development and re-configuration” Guide investment decisions, nationally and locally, including in relation to commitment to developing new information products Encourage the spread and adoption of best practice and ‘new’ models of service delivery, bringing evidence closer to teams and to decision-making. HEE during the COVID-19 pandemic The national HEE team supported the wider NHS system during the COVID-19 pandemic. HEE launched a bank of Coronavirus literature searches and a collection of COVID-19 current awareness bulletins, with users recognising that: “They are willing to share the work they are doing with other services in the NHS and recognising that in many cases this only needs to happen once.” Junior Doctors controversies In February 2016, the chief executive of HEE Ian Cumming sent a letter to all the chief executives of NHS Foundation trusts indicating that the organisation could cut funding for training posts in any trust which refused to impose the new juniors doctor contract. In January 2017, emails seen by the newspaper The Independent showed that HEE sent drafts of the letter to the Department of Health and that the Secretary of State for Health Jeremy Hunt was aware of the letter prior to publication. In May 2017 the Court of Appeal decided that the organisation could be considered as an employer of junior doctors, in relation to whistle blowing claims brought via an Employment Tribunal, through the case of Dr Chris Day. Dr Day claimed he was discriminated against as a whistle blower but later acknowledged, as part of a settlement agreement, that HEE had acted in good faith towards him. However, there is evidence to suggest that the settlement was forced upon Dr. Day and he continues to appeal. References External links 2012 establishments in England Career development in the United Kingdom Department of Health and Social Care Education in England Government agencies established in 2012 Medical education organisations based in the United Kingdom Non-departmental public bodies of the United Kingdom government Nursing education in the United Kingdom Organisations based in Leeds

Dual process model of coping

The dual process model of coping is a model for coping with grief developed by Margaret Stroebe and Henk Schut. This model seeks to address shortcomings of prior models of coping, and provide a framework that better represents the natural variation in coping experience on a day to day basis. The authors came up with a dual process model to better represent human grief. They explain that coping with bereavement, a state of loss, can be a combination of accepting loss and confronting life changes that can be experienced simultaneously. This model suggests that healthy coping is done through the oscillation between this acceptance and confrontation. It informs on how the combination of healthy emotional catharsis and changing perspective can be a good and healthy process to cope. Being able to confront the situation and also deal with everyday life events allows the person to live their lives with desired states of stability in a subjective post-loss world in which bereaved persons find themselves (Parkes, 1993). Coping Bereavement and the adjective 'bereaved' are derived from a verb, 'reave', which means "to despoil, rob, or forcibly deprive" according to the Oxford English Dictionary. Thus, a bereaved person is one who has been deprived, robbed, plundered, or stripped of someone or something that they valued. Reaction to this state or impact of loss is called grief. According to Lazarus and Folkman (1984), coping strategies are the "constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing on or exceeding the resources of the person". People vary in the ways they grieve and in the ways they cope. But acknowledging it and allowing themselves to go through the motions will allow them to cope in a healthy way. To cope with the loss, the person requires to relearn the world around them and simultaneously make a multifaceted transition from loving in presence to loving in absence (Attig, 2001). A healthy relocation of the deceased internally and maintaining a healthy dynamic connectedness/relationship is observed to provide solace to the grieving, but the weightage differed in pluralistic cultural settings. Grievers will go through times of extreme sadness and also times where they are numb to what has happened. Lack of appropriate coping can bring many ailments to a person, mental and physical. Healthy coping is achieved when the bereaved person is enabled to go forward with healthy, productive living by effortfully developing "new normals" to guide that living which is characterized by lesser stressful demands compared to the initial phase of grief. There are multiple ways to facilitate healthy coping and grieving. For instance, spirituality has been identified as a potential factor that could help facilitate healthy coping strategies and reduce the likelihood of developing complicated grief. Greenblatt has reviewed spousal mourning as being essential for transition. He describes four phases of mourning: the initial reaction of shock, numbness, denial and disbelief; followed by pining, yearning, depression then in a healthy environment resolution phase begins with emancipation from the loved one and readjustment to the new environment. In the dual process model, healthy coping can be understood as finding a proper balance between the loss oriented and restoration oriented process, ensuring that an individual has ample time to both acknowledge and process their grief while simultaneously finding distractions and new meaning. Dual process model Loss oriented The loss oriented process focuses on coping with bereavement, the loss itself, recognizing it and accepting it. In this process a person may express feelings of grief with all the losses that occur from losing their loved one. There will be many changes from work to family and friendships. There might also be demographic changes and even economic ones. Loss oriented coping has been identified as an especially important aspect of early-stage bereavement, and depending on how an individual copes can significantly impact future adjustment. It has also been identified that ruminating on feelings of loss might lead to distorted, complicated or prolonged grief. The loss oriented process will bring on a lot of yearning, irritability, despair, anxiety and depression. During this process they are only concentrated on their pain that this loss has caused. Lack or denial of early adaptive acknowledgement that they will no longer speak to deceased or see them again might instigate compulsive and self-destructive behaviors. People attached with the deceased have to reconfigure their identity as an autonomous being. These processes in a non-resilient griever can appear overwhelming, and associated guilt can be exported over friends and family in an assumptive effort which might affect interpersonal relationships. In the context of disaster related losses or anticipated losses, such as climate change related losses, there is evidence that engaging with these emotional experiences in order to make meaning of them is a necessary step. Research indicates that without this process of reflecting on emotional experiences, it is not possible to transform them into more adaptive expressions, leading to poor mental health. Restoration oriented In restoration-oriented process, an individual will tackle issues tangentially related to their loss, and will engage in activities that can help distract from grief and facilitate adjustment to a post-loss life. These include focusing on the new roles in their post loss reality and responsibilities in lives. The restoration-oriented process incorporates endurance through reconstruction of perspective by taking over grief; grieving thoughts are adjusted adaptively by creating new meanings with the deceased. The restoration process is a confrontation process that allows the person to adjust to a world without the deceased. People in this process can feel subjective oscillations of pride and grief related stressors in the avoidance mentalization. This process allows the person to live their daily life as a changed individual without being consumed by the grieving they are facing. William Worden calls this the four tasks of grief. Therese A. Rando calls the letting go process as emancipation from bondage due to the strength required for change and recovery. Again, in the context of disaster related losses or anticipated losses due to climate change, the process of reflecting on and making meaning of emotional experiences leads to growth in resilience, psychological flexibility, increased community engagement and greater solidarity. It is the emotional processing component of this grief that supports the action and restoration that occurs in responses to these losses. Oscillation Addressing limitations of other models of grief, such as the five stages of grief, the authors designed the dual process model of coping to help depict a more accurate experience of grief and bereavement in everyday life. This model is based on the idea that individuals will contend with multiple stressors following a significant loss, and will not be able to deal with one isolated issue at a time. Bereaved individuals may even experience gaps and fluctuations in the amount of grief they experience daily. The role of oscillation in the dual process model is to suggest that grieving individuals will regularly transition between the loss oriented and restoration oriented process. Jennifer Fiore, in a 2019 systematic review, describes this process of oscillation as an element of the dual process model of coping that is crucial for an individual to cope with their loss in a healthy manner. Oscillation between these two processes allows for an individual to address two distinct areas of life post-loss that are foundational for healthy coping. While understood to be an essential part of the dual process model, oscillation is also not fully understood by present research. Fiore's 2019 systematic review acknowledged that there is currently no consensus about the optimal balance between loss oriented and restoration oriented coping. However, it is generally understood that an individual will prioritize the loss-oriented process early into the grieving process, and will gradually prioritize the restoration-oriented process more as time progresses. Oscillation has also been observed to be influenced by culture and individual characteristics. Different cultural norms and personal preferences may guide individuals to prioritize one type of process over another, making oscillation a dynamic aspect of the dual process model. Conclusion The dual process model of coping takes into consideration that most will have multiple stressful life events while they are coping with bereavement. Their lives will continue and so will the problems associated with it, confounded by the newfound loss that an individual may be contending with. There will be many situations that will take them away from grieving, necessitating a balance between coming to terms with one's loss, while simultaneously tending to establishing new social aspects of life that transcend their grief. These situations can either benefit them or affect them negatively if they allow them to. Being aware and prepared to change can allow them to continue and deal with post-loss life events. See also Death anxiety Survivor guilt References Further reading Grief Counseling

Psychiatric disorders of childbirth

Psychiatric disorders of childbirth (parturition, labor, delivery), as opposed to those of pregnancy or the postpartum period, are psychiatric complications that develop during or immediately following childbirth. Despite modern obstetrics and pain control, these disorders are still observed. Most often, psychiatric disorders of childbirth present as delirium, stupor, rage, acts of desperation, or neonaticide. These psychiatric complications are rarely seen in patients under modern medical supervision. However, care disparities between Europe, North America, Australia, Japan, and other countries with advanced medical care and the rest of the world persist. The wealthiest nations represent 10 million births each year out of the world's total of 135 million. These nations have a maternal mortality rate (MMR) of 6–20/100,000. Poorer nations with high birth rates can have an MMR more than 100 times higher. In Africa, India & South East Asia, as well as Latin America, these complications of parturition may still be as prevalent as they have been throughout human history. Three settings for childbirth Modern childbirth In nations with state-of-the-art obstetric services, childbirth is usually supervised by a midwife or obstetrician. Pain can be relieved by nitrous oxide, pethidine or an epidural anesthetic. Complications can be dealt with promptly, if necessary, by emergency Caesarean, also known as a C-section. These services are now standard procedure in many countries. Even so, parturition can still be a severe ordeal, and at least one third find it to be a traumatic experience. Women may spend anywhere from a few hours to a few days in labor, thus leading to an emotionally and physically intense experience, as shown by the frequency of post-traumatic stress disorder. The complications listed below, though rare, can still occur. Historic childbirth "Historic childbirth" is a term used to describe the birth of children before the introduction of effective pain relief in 1847. During that time psychiatric complications were clearly described, well recognized and common in countries with the best health services. Those conditions still exist in nations with high birth rates and a dearth of trained staff. At the beginning of this century only about one third of births in tropical Africa and South-East Asia were attended by doctors or midwives. Although there has been some improvement since then, it is still true that about half the births in many nations are not supervised by skilled attendants. Traditional birth attendants are widespread. Clandestine labor The third setting is concealed labor, endured by a woman who has dissembled her pregnancy. Not only is there no analgesia or skilled attendance, but there is no emotional support; on the contrary, the mother's mental state is disturbed by anger, fear, shame or despair. Most neonaticides occur in this setting. Perpetrators have rarely given a personal account, but experienced obstetricians have attempted a graphic description of their state of mind. There is objective evidence that complications are much more common. Tokophobia The word comes from the Greek τόκος (tókos), meaning parturition. Early authors like Ideler wrote about this fear, and, in 1937, Binder drew attention to a group of women who sought sterilization because of tokophobia. In the last 40 years there have been a series of papers published mainly from Scandinavia. Tokophobia can be primary (before the first child is born) or secondary (typically after extremely traumatic deliveries). Elective Caesarean section is one solution, but psychotherapy can also help these women to give birth vaginally. Obstetric factitious disorder Factitious disorder (self-induced illness) can take many forms, and, during pregnancy, they include obstetric complications such as antepartum bleeding and hyperemesis. They also include simulation of labor by contractions of the abdominal muscles or manipulation of tocodynamometry. Other women have induced premature labor by rupture of the membranes or by prostaglandin suppositories or both. These extreme cases illustrate the strong wish that some women have to bring pregnancy to an end; occasionally they importunately demand premature delivery, whatever the risk to the infant. Delirium during labor Under the name 'parturient delirium', this is defined as an acute (usually sudden) clouding of consciousness, lasting minutes or hours, with full recovery. Onset is usually towards the end of labor, and recovery after the birth. Any of the following may be observed – incoherent speech, misidentification of persons, visual hallucinations, inappropriate behavior such as singing, or memory loss for the episode. A phasic course, with alternate delirium and clarity, continuation into the puerperium, and recurrence after another pregnancy have been described in a few cases. It was one of the first psychiatric disorders, related to childbearing, to be described, and its importance in the early 19th century is indicated by an early classification, stating that it was one of two recognized forms of puerperal insanity. More than 50 cases have been described, most of them in the epoch when parturition was endured without effective pain relief. The disorder has almost disappeared in nations with advanced obstetrics, with only two early 20th century reports. But, within the last ten years, there were 28 nations in which fewer than half the births were attended by skilled birth attendants; they included Nigeria, Pakistan, Ethiopia and Bangladesh, each with more than 3 million births/year. In 2012, it was estimated that 130-180 million infants would be delivered in the quinquennium 2011-2015 without skilled birth attendance. There are still many countries where parturition in the 21st century is like that in Europe in the early 19th century, and women are at risk of becoming delirious during labor. Unconscious delivery Childbirth can occur during natural sleep, and under excessively heavy sedation, including alcohol intoxication. A diverse list of medical disorders have led to delivery during coma, including head injury, antepartum bleeding, severe hypotension and hypothermia. Of these the commonest is eclampsia. There are ten cases in the literature of unexplained stupor or coma, including cases with features of catatonia. Acts of desperation In women facing death during obstructed labor, panic or despair can drive them to take desperate remedies. There are about twenty cases of suicide or suicide attempts. The suicidal motive is not depression or shame, but unbearable pain and despair. The methods – throwing themselves out of the window, hanging or drowning – show the extremity of the woman's suffering. There are more than 20 descriptions of auto-Caesarean section. In a few cases the apparent motive has been psychiatric illness, but the majority were either the destruction of an unwanted child, or desperate remedies when the infant cannot be delivered and the nearest obstetric unit was beyond reach. Most of these cases have been reported from poor countries, where contributions to literature are scarce, and they may be more common there. The mother usually survives, but few infants survive. Psychosis during labor Various psychoses can start during labor. Of the organic psychoses, eclamptic, Donkin, epileptic and infective psychoses have all started during labor, although postpartum onset is usual. These differ from parturient delirium in their duration, lasting at least a few days, rather than a few hours. In addition, there are 19 cases of bipolar episodes with onset during labor; they differ from parturient delirium in their symptomatology (mania rather than delirium) and duration measured in weeks. These cases are evidence that, on the balance of probability, the trigger of bipolar/cycloid episodes is already active during parturition. Parturient rage During the final painful contractions which lead to the expulsion of the infant, some women have become extremely angry. Before the introduction of effective pain relief (1847), obstetricians were familiar with this, and referred to it under names like parturient rage, furor uterinus, Wut der Gebärenden and colère d'accouchées. Some mothers lost control and attacked their husbands, obstetricians, midwives or other attendants. At one time it was common, and clearly described. It still occurs occasionally under modern obstetric conditions. The infant is at risk, because angry mothers have reached down to haul the baby out, or made a dangerous assault on the new-born; for example, a 40-year-old mother, at the end of her 1st pregnancy, kicked away the midwife, tore out the infant, and killed it by striking its head against the bedpost. In most neonaticides, the infant is killed by suffocation, drowning or exposure. But in a minority there is extraordinary brutality – the head smashed with multiple fractures or splintering of bone, the head cut or torn off, the infant stabbed many times, or a combination of these. The pathology bears witness to the mother's mental state. Nowadays, this phenomenon would not be regarded as a mental illness, and the only diagnosis could be 'unspecified disorder of adult personality and behavior. But this has not always been so. In France, Esquirol mentioned a mother who stabbed her infant 26 times with a pair of scissors; she was acquitted because the judges considered that she was suffering from mental derangement. There is an insoluble judicial problem, because violence is sometimes a feature of delirium; in a clandestine birth, it is impossible to know whether consciousness was clouded or not. Pathological mental states immediately after the birth Immediately after giving birth, an exhausted mother, fainting or in shock, may not be able to care for the new-born, who often needs resuscitation, and can suffocate in mucus or blood. Exhaustion alone, without syncope or delirium, can prevent a mother from helping a dying infant; in clandestine labors, it can be fatal to the new-born, without mens rea. Brief states of delirium have been described with onset after the birth, less common but similar to those that occur during parturition. There are about 20 in the literature. Several of them have been accompanied by violence, and, after recovery a few hours later, followed by amnesia. Occasionally mothers have had recurrent episodes. Postpartum stupor has been described, beginning immediately or very shortly after the birth. The mother remains speechless, immobile and unresponsive to any stimuli for hours or even a day or more. These stupors differ in duration and clinical features from postpartum bipolar disorder. They have been phasic, with recovery and relapse. Their causes are unknown. Childbirth-related post-traumatic stress disorder (PTSD) Postpartum PTSD was first described in 1978. Since then more than 100 papers have been published. After excessively painful labors, or those with a disturbing loss of control, fear of death or infant loss, or complications requiring forceps delivery or emergency Caesarean section, some mothers experience symptoms similar to those occurring after other harrowing experiences; these include intrusive memories (flashbacks), nightmares, and a high-tension state, with avoidance of triggers such as hospitals or words associated with parturition. The frequency depends on criteria and severity, but figures of 2-4% are representative; these symptoms can last for many months. Some avoid further pregnancy (secondary tocophobia), and those who become pregnant again may experience a return of symptoms, especially in the last trimester. These mothers can be helped by counseling soon after birth or a variety of trauma-focused psychological therapies. Complaining reactions Another reaction to a severe experience of childbirth is pathological complaining (paranoia querulans in the International Classification of Diseases). These mothers complain bitterly about perceived mismanagement. The complaints, directed at midwives or other staff members, vary from lack of pain relief, unnecessary epidural anesthesia, poor condition of the baby, humiliation or 'dehumanization', excessive use of technology, student examinations, or lack of explanation and sympathy. Occasionally the content is truly absurd – one mother's intense resentment was her husband suggesting the wrong name for the infant. In response to these 'outrages', mothers may harangue the midwives repeatedly or write critical letters and are preoccupied with fantasies of revenge – 'beating the midwives to pulp', 'smashing the doctor's head in', 'burning the hospital down'. Angry rumination may continue for weeks, months or more than a year. The frequency is similar to post-traumatic stress disorder, and there is an association between the two complications. The effect on childcare is like that of severe depression, but the emotional state (furious anger, not sadness and despair) and treatment strategy are different. Psychotherapy is directed at distracting the mother from her grievances and reinforcing productive child-centered activity; a diary is a useful focus – the therapist listens with sympathy to her complaints, then turns to the written record, expressing pleasure and interest in the mother's achievements in spite of them. See also Menstruation and mental health Gender disappointment Postpartum depression Postpartum psychosis References Bibliography External links Pathology of pregnancy, childbirth and the puerperium Mental disorders associated with pregnancy, childbirth or the puerperium

Nursing research

Nursing research is research that provides evidence used to support nursing practices. Nursing, as an evidence-based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in the health care setting. Nurse education places focus upon the use of evidence from research in order to rationalise nursing interventions. In England and Wales, courts may determine if a nurse acted reasonably based upon whether their intervention was supported by research. Areas of research Nursing research falls largely into two areas: Quantitative research is based in the paradigm of logical positivism and is focused upon outcomes for clients that are measurable, generally using statistics. The dominant research method is the randomised controlled trial. Qualitative research is based in the paradigm of phenomenology, grounded theory, ethnography and others, and examines the experience of those receiving or delivering the nursing care, focusing, in particular, on the meaning that it holds for the individual. The research methods most commonly used are interviews, case studies, focus groups and ethnography Recently in the UK, action research has become increasingly popular in nursing. Evidence-based quality improvement practices In 2008, the Agency for Healthcare Research and Quality AHRQ created the AHRQ Health Care Innovations Exchange to document and share health care quality improvement programs, including hundreds of profiles featuring nursing innovations. Each of the nursing profiles contained in this collection contains an evidence rating that assesses how strong the relationship is between the innovative practice and the results described in the profile. Evidence-Based Practice (EBP) is both a goal and approach in nursing, however, there are nurse-related barriers to evidence based-practice such as limited knowledge of EBP and work overload. See also AHRQ Health Care Innovations Exchange Evidence-based medicine Nursing journal Nursing theory References External links Health research

Dysorthography

Dysorthography is a disorder of spelling which accompanies dyslexia by a direct consequence of the phonological disorder. In the American classification from the American Psychiatric Association (APA) and the classification from the World Health Organization (WHO), it is a subtype of specific learning disorder with impairment in written expression. Signs and symptoms Dysorthography impacts some individuals more than others, but the most typical symptoms are usually difficulty spelling and spelling mistakes, mistaking spoken and written words, writing words together, or confusing letters, using apostrophes improperly or not at all, and article misuse or confusion. Treatment The cause of this disorder needs to be identified in order to be treated. Pronunciation problems, visual or auditory impairments, or even an unfavorable study environment are frequently the causes. The speech therapist or child psychologist may recommend a course of treatment that focuses on learning and applying proper spelling, as well as resolving related issues, based on the cause and degree of impairment. See also Orthography Dyslexia References Further reading External links Neurodevelopmental disorders Writing Learning disabilities

Thinking processes (theory of constraints)

The thinking processes in Eliyahu M. Goldratt's theory of constraints are the five methods to enable the focused improvement of any cognitive system (especially business systems). Purpose The purpose of the thinking processes is to help answer questions essential to achieving focused improvement: What to change? What to change it into? How to cause the change? Sometimes two other questions are considered as well: Why change? and: How to maintain the process of ongoing improvement (POOGI)? A more thorough rationale is presented in What is this thing called theory of constraints and how should it be implemented. A more thorough work, mapping the use and evolution of the Thinking Processes, was conducted by Victoria Mabin et al. Processes The primary thinking processes, as codified by Goldratt and others: Current reality tree (CRT, similar to the current state map used by many organizations) — evaluates the network of cause-effect relations between the undesirable effects (UDE's, also known as gap elements) and helps to pinpoint the root cause(s) of most of the undesirable effects. Evaporating cloud (conflict resolution diagram or CRD) - solves conflicts that usually perpetuate the causes for an undesirable situation. Core conflict cloud (CCC) - A combination of conflict clouds based on several UDE's. Looking for deeper conflicts that create the undesirable effects. Future reality tree (FRT, similar to a future state map) - Once some actions (injections) are chosen (not necessarily detailed) to solve the root cause(s) uncovered in the CRT and to resolve the conflict in the CRD the FRT shows the future states of the system and helps to identify possible negative outcomes of the changes (Negative Branches) and to prune them before implementing the changes. Negative branch reservations (NBR) - Identify potential negative ramifications of any action (such as an injection, or a half-baked idea). The goal of the NBR is to understand the causal path between the action and negative ramifications so that the negative effect can be "trimmed." Positive reinforcement loop (PRL) - Desired effect (DE) presented in FRT amplifies intermediate objective (IO) that is earlier (lower) in the tree. While intermediate objective is strengthened it positively affects this DE. Finding out PRLs makes FRT more sustaining. Prerequisite tree (PRT) - states that all of the intermediate objectives necessary to carry out an action chosen and the obstacles that will be overcome in the process. Transition tree (TT) - describes in great detail the action that will lead to the fulfillment of a plan to implement changes (outlined on a PRT or not). Strategy & tactics (S&T) - the overall project plan and metrics that will lead to a successful implementation and the ongoing loop through POOGI. Goldratt adapted three operating level performance measures—throughput, inventory and operating expense—and adopted three strategic performance measures—net income, return on investment, and cash flow—to maintain the change. Some observers note that these processes are not fundamentally very different from some other management change models such as PDCA "plan–do–check–act" (aka "plan–do–study–act") or "survey–assess–decide–implement–evaluate", but the way they can be used is clearer and more straightforward. Books H. William Dettmer. The Logical Thinking Process: A Systems Approach to Complex Problem Solving (2007). H. William Dettmer. Strategic Navigation: A Systems Approach to Business Strategy (2003). Eliyahu M. Goldratt and Jeff Cox. The Goal: A Process of Ongoing Improvement. Eliyahu M. Goldratt. It's Not Luck. Eliyahu M. Goldratt. Critical Chain. Eliyahu M. Goldratt, Eli Schragenheim, Carol A. Ptak. Necessary But Not Sufficient. Lisa J. Scheinkopf. Thinking For a Change: Putting the TOC Thinking Processes to Use. Eli Schragenheim. Management Dilemmas: The Theory of Constraints Approach to Problem Identification and Solutions. John Tripp TOC Executive Challenge A Goal Game. References Theory of constraints

Contextual learning

Contextual learning is based on a constructivist theory of teaching and learning. Learning takes place when teachers are able to present information in such a way that students are able to construct meaning based on their own experiences. Contextual learning experiences include internships, service learning and study abroad programs. Contextual learning has the following characteristics: emphasizing problem solving recognizing that teaching and learning need to occur in multiple contexts assisting students in learning how to monitor their learning and thereby become self-regulated learners anchoring teaching in the diverse life context of students encouraging students to learn from each other employing authentic assessment Key elements Current perspectives on what it means for learning to be contextualized include situated cognition – all learning is applied knowledge social cognition – intrapersonal constructs distributed cognition – constructs that are continually shaped by other people and things outside the individual Constructivist learning theory maintains that learning is a process of constructing meaning from experience Benefits Both direct instruction and constructivist activities can be compatible and effective in the achievement of learning goals. Increasing one’s efforts results in more ability. This theory opposes the notion that one’s aptitude is unchangeable. Striving for learning goals motivates an individual to be engaged in activities with a commitment to learning. Children learn the standards values, and knowledge of society by raising questions and accepting challenges to find solutions that are not immediately apparent. Other learning processes are explaining concepts, justifying their reasoning and seeking information. Therefore, learning is a social process which requires social and cultural factors to be considered during instructional planning. This social nature of learning also drives the determination of the learning goals. Knowledge and learning are situated in particular physical and social context. A range of settings may be used such as the home, the community, and the workplace, depending on the purpose of instruction and the intended learning goals. Knowledge may be viewed as distributed or stretched over the individual, other persons, and various artifacts such as physical and symbolic tools and not solely as a property of individuals. Thus, people, as an integral part of the learning process, must share knowledge and tasks. Assessment One of the main goals of contextual learning is to develop an authentic task to assess performance. Creating an assessment in a context can help to guide the teacher to replicate real world experiences and make necessary inclusive design decisions. Contextual learning can be used as a form of formative assessment and can help give educators a stronger profile on how the intended learning goals, standards and benchmarks fit the curriculum. It is essential to establish and align the intended learning goals of the contextual task at the beginning to create a shared understanding of what success looks like. Self-directed theory states that humans by nature seek purpose and the desire to make a contribution and to be part of a cause greater and more enduring then oneself. Contextual learning can help bring relevance and meaning to the learning, helping students relate to the world they live in. Questions to address when defining and developing a contextual task Does the task fulfill the intended learning goals? Does the task involve problems that require the students to use their knowledge creatively to find a solution? Is the task an engaging learning experience? Is the audience as authentic as possible? Does the task require students to use processes, products and procedures that simulate those used by people working in a similar field? Is the task inclusive? Are there clear criteria for students on how the product, performance or service will be evaluated? Are there models of excellence which demonstrate standards? Are the students involved in the assessment process? Is there a provision made for continuous formative feedback, from oneself, from teachers and peers to help the students improve? Is there an opportunity for student choice and ownership to the extent that would be. GRASPS Concept Wheel See also Context-based learning Experiential learning References Alternative education

Clinical Document Architecture

The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. In November 2000, HL7 published Release 1.0. The organization published Release 2.0 with its "2005 Normative Edition". Content CDA specifies the syntax and supplies a framework for specifying the full semantics of a clinical document, defined by six characteristics: Persistence Stewardship Potential for authentication Context Wholeness Human readability CDA can hold any kind of clinical information that would be included in a patient's medical record; examples include: Discharge summary (following inpatient care) History & physical Specialist reports, such as those for medical imaging or pathology An XML element in a CDA supports unstructured text, as well as links to composite documents encoded in pdf, docx, or rtf, as well as image formats like jpg and png. It was developed using the HL7 Development Framework (HDF) and it is based on the HL7 Reference Information Model (RIM) and the HL7 Version 3 Data Types. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part relies on coding systems (such as from SNOMED and LOINC) to represent concepts. Consolidated Clinical Document Architecture In 2012, in response to conflicting CDAs in use by the healthcare industry, the Office of the National Coordinator for Health Information Technology (ONC) streamlined commonly used templates to create the Consolidated-CDA (C-CDA). Transport The CDA standard doesn't specify how the documents should be transported. CDA documents can be transported using HL7 version 2 messages, HL7 version 3 messages, IHE protocols such as XDS, as well as by other mechanisms including: DICOM, MIME attachments to email, http or ftp. Standard certification and adoption The standard is certified by ANSI. CDA Release 2 has been adopted as an ISO standard, ISO/HL7 27932:2009. Country-specific implementations Australia Australia's Personally Controlled Electronic Health Record (PCEHR), known as "My Health Record", uses a specialized implementation of HL7 CDA Release 2. United Kingdom In the UK the Interoperability Toolkit (ITK) utilises the "CDA R2 from HL7 V3 – for CDA profiles" for the Correspondence pack. United States In the U.S. the CDA standard is probably best known as the basis for the Continuity of Care Document (CCD) specification, based on the data model as specified by ASTM's Continuity of Care Record. The U.S. Healthcare Information Technology Standards Panel has selected the CCD as one of its standards. See also EHRcom Health Informatics Service Architecture (HISA) Gello Expression Language Fast Healthcare Interoperability Resources References Further reading External links Standards for electronic health records Computer file formats Industry-specific XML-based standards

Omaha System

The Omaha System is a standardized health care terminology consisting of an assessment component (Problem Classification Scheme), a care plan/services component (Intervention Scheme), and an evaluation component (Problem Rating Scale for Outcomes). Approximately 22,000 health care practitioners, educators, and researchers use Omaha System to improve clinical practice, structure documentation, and analyze secondary data. Omaha System users from Canada, China, The Czech Republic, Estonia, Hong Kong, Japan, Mexico, New Zealand, The Netherlands, Turkey, the United States, and Wales, have presented at Omaha System International Conferences. The Omaha System is integrated into the National Library of Medicine's Metathesaurus, CINAHL, ABC Codes, NIDSEC, Logical Observation Identifiers, Names, and Codes (LOINC), and SNOMED CT. It is registered (recognized) by Health Level Seven (HL7), and is congruent with the reference terminology model for the International Organization for Standardization (ISO).The Omaha System has the ability to code the majority of the problems and interventions from the hospital record. Origin The Omaha System originated at the Visiting Nurse Association of Omaha (located in Nebraska) as a collaborative effort between researchers and interprofessional practitioners. Practitioners developed the Omaha System as part of four federally funded research projects conducted between 1975 and 1993.The Omaha System was constantly refined in its structure and terms during this period to establish reliability, validity, and usability. Users Users include nurses, physicians, occupational therapists, physical therapists, registered dietitians, recreational therapists, speech and language pathologists, and social workers. When multidisciplinary health teams use the Omaha System accurately and consistently, they have an effective basis for documentation, communication, coordination of care, and outcome measurement. Use in nursing The American Nurses Association recognized the Omaha System as a standardized terminology to support nursing practice in 1992. In 2014, Minnesota became the first state to recommend that point-of-care terminologies recognized by the American Nurses Association be used in all electronic health records. The evidence underlying this decision was a survey that showed that the Omaha System was used in 96.5% of Minnesota counties. The Omaha System became a member of the Alliance for Nursing Informatics in 2009. It is a reliable nursing documentation tool for outcome and quality of care measurement for clients with mental illness. The Omaha System is also a tool that can be used as a strategy to introduce and incorporate evidence-based practice in the undergraduate nursing clinical experience. Tools that can be utilized in the Omaha System include a comprehensive list of client health problems, nursing interventions, and an outcome rating scale assessing client knowledge, behavior, and health status to standardize nursing care and client outcomes. See also Clinical Care Classification System Health informatics Nursing care plan Nursing diagnosis Nursing practice Nursing process Nursing Minimum Data Set NANDA Nursing Interventions Classification Nursing Outcomes Classification References External links Omaha System Community of Practice website Omaha System Partnership website Omaha System Guidelines website Clinical procedure classification Nursing classification

Professional abuse

Professional abuse is "a pattern of conduct in which a person abuses, violates, or takes advantage of a victim within the context of the abuser's profession." This typically involves a violation of the relevant professional organization's code of ethics. Organizational ethics or standards of behavior require the maintenance of professional boundaries and the treatment of people with respect and dignity. Professional abuse involves those working in a facility were patients/clients are abused due to their vulnerability relying on professionals for assistance. They are taken advantage of because of this leaving them treated unethically. This type of abuse isn’t noticed as much as other abuse because of the trust that these patients think they have for the abuser and the manipulation antics used upon them. Settings and context in which it occurs These types of situations tend to happen in hospitals, nursing homes, rehabilitation centers, schools and many more health related facilities. It’s not just limited to these facilities however, It could also take place in offices that deal heavily with patients. Forms of abuse There are many forms of abuse: discriminatory, financial, physical, psychological, and sexual. Professional abuse always involves: betrayal, exploitation, and violation of professional boundaries. Professionals can abuse in three ways: nonfeasance - ignore and take no indicated action - neglect. misfeasance - take inappropriate action or give intentionally incorrect advice. malfeasance - hostile, aggressive action taken to injure the client's interests. Factors contributing to professional abuse In a working environment, the abuse of power against staff can manifest in various harmful ways. Often, abuse originates from an individual who holds power (i.e. the boss, executive or managers), but as the examples below demonstrate, abuse can also come from someone in a less powerful position. Healthcare settings There are numerous risk factors impacting both perpetrators and professionals who fall victim to assaults. In the context of healthcare settings, healthcare workers are more vulnerable to violence due in large part to the conditions under which care and services are provided. Extensive research conducted identifies that one critical aspect contributing to this heightened vulnerability is the nature of interactions between healthcare workers, patients, friends or visitors. These individuals often find themselves emotionally charged, grappling with complex health issues, uncertainties and high expectations regarding the care and outcomes for their loved ones. This emotional intensity, combined with the perception of healthcare workers as authority figures responsible for the well-being of patients, can contribute to feelings of powerlessness or frustration among individuals receiving care. In some cases, this sense of powerlessness may manifest as aggression or violence towards healthcare. Furthermore, the likelihood of violence is further increased by structural and environmental variables like crowded facilities, long wait times, strict visiting restrictions, a lack of information, and linguistic and cultural disparities. In relation to healthcare workers themselves, they may be faced with shortage of staff, inexperience staff, or a lack of training. Short-staffing not only places a heavier workload on existing personnel but also increases stress levels and reduces the ability of staff to effectively manage patient interactions. As a result, healthcare workers may find themselves stretched thin, forced to juggle multiple responsibilities simultaneously, and unable to provide the level of care and attention they desire. Moreover, the composition of healthcare teams may also play a role in increasing susceptibility to violence. Inexperienced or newly hired staff members, for instance, may lack the confidence, skills, and familiarity with institutional protocols necessary to navigate challenging situations effectively. This lack of experience can leave them feeling ill-equipped to handle confrontations or de-escalate tense interactions with patients or their families, potentially exacerbating conflicts and increasing the risk of violence. Workplace abuse The culture and structure within an organization are critical factors in determining whether the workplace is supportive or hostile. According to Perez Moroz and Brian Kleiner, where there exists a competitive organizational structure, power dynamics often favour a select few individuals who wield authority and influence. This power dynamic can lead to the emergence of abusive behaviours within the organization as those in positions of authority may misuse their power to assert control or dominance over others. The objective of those in positions of power is to secure personal comfort and well-being. Consequently, to achieve this comfort, individuals commonly referred to as management, misuse their authority as a means to accomplish tasks. Bassman and London (1993) highlight the absence of standardized guidelines for handling mistreated subordinates by supervisors/managers in numerous organizations. The imperative to maintain their positions within an organization may drive these managers to mistreat their subordinates. However, managerial abuse may not solely arise from the fear of losing power but could also be influenced by personality disorders, job stress, and learned patterns of aggression. Such managers may engage in nepotism by promoting undeserving subordinates while leveraging company resources for personal gain. A manager displaying abusive tendencies might possess significant self-assurance and managerial skills to mask this unethical behaviour. Furthermore, the gratification derived from abuse may stem from a sense of control and superiority. Impact on victims and communities The impact of workplace abuse, particularly by supervisors or managers, extends beyond individual victims to affect the broader community and organizational culture. Gary Powell (1998) describes an abusive organization as displaying little regard for its employees' well-being, creating an environment where concerns for human needs are disregarded. In such settings, workplace trauma is pervasive, leading to significant emotional and psychological distress among employees. Employees subjected to this emotional abuse, scrutiny, and intrusive surveillance experience diminished job performance and self-worth, while facing increased levels of stress and anxiety. This reduces the overall productivity of the workforce. According to studies, employees who experience abusive supervision have greater turnover rates, less favourable job attitudes, and increased conflict between work and family life among employees. Workplace abuse also perpetuates a cycle of dysfunction, contributing to communication breakdowns, reduced performance, and increased absenteeism. Solutions There are several strategies available to organizations seeking to address professional abuse. A study, for instance, revealed that this problem often arises when there is an extreme power imbalance between the professional and the victim. A framework based on different grades of client empowerment and ways of strengthening it can help solve the problem. Those who have been subjected to professional abuse could also pursue any of the following courses of actions: lodging a complaint; reporting abuse to the police; and, taking legal action. There are also organizations that can help those who are victimized learn more about their rights and the options available to them. An alternative to the solutions posed above is developing a plan of ‘zero tolerance’ which deals with any type or form of discrimination and workplace abuse. This policy would entail the establishment of clear guidelines aimed at addressing any instances or form of discrimination and abuse within the workplace. Education and training initiatives can also be deemed beneficial for addressing workplace abuse effectively. These programs would involve both managers and employees, being educated about acceptable conduct and behaviour in the workplace. For managers, such initiatives provide insights into recognizing the signs of abuse, understanding the impact it can have on individuals and the organization, and learning effective strategies for prevention and intervention. Similarly, education and training initiatives help employees understand their obligations, rights, and methods for reporting abuse. See also References Further reading Books Dorpat Theodore L. Gaslighting, the Double Whammy, Interrogation and Other Methods of Covert Control in Psychotherapy and Analysis (1996) Penfold, P. Susan Sexual Abuse by Health Professionals: A Personal Search for Meaning and Healing (1998) Peterson Marilyn R. At Personal Risk: Boundary Violations in Professional-Client Relationships (1992) Richardson, Sarah and Melanie Cunningham Broken Boundaries - stories of betrayal in relationships of care (2008) Sheehan Michael J. Eliminating professional abuse by managers - Chapter 12 of Bullying: from backyard to boardroom (1996) Academic papers Criticism of work Abuse Professional ethics Institutional abuse

Établissement d'hébergement pour personnes âgées dépendantes

An Établissement d'hébergement pour personnes âgées dépendantes (also called EHPAD) is the most widespread type of French residential care for senior citizens. History After World War II residential care homes for senior citizens were called hospices. A French law of 3 June 1975 changed the designation to maison de retraite (retirement home), partly because the old terminology had become derogatory. Another reform in 1999 created the new term Établissement d’hébergement pour personnes âgées dépendantes (EHPAD). Operation EHPADs can be public or privately owned. In 2017 of a total of 7000 in France 40% were public, 30% belonged to non-commercial organizations and 30% belonged to the private sector. The largest private groups managing EHPAD in France in 2020 were: Korian, with approximately 25,000 beds , with approximately 20,000 beds , with approximately 17,000 beds. Residents The level of dependency of seniors in EHPADs is high: in 2011, more than 40% of residents had Alzheimer's disease, and three quarters had a Cardiovascular disease. Dependency levels A standardized scale determines the level of dependency of a resident. This scale called GIR (groupe iso-ressources) has the following values: GIR 1 : Total mental and physical dependency GIR 2 : High mental and physical dependency GIR 3 : Physical dependency GIR 4 : Partial physical dependency GIR 5 : Moderate dependency GIR 6 : No dependency Costs The cost for a resident can be high. According to a 2010 KPMG study the mean cost of one day for an EHPAD place is 49 € for accommodation and 24 € for care. References Caregiving Elderly care Housing for the elderly

Functional behavior assessment

Functional behavior assessment (FBA) is an ongoing process of collecting information with a goal of identifying the environmental variables that control a problem or target behavior. The purpose of the assessment is to prove and aid the effectiveness of the interventions or treatments used to help eliminate the problem behavior. Through functional behavior assessments, we have learned that there are complex patterns to people's seemingly unproductive behaviors. It is important to not only pay attention to consequences that follow the behavior but also the antecedent that evokes the behavior. More work needs to be done in the future with functional assessment including balancing precision and efficiency, being more specific with variables involved and a more smooth transition from assessment to intervention. Definition Functional behavior assessment (FBA) is a method developed by applied behavior analysis (ABA) to identify the variables that maintain a problem behavior. Behavior is lawful. Whether it is desirable or undesirable, behavior is controlled by environmental variables. Behavior is a function of the antecedent and consequences that make up the three-term contingency. Functional assessment is the process of gathering information about the antecedent stimuli and consequences functional to the problem behavior. It attempts to provide an explanation to why the problem behavior may be occurring. The information about the antecedent stimuli may include the time and place, the presence of others and the frequency. The information collected helps identify which of the antecedent and consequences are maintaining the behavior. The information collected from functional assessment can also help develop appropriate treatments for the target behavior. Stimulus that may have been found to be reinforcing for the original behavior could be transferred to reinforce a more appropriate behavior. Functions of problem behavior The purpose of conducting a functional assessment is to identify the function of the target behavior. There are four main classes of functions of problem behavior. Social positive reinforcement Social positive reinforcement is when another person delivers a positive reinforcement after the problem behavior occurs. This is include the giving of attention, fun activities or goods and services provided by the person. An example of social positive reinforcement would be Max's mother (social) dropping what she is doing and provide attention (positive reinforcement) to her son when he engages in head banging on the wall (problem behavior). Social negative reinforcement Social negative reinforcement is when another person delivers a negative reinforcement after the problem behavior occurs. The person may terminate an aversive stimuli (interaction, task or activity) and the behavior is more likely to be maintained. An example of social negative reinforcement would be Max complains (problem behavior) to his parents (social) when he is asked to do chores, as a result, his parents allows him to escape the task (negative reinforcement). Automatic positive reinforcement Automatic positive reinforcement is when a positive reinforcement occurs automatically and is not mediated by another person. The behavior is strengthened by an automatic reinforcing consequence. An example of automatic positive reinforcement would be an autistic child waving his hands in front of his face (problem behavior) because the sensory stimulation (automatic positive reinforcement) produced is reinforcing for the child. Automatic negative reinforcement Automatic negative reinforcement is when a negative reinforcement occurs automatically reducing or eliminating an aversive stimulus as a reinforcing consequence of the behavior. A popular example of automatic negative reinforcement would be binge eating. Binge eating (problem behavior) had been found to temporarily reduce any unpleasant emotions the person may be experiencing before the binge (automatic negative reinforcement). Assessment methods There are various different methods used to conduct functional assessment, all of which falls into three distinct categories. Indirect methods Indirect functional assessment methods use behavior interviews or surveys to gather information about the person exhibiting the behavior from themselves others who know this person well. The main advantage of indirect methods is they are easy and cheap to conduct and do not take much time. The main disadvantage of indirect methods is that the people involved are relying on their memories, thus some information may be lost or inaccurate. Because of their convenience, indirect methods are used most commonly. It is essential assessment to be clear and objective as this will produce the most accurate answers without interpretation. The goal of the indirect assessment method is to generate information on the antecedent, behavior and consequence that can help generate a hypothesis about the variables that maintains the behavior. Indirect methods can help develop a correlation hypothesis but not a functional relationship. Direct observation methods Direct observation methods involve is present to observe and record the problem behavior as it occurs. The goal of direct observation is to record the immediate antecedent and consequences that functions with the problem behavior within a natural environment. The main advantage of direct observation is that the antecedents and consequences are recorded as it happens instead of recollection of memory. Therefore, the information recorded is generally more accurate. The main disadvantage of direct observation is it requires a considerable amount of time and effort to implement. Another thing about direct observation is, like indirect methods, it can only demonstrate a correlation but not a functional relationship. The observer of the direct observation method should be present in the natural environment when the problem behavior is most likely to occur. The observer should also be trained to record the problem behavior and its functional antecedent and consequences immediately, correctly and objectively. Direct observation can also be an ABC observation. Together with indirect methods, direct and indirect assessments are categorized as descriptive assessment because the antecedent and consequences are described from with memory of events. The information collected aids the development of a hypothesis, but to demonstrate a functional relationship, one must use the experimental method. Experimental methods Experimental methods involve manipulating either the antecedent or consequent variables to determine their influence on the problem behavior. This is the only method that can demonstrate a functional relationship between the antecedent stimulus or the reinforcing consequence and the problem behavior. The main advantage of the experimental method is the demonstration of a functional relationship. The main disadvantage of the experimental method is the extensive use of time and effort to create an experiment. Experimental methods can also be called experimental analysis or functional analysis. Conducting a functional assessment A functional assessment should always be conducted before treating a problem behavior. To develop appropriate treatment, one must have the correct information about the antecedents and consequences controlling the behavior because treatment involves manipulating these environmental events to evoke a change in the problem behavior. Here is the proper procedure to correctly implement a functional assessment. The first step should start with a behavioral interview with the client or someone who knows him/her well. The interview from the first step should help develop a hypothesis about which antecedent would produce the behavior and which reinforcing consequence would maintain it. Once a hypothesis has been formed, the next step is to conduct a direct observation assessment in the natural environment. If the data collected from the interview is consistent with the observation, the validity of the hypothesis is strengthened. With the information from both sources being consistent, confirm your initial hypothesis to develop appropriate treatment plans for the identified antecedent and consequence. If the data collected from the behavioral interview and the information observed from the direct observation is inconsistent, conduct further assessments such as another interview or continued observation to clear up any of the inconsistencies. If after review and extra interviews and further observations, the information collected are still inconsistent, it is time to conduct a functional analysis. A functional analysis is also need if the information is consistent but can not lead to a conclusive, firm hypothesis about the predictably of the antecedent and consequence. Functional interventions After a functional behavior assessment has been conducted, the information collected is used to develop treatments and interventions. Interventions are designed to manipulate the antecedent or/and the consequence of the problem behavior to decrease its occurrence rate and increase the rate of occurrence of functional replacement behaviors. Functional interventions include extinction, differential reinforcement and antecedent manipulations. These intervention are functional because they deal with the environmental events that are functional to the problem behavior. They are also non-aversive as punishment is not involved. More aversive interventions can be used as latter resort if previous non-aversive intervention have been tried and shown ineffective. Punishment such as time-out and response cost are considered negative punishment, which although is still controversial, is more widely accepted than positive punishment such as overcorrection, contingent exercise, guided compliance and physical restraint. As mentioned punishment should only be used as a last resort when other methods have already been considered. Research A lot of research being done with functional assessment deals with self injurious behaviors of mentally challenged children or adults and autistic children. Carr, Newsom and Binkoff conducted an experimental method of functional assessment on two boys with intellectual disabilities exhibiting aggressive behaviors. They hypothesized that their aggressive behaviors were maintained by escape from academic tasks. To test their hypothesis, they set two different experimental conditions; 1. Academic demands were put on the boys, 2. Academic demands were not put on the children. If their hypothesis is true, then the problem behavior should occur much more often in the first condition than the second. Results show that their hypothesis was indeed true as the aggressive behavior occurred at a much higher frequency in the first condition. The researchers concluded that the boy's problem behavior was indeed maintained by the antecedent of academic demands and the consequence of escape from the demands. Another functional assessment research done by Brian Iwata in 1982 worked with children with developmental disabilities showing self injurious behaviors. The research could not conclude what was maintaining their behavior but believed it was either adult attention, escape from demands or sensory stimulation from the injuries. For each of the hypotheses, they created a condition that would fit into the category. For adult attention hypothesis, they created an environment where an adult is in the room with the child but pays no attention to him/her until after the behavior occurs. For the escape from demands hypothesis, they had an adult make a normal demand towards the child, but terminate it if the self injurious behavior occurs. For the sensory stimulation hypothesis, the child is left alone without the presence of anyone or any stimulating activities. Iwata compared the levels of self injurious behaviors across the three conditions and demonstrated that the function of the problem behavior for each child was different. Some wanted attention, others escaped while some were maintained by automatic reinforcement. As shown here, it is very important to conduct a functional assessment to determine what exactly is maintaining the behavior before any function interventions are taken. See also Behavior modification Behavioral targeting Functional analysis (psychology) References Behavior modification Behavioural sciences Educational assessment and evaluation Behavior therapy Disability

Developmental systems theory

Developmental systems theory (DST) is an overarching theoretical perspective on biological development, heredity, and evolution. It emphasizes the shared contributions of genes, environment, and epigenetic factors on developmental processes. DST, unlike conventional scientific theories, is not directly used to help make predictions for testing experimental results; instead, it is seen as a collection of philosophical, psychological, and scientific models of development and evolution. As a whole, these models argue the inadequacy of the modern evolutionary synthesis on the roles of genes and natural selection as the principal explanation of living structures. Developmental systems theory embraces a large range of positions that expand biological explanations of organismal development and hold modern evolutionary theory as a misconception of the nature of living processes. Overview All versions of developmental systems theory espouse the view that: All biological processes (including both evolution and development) operate by continually assembling new structures. Each such structure transcends the structures from which it arose and has its own systematic characteristics, information, functions and laws. Conversely, each such structure is ultimately irreducible to any lower (or higher) level of structure, and can be described and explained only on its own terms. Furthermore, the major processes through which life as a whole operates, including evolution, heredity and the development of particular organisms, can only be accounted for by incorporating many more layers of structure and process than the conventional concepts of ‘gene’ and ‘environment’ normally allow for. In other words, although it does not claim that all structures are equal, development systems theory is fundamentally opposed to reductionism of all kinds. In short, developmental systems theory intends to formulate a perspective which does not presume the causal (or ontological) priority of any particular entity and thereby maintains an explanatory openness on all empirical fronts. For example, there is vigorous resistance to the widespread assumptions that one can legitimately speak of genes ‘for’ specific phenotypic characters or that adaptation consists of evolution ‘shaping’ the more or less passive species, as opposed to adaptation consisting of organisms actively selecting, defining, shaping and often creating their niches. Developmental systems theory: Topics Six Themes of DST Joint Determination by Multiple Causes: Development is a product of multiple interacting sources. Context Sensitivity and Contingency: Development depends on the current state of the organism. Extended Inheritance: An organism inherits resources from the environment in addition to genes. Development as a process of construction: The organism helps shape its own environment, such as the way a beaver builds a dam to raise the water level to build a lodge. Distributed Control: Idea that no single source of influence has central control over an organism's development. Evolution As Construction: The evolution of an entire developmental system, including whole ecosystems of which given organisms are parts, not just the changes of a particular being or population. A computing metaphor To adopt a computing metaphor, the reductionists (whom developmental systems theory opposes) assume that causal factors can be divided into ‘processes’ and ‘data’, as in the Harvard computer architecture. Data (inputs, resources, content, and so on) is required by all processes, and must often fall within certain limits if the process in question is to have its ‘normal’ outcome. However, the data alone is helpless to create this outcome, while the process may be ‘satisfied’ with a considerable range of alternative data. Developmental systems theory, by contrast, assumes that the process/data distinction is at best misleading and at worst completely false, and that while it may be helpful for very specific pragmatic or theoretical reasons to treat a structure now as a process and now as a datum, there is always a risk (to which reductionists routinely succumb) that this methodological convenience will be promoted into an ontological conclusion. In fact, for the proponents of DST, either all structures are both process and data, depending on context, or even more radically, no structure is either. Fundamental asymmetry For reductionists there is a fundamental asymmetry between different causal factors, whereas for DST such asymmetries can only be justified by specific purposes, and argue that many of the (generally unspoken) purposes to which such (generally exaggerated) asymmetries have been put are scientifically illegitimate. Thus, for developmental systems theory, many of the most widely applied, asymmetric and entirely legitimate distinctions biologists draw (between, say, genetic factors that create potential and environmental factors that select outcomes or genetic factors of determination and environmental factors of realisation) obtain their legitimacy from the conceptual clarity and specificity with which they are applied, not from their having tapped a profound and irreducible ontological truth about biological causation. One problem might be solved by reversing the direction of causation correctly identified in another. This parity of treatment is especially important when comparing the evolutionary and developmental explanations for one and the same character of an organism. DST approach One upshot of this approach is that developmental systems theory also argues that what is inherited from generation to generation is a good deal more than simply genes (or even the other items, such as the fertilised zygote, that are also sometimes conceded). As a result, much of the conceptual framework that justifies ‘selfish gene’ models is regarded by developmental systems theory as not merely weak but actually false. Not only are major elements of the environment built and inherited as materially as any gene but active modifications to the environment by the organism (for example, a termite mound or a beaver’s dam) demonstrably become major environmental factors to which future adaptation is addressed. Thus, once termites have begun to build their monumental nests, it is the demands of living in those very nests to which future generations of termite must adapt. This inheritance may take many forms and operate on many scales, with a multiplicity of systems of inheritance complementing the genes. From position and maternal effects on gene expression to epigenetic inheritance to the active construction and intergenerational transmission of enduring niches, development systems theory argues that not only inheritance but evolution as a whole can be understood only by taking into account a far wider range of ‘reproducers’ or ‘inheritance systems’ – genetic, epigenetic, behavioural and symbolic – than neo-Darwinism’s ‘atomic’ genes and gene-like ‘replicators’. DST regards every level of biological structure as susceptible to influence from all the structures by which they are surrounded, be it from above, below, or any other direction – a proposition that throws into question some of (popular and professional) biology’s most central and celebrated claims, not least the ‘central dogma’ of Mendelian genetics, any direct determination of phenotype by genotype, and the very notion that any aspect of biological (or psychological, or any other higher form) activity or experience is capable of direct or exhaustive genetic or evolutionary ‘explanation’. Developmental systems theory is plainly radically incompatible with both neo-Darwinism and information processing theory. Whereas neo-Darwinism defines evolution in terms of changes in gene distribution, the possibility that an evolutionarily significant change may arise and be sustained without any directly corresponding change in gene frequencies is an elementary assumption of developmental systems theory, just as neo-Darwinism’s ‘explanation’ of phenomena in terms of reproductive fitness is regarded as fundamentally shallow. Even the widespread mechanistic equation of ‘gene’ with a specific DNA sequence has been thrown into question, as have the analogous interpretations of evolution and adaptation. Likewise, the wholly generic, functional and anti-developmental models offered by information processing theory are comprehensively challenged by DST’s evidence that nothing is explained without an explicit structural and developmental analysis on the appropriate levels. As a result, what qualifies as ‘information’ depends wholly on the content and context out of which that information arises, within which it is translated and to which it is applied. Criticism Philosopher Neven Sesardić, while not dismissive of developmental systems theory, argues that its proponents forget that the role between levels of interaction is ultimately an empirical issue, which cannot be settled by a priori speculation; Sesardić observes that while the emergence of lung cancer is a highly complicated process involving the combined action of many factors and interactions, it is not unreasonable to believe that smoking has an effect on developing lung cancer. Therefore, though developmental processes are highly interactive, context dependent, and extremely complex, it is incorrect to conclude main effects of heredity and environment are unlikely to be found in the "messiness". Sesardić argues that the idea that changing the effect of one factor always depends on what is happening in other factors is an empirical claim, as well as a false one; for example, the bacterium Bacillus thuringiensis produces a protein that is toxic to caterpillars. Genes from this bacterium have been placed into plants vulnerable to caterpillars and the insects proceed to die when they eat part of the plant, as they consume the toxic protein. Thus, developmental approaches must be assessed on a case by case basis and in Sesardić's view, DST does not offer much if only posed in general terms. Hereditarian Psychologist Linda Gottfredson differentiates the "fallacy of so–called "interactionism"" from the technical use of gene-environment interaction to denote a non–additive environmental effect conditioned upon genotype. “Interactionism's” over–generalization cannot render attempts to identify genetic and environmental contributions meaningless. Where behavioural genetics attempts to determine portions of variation accounted for by genetics, environmental–developmentalistics like DST attempt to determine the typical course of human development and erroneously conclude the common theme is readily changed. Another Sesardić argument counters another DST claim of impossibility of determining contribution of trait influence (genetic vs. environment). It necessarily follows a trait cannot be causally attributed to environment as genes and environment are inseparable in DST. Yet DST, critical of genetic heritability, advocates developmentalist research of environmental effects, a logical inconsistency. Barnes et al., made similar criticisms observing that the innate human capacity for language (deeply genetic) does not determine the specific language spoken (a contextually environmental effect). It is then, in principle, possible to separate the effects of genes and environment. Similarly, Steven Pinker argues if genes and environment couldn't actually be separated then speakers have a deterministic genetic disposition to learn a specific native language upon exposure. Though seemingly consistent with the idea of gene–environment interaction, Pinker argues it is nonetheless an absurd position since empirical evidence shows ancestry has no effect on language acquisition — environmental effects are often separable from genetic ones. Related theories Developmental systems theory is not a narrowly defined collection of ideas, and the boundaries with neighbouring models are porous. Notable related ideas (with key texts) include: The Baldwin effect Evolutionary developmental biology Neural Darwinism Probabilistic epigenesis Relational developmental systems See also Systems theory Complex adaptive system Developmental psychobiology The Dialectical Biologist - a 1985 book by Richard Levins and Richard Lewontin which describe a related approach. Living systems References Bibliography Reprinted as: Dawkins, R. (1976). The Selfish Gene. New York: Oxford University Press. Dawkins, R. (1982). The Extended Phenotype. Oxford: Oxford University Press. Oyama, S. (1985). The Ontogeny of Information: Developmental Systems and Evolution. Durham, N.C.: Duke University Press. Edelman, G.M. (1987). Neural Darwinism: Theory of Neuronal Group Selection. New York: Basic Books. Edelman, G.M. and Tononi, G. (2001). Consciousness. How Mind Becomes Imagination. London: Penguin. Goodwin, B.C. (1995). How the Leopard Changed its Spots. London: Orion. Goodwin, B.C. and Saunders, P. (1992). Theoretical Biology. Epigenetic and Evolutionary Order from Complex Systems. Baltimore: Johns Hopkins University Press. Jablonka, E., and Lamb, M.J. (1995). Epigenetic Inheritance and Evolution. The Lamarckian Dimension. London: Oxford University Press. Kauffman, S.A. (1993). The Origins of Order: Self-Organization and Selection in Evolution. Oxford: Oxford University Press. Levins, R. and Lewontin, R. (1985). The Dialectical Biologist. London: Harvard University Press. Neumann-Held, E.M. (1999). The gene is dead- long live the gene. Conceptualizing genes the constructionist way. In P. Koslowski (ed.). Sociobiology and Bioeconomics: The Theory of Evolution in Economic and Biological Thinking, pp. 105–137. Berlin: Springer. Waddington, C.H. (1957). The Strategy of the Genes. London: Allen and Unwin. Further reading Depew, D.J. and Weber, B.H. (1995). Darwinism Evolving. System Dynamics and the Genealogy of Natural Selection. Cambridge, Massachusetts: MIT Press. Eigen, M. (1992). Steps Towards Life. Oxford: Oxford University Press. Gray, R.D. (2000). Selfish genes or developmental systems? In Singh, R.S., Krimbas, C.B., Paul, D.B., and Beatty, J. (2000). Thinking about Evolution: Historical, Philosophical, and Political Perspectives. Cambridge University Press: Cambridge. (184-207). Koestler, A., and Smythies, J.R. (1969). Beyond Reductionism. London: Hutchinson. Lehrman, D.S. (1953). A critique of Konrad Lorenz’s theory of instinctive behaviour. Quarterly Review of Biology 28: 337-363. Thelen, E. and Smith, L.B. (1994). A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, Massachusetts: MIT Press. External links William Bechtel, Developmental Systems Theory and Beyond presentation, winter 2006. Biological systems Systems theory Evolutionary biology

Scenario (computing)

In computing, a scenario (, ; loaned , ) is a narrative of foreseeable interactions of user roles (known in the Unified Modeling Language as 'actors') and the technical system, which usually includes computer hardware and software. A scenario has a goal, which is usually functional. A scenario describes one way that a system is used, or is envisaged to be used, in the context of an activity in a defined time-frame. The time-frame for a scenario could be (for example) a single transaction; a business operation; a day or other period; or the whole operational life of a system. Similarly the scope of a scenario could be (for example) a single system or a piece of equipment; an equipped team or a department; or an entire organization. Scenarios are frequently used as part of the system development process. They are typically produced by usability or marketing specialists, often working in concert with end users and developers. Scenarios are written in plain language, with minimal technical details, so that stakeholders (designers, usability specialists, programmers, engineers, managers, marketing specialists, etc.) can have a common ground to focus their discussions. Increasingly, scenarios are used directly to define the wanted behaviour of software: replacing or supplementing traditional functional requirements. Scenarios are often defined in use cases, which document alternative and overlapping ways of reaching a goal. Types of scenario in system development Many types of scenario are in use in system development. Alexander and Maiden list the following types: Story: "a narrated description of a causally connected sequence of events, or of actions taken". Brief User stories are written in the Agile style of software development. Situation, Alternative World: "a projected future situation or snapshot". This meaning is common in planning, but less usual in software development. Simulation: use of models to explore and animate 'Stories' or 'Situations', to "give precise answers about whether such a scenario could be realized with any plausible design" or "to evaluate the implications of alternative possible worlds or situations". Storyboard: a drawing, or a sequence of drawings, used to describe a user interface or to tell a story. This meaning is common in Human–computer interaction to define what a user will see on a screen. Sequence: a list of interactive steps taken by human or machine agents playing system roles. The many forms of scenario written as sequences of steps include Operational Scenarios, Concepts of Operations, and Test Cases. Structure: any more elaborately-structured representation of a scenario, including Flowcharts, UML/ITU 'Sequence Charts', and especially in software development Use cases. Negative scenarios or misuse cases may be written to indicate likely threats which should be countered to ensure that systems have sufficient security, safety, and reliability. These help to discover non-functional requirements. Uses in system development Scenarios have numerous possible applications in system development. Carroll (1995) lists 10 different "roles of scenarios in the system development lifecycle": Requirements analysis: scenarios describe the "state-of-the-art" (often called "as-is"); acted scenarios help to discover requirements as analysts "stage a simulated work situation". User-designer communication: users contribute scenarios important to them, or situations they want to experience or avoid. Design rationale: rationale can explain design "with respect to particular scenarios of user interaction". Envisionment: scenarios "can be a medium for working out what a system being designed should look like and do." In this role, scenarios can be "graphical mockups such as storyboards or video-based simulations", and may form early prototypes of the system under design. Software design: "scenarios can be analyzed to identify the central problem domain objects" needed; the same scenarios can be developed to describe the objects' state, behavior and interactions. Implementation: software can be built one scenario at a time, helping "to keep developers focused" and "producing code that is more generally useful". Documentation and Training: "scenarios of interaction that are meaningful to the users" can bridge the gap between the system as built "and the tasks that users want to accomplish using it". Evaluation and testing: since "a system must be evaluated against the specific user tasks it is intended to support", scenarios are ideal for evaluation. Abstraction: general rules that apply across different tasks (or systems) can be identified by comparing scenarios. Team building: "a set of touchstone stories is an important cohesive element in any social system". In differing styles of system development The choice of scenario representation varies widely with style of development, which is related to the industrial context. See also Happy path Scenario testing Strategic assumptions Computer supported brainstorming References Bibliography Alexander, Ian and Beus-Dukic, Ljerka. Discovering Requirements: How to Specify Products and Services. Wiley, 2009. Alexander, Ian F. and Maiden, Neil. Scenarios, Stories, Use Cases. Wiley, 2004. Carroll, John M. (ed) Making Use: Scenario-based Design of Human-Computer Interactions. MIT Press, 2000. Carroll, John M. (ed) Scenario-Based Design: Envisioning Work and Technology in System Development. Wiley, 1995. Cockburn, Alistair. Writing Effective Use Cases. Addison-Wesley, 2001. Cohn, Mike. User Stories Applied: for Agile Software Development. Addison-Wesley, 2004. Fowler, Martin. UML Distilled. 3rd Edition. Addison-Wesley, 2004. External links Notes on Design Practice: Stories and Prototypes as Catalysts for Communication. by Thomas Erickson, in Carroll, 1995. Software requirements Software design Usability

Maximum medical improvement

Maximum Medical Improvement (MMI) occurs when an injured person reaches a state where their condition cannot be improved further or their healing process reaches a Treatment Plateau . It can mean that the patient has fully recovered from the injury or their medical condition has stabilized to the point that no major medical or emotional change can be expected in the person's condition. At that point, no further healing or improvement is deemed possible and this occurs despite continuing medical treatment or rehabilitative programs the injured person partakes in. MMI is relevant in multiple contexts, including personal injury cases and workers' compensation cases. When a worker receiving Workers' Compensation benefits reaches maximum medical improvement, their condition is assessed and a degree of permanent or partial impairment is determined. This degree will impact the amount of benefits the worker is able to receive. MMI means that treatment options have been exhausted. Temporary disability payments are terminated and a settlement is agreed regarding the condition of the worker at this point. References External links Workerscompensation.com, Worker's Compensation resource website https://www.nolo.com/legal-encyclopedia/should-i-wait-until-i-reach-mmi-before-accepting-a-car-accident-settlement-offer.html, personal injury resource website Labour law personal injury Health insurance

Functional capacity evaluation

A functional capacity evaluation (FCE) is a set of tests, practices and observations that are combined to determine the ability of the evaluated person to function in a variety of circumstances, most often employment, in an objective manner. Physicians change diagnoses based on FCEs. They are also required by insurers in when an insured person applies for disability payments or a disability pension in the case of permanent disability. Purpose An FCE can be used to determine fitness to work following an extended period of medical leave. If an employee is unable to return to work, the FCE provides information on prognosis, and occupational rehabilitation measures that may be possible. An FCE can also be used to help identify changes to employee workload, or modifications to working conditions such as ergonomic measures, that the employer may be able to undertake in an effort to accommodate an employee with a disability or medical condition. FCEs are needed to determine if an employee is able to resume working in a capacity "commensurate with his or her skills or abilities" before the disability or medical condition was diagnosed. An FCE involves assessments made by one or more medical doctors. There are two types of FCE used by the United States Social Security Administration: the Mental Functional Capacity Evaluation (MFCE) that measures emotional and mental capacity, and the Physical Functional Capacity Evaluation (PFCE) that measures physical functioning. Studies have been undertaken to assess the accuracy of FCEs in predicting the longterm outcomes for patients, both in terms of returning to work, and in probability of permanent disability. Questions that have been raised include how to identify medical and societal variables in predicting disability. FCEs may be required by law for some employers before an employee can return to work, as well as by insurers before insurance payments can be made. FCEs are also used to determine eligibility for disability insurance, or pension eligibility in the event that an employee is permanently unable to return to work. The United States Social Security Administration has its own FCE, called the Assessment of Disability. A newer FCE model is the World Health Organization's International Classification of Functioning, Disability and Health. During most FCEs, the following measurements are also taken: Lifting power Push and pull power How long one can stand, sit or walk Flexibility and reaching Grasping and holding capabilities Bending capabilities Balance capabilities Metabolic Equivalents (METs) Functional capacity can also be expressed as "METs" and can be used as a reliable predictor of future cardiac events. One MET is defined as the amount of oxygen consumed while sitting at rest, and is equal to 3.5 ml oxygen per kilogram body weight per minute. In other words, a means of expressing energy cost of physical activity as a multiple of the resting rate. For instance; walking on level ground at about 6 km/h or carrying groceries up a flight of stairs expends about 4 METs of activity. Generally, >7 METs of activity tolerance is considered excellent while <4 is considered poor for surgical candidates. Determining one's functional capacity can elucidate the degree of surgical risk one might undertake for procedures that risk blood loss, intravascular fluid shifts, etc. and may tax an already strained cardiovascular system. See also Duke Activity Status Index References Vocational rehabilitation Management cybernetics

Outcome Questionnaire 45

The Outcome Questionnaire 45 (OQ-45), created by Gary M Burlingame and Michael J. Lambert at Brigham Young University, is a 45-item multiple-choice self-report inventory used to measure psychotherapy progress in adults patients. The OQ-45 is currently in its second version (OQ-45.2), which was released in October 2013 by OQ Measures, the company founded by Burlingame and Lambert. Clinical use The instrument was designed as a brief scale to measure the subjective experience of a person, as well as the way they function in the world. Authors intended it to be a low cost instrument with a quick administration time that is sensitive to change across time. The inventory is not intended to be used for diagnostic purposes. Format The OQ-45 contains 45 items. Individuals are asked to describe their experiences in the last week, using a multiple choice format. This response format is consistent across questions: Never, Rarely, Sometimes, Frequently, and Almost Always. The questionnaire was originally developed as a paper version, and was later made available in mobile and web-based formats. Domains of Measurement The OQ-45 measures progress across three different domains of experience: Symptom Distress (SD): Measures an individual's degree of subjective discomfort Interpersonal Relations (IR): Measures impairment in interpersonal functioning Social Role (SR): Measures impairment in functioning at work and in other social roles Scoring Points are assigned for each response using the following scoring rubric: Never (0), Rarely (1), Sometimes (2), Frequently (3), and Almost Always (4). Individual subscales are totaled using addition, after reverse-coding procedures are performed. Higher scores indicate more severe distress and functional impairment. The Symptom Distress subscale contains 25 items, and scores range from 0 to 100. The Interpersonal Relations subscale contains 11 items, and scores range from 0 to 44. The Social Role subscale contains 9 items, and scores range from 0 to 36. A total score (TOT) is calculated by summing the subscales, and scores range from 0 to 180. The instrument's administration and scoring manual provides thresholds for clinically significant distress and impairment, and for reliable change. See also Gary M. Burlingame Michael J. Lambert Outcome measure Psychological evaluation External links OQ-45.2 Website Mental disorders screening and assessment tools

Functional discourse grammar

Functional grammar (FG) and functional discourse grammar (FDG) are grammar models and theories motivated by functional theories of grammar. These theories explain how linguistic utterances are shaped, based on the goals and knowledge of natural language users. In doing so, it contrasts with Chomskyan transformational grammar. Functional discourse grammar has been developed as a successor to functional grammar, attempting to be more psychologically and pragmatically adequate than functional grammar. The top-level unit of analysis in functional discourse grammar is the discourse move, not the sentence or the clause. This is a principle that sets functional discourse grammar apart from many other linguistic theories, including its predecessor functional grammar. History Functional grammar (FG) is a model of grammar motivated by functions, as Dik's thesis pointed towards issues with generative grammar and its analysis of coordination back then, and proposed to solve them with a new theory focused on e.g. concepts such as subject and object. The model was originally developed by Simon C. Dik at the University of Amsterdam in the 1970s, and has undergone several revisions since then. The latest standard version under the original name is laid out in the 1997 edition, published shortly after Dik's death. The latest version features the expansion of the model with a pragmatic/interpersonal module by Kees Hengeveld and Lachlan Mackenzie. This has led to a renaming of the theory to functional discourse grammar. This type of grammar is quite distinct from systemic functional grammar as developed by Michael Halliday and many other linguists since the 1970s. The notion of "function" in FG generalizes the standard distinction of grammatical functions such as subject and object. Constituents (parts of speech) of a linguistic utterance are assigned three types or levels of functions: Semantic function (Agent, Patient, Recipient, etc.), describing the role of participants in states of affairs or actions expressed Syntactic functions (Subject and Object), defining different perspectives in the presentation of a linguistic expression Pragmatic functions (Theme and Tail, Topic and Focus), defining the informational status of constituents, determined by the pragmatic context of the verbal interaction Principles of functional discourse grammar There are a number of principles that guide the analysis of natural language utterances according to functional discourse grammar. Functional discourse grammar explains the phonology, morphosyntax, pragmatics and semantics in one linguistic theory. According to functional discourse grammar, linguistic utterances are built top-down in this order by deciding upon: The pragmatic aspects of the utterance The semantic aspects of the utterance The morphosyntactic aspects of the utterance The phonological aspects of the utterance According to functional discourse grammar, four components are involved in building up an utterance: The conceptual component, which is where the communicative intention that drives the utterance construction arises The grammatical component, where the utterance is formulated and encoded according to the communicative intention The contextual component, which contains all elements that can be referred to in the history of the discourse or in the environment The output component, which realizes the utterance as sound, writing, or signing The grammatical component consists of four levels: The interpersonal level, which accounts for the pragmatics The representational level, which accounts for the semantics The morphosyntactic level, which accounts for the syntax and morphology The phonological level, which accounts for the phonology of the utterance Example This example analyzes the utterance "I can't find the red pan. It is not in its usual place." according to functional discourse grammar at the interpersonal level. At the interpersonal level, this utterance is one discourse move, which consists of two discourse acts, one corresponding to "I can't find the red pan." and another corresponding to "It is not in its usual place." The first discourse act consists of: A declarative illocutionary force A speaker, denoted by the word "I" An addressee A communicated content, which consists of: A referential subact corresponding to "I" An ascriptive subact corresponding to "find", which has the function Focus A referential subact corresponding to "the red pan", which contains two ascriptive subacts corresponding to "red" and "pan", and which has the function Topic The second discourse act consists of: A declarative illocutionary force A speaker An addressee A communicated content, which consists of: A referential subact corresponding to "it", which has the function Topic An ascriptive subact corresponding to "in its usual place", which has the function Focus Within this subact there is a referential subact corresponding to "its usual place", which consists of: A referential subact corresponding to "its" An ascriptive subact corresponding to "usual" An ascriptive subact corresponding to "place" Similar analysis, decomposing the utterance into progressively smaller units, is possible at the other levels of the grammatical component. See also Nominal group Thematic equative Verbal Behavior (book) References External links Functional Grammar home page Functional Discourse Grammar homepage Grammar Grammar frameworks de:Functional Discourse Grammar

St Andrew's Hospital

St Andrews Hospital is a mental health facility in Northampton, England. It is managed by St Andrew's Healthcare. History Formation The facility was founded by public subscription for "private and pauper lunatics" and opened as the Northampton General Lunatic Asylum on 1 August 1838. Thomas Octavius Prichard was appointed as the hospital's first medical superintendent: he was one of the pioneers of "moral management", the humane treatment of the mentally ill. The chapel was designed by Sir George Gilbert Scott and opened in 1863. It became St Andrew's Hospital for Mental Diseases in the 1930s and elected to remain a charity rather than joining the National Health Service in 1948. Controversies Dispatches exposure In 2017, Channel 4 Dispatches aired Under Lock and Key, which highlighted that people with learning disabilities and autism were being kept in secure hospitals, in concerning conditions. The show detailed the experiences of several former patients at St Andrew's Hospital. Concerns included the use of restraint, seclusion and frequent sedation, with one patient remaining mostly in segregation for 22 months, in a room with minimal natural light.  It was also revealed that four patients had died on one ward between October 2010 and May 2011 and that all had been prescribed Clozapine. Information that highlighted the role of the use of Clozapine in the deaths of these patients was not shared with the coroner at the initial inquest into one of the deaths. After the programme's broadcast, St Andrew's issued a statement refuting the allegations that appeared in the programme. Girls on the Edge In 2018 the Child and Adolescent Mental Health Services at the hospital was featured in a BBC Two documentary entitled Girls on the Edge. The programme followed three families whose adolescent daughters had been sectioned under the Mental Health Act 1983 to protect them from harming themselves. The film, made by Dragonfly Film and Television, won a Mind Media Award. Walsall Council legal action In 2018, the father of a girl who has autism and anxiety won a court case against Walsall Council, who had sought to prevent him from publicising details of the conditions his daughter was being detained under, in St Andrew's Hospital. His daughter was being kept in a 12 ft by 10 ft room, with a mattress and chair, with family members being forced to communicate with her via a hole in the metal door, which she was also being fed through. An earlier assessment had concluded that "the current setting is not able to satisfactorily meet her individual care needs" and a recommendation was made suggesting she be moved to a residential setting in the community with high support, but she continued to remain in the conditions, whilst her father was forced to defend legal action taken by Walsall Council to stop him publicly discussing his daughter and the conditions she was being detained under, at St Andrew's Hospital. St Andrew's Chief Executive, Katie Fisher, has spoken publicly about the challenges the hospital faces when discharging patients, as there is a lack of suitable community places for people to move on to. In May 2019, Fisher told the BBC that the organisation "has up to 50 patients stuck in secure units". Notable patients Malcolm Arnold, British composer Frank Bruno, boxer John Clare, the "Northamptonshire peasant poet" Louis de Zoysa, convicted of the 2020 murder of Matt Ratana, a Metropolitan Police sergeant Frank Foster, Warwickshire and England cricketer Violet Gibson, Irish woman who shot Mussolini Josef Hassid, the Polish violinist Lucia Joyce, daughter of James Joyce, stayed here from 1951 until her death in 1982 The Ven. David Roberts, Archdeacon of Monmouth from 1926 to 1930 George Gilbert Scott junior, architect (son of the designer of the chapel) Gladys Spencer-Churchill, Duchess of Marlborough, spent her last 15 years of life in the hospital James Kenneth Stephen, poet References Sources Private hospitals in the United Kingdom Hospital buildings completed in 1838 Psychiatric hospitals in England Hospitals in Northampton

Evolution of schizophrenia

The evolution of schizophrenia refers to the theory of natural selection working in favor of selecting traits that are characteristic of the disorder. Positive symptoms are features that are not present in healthy individuals but appear as a result of the disease process. These include visual and/or auditory hallucinations, delusions, paranoia, and major thought disorders. Negative symptoms refer to features that are normally present but are reduced or absent as a result of the disease process, including social withdrawal, apathy, anhedonia, alogia, and behavioral perseveration. Cognitive symptoms of schizophrenia involve disturbances in executive functions, working memory impairment, and inability to sustain attention. Given the high numbers of individuals diagnosed with schizophrenia (nearly 1% of modern-day populations), it is unlikely that the disorder has arisen solely from random mutations. Instead it is believed that, despite its maladaptive nature, schizophrenia has been either selected for throughout the years or exists as a selective by-product. Hypotheses Balancing Selection and Positive Selection Hypothesis The balancing selection hypothesis suggests that balancing selection, an evolutionary mechanism, has allowed for the persistence of certain schizophrenia genes. This mechanism is defined as maintaining multiple alleles of a gene in the gene pool of a population despite having selective pressures. Heterozygote advantage, a mechanism of balancing selection, is when the presence of both the dominant and recessive allele for a particular gene allow for greater fitness in an individual as compared to if the individual only expressed one type of allele. This mechanism can be seen in the carriers for the schizophrenia gene who express both the dominant and recessive allele. These carriers may express certain advantageous traits that would allow the schizophrenia gene to be selected for. Evidence has suggested a carrier of the schizophrenia gene could experience selective advantage due to their expression of advantageous traits as compared to those who do not express the schizophrenia gene. Studies have shown that some of the carriers for the schizophrenia gene may express adaptive benefits such as a decreased frequency of viral infections. Additional beneficial traits may include a higher IQ, increased creativity, and mathematical reasoning. Due to the presence of these beneficial traits, the schizophrenia gene has not been selected against and has remained prevalent in human development over numerous generations. While the idea of balancing selection hypothesis sounds plausible, there is no substantial evidence in support of this hypothesis. Within the studies that found a positive correlation between specific favorable characteristics and the schizophrenia gene, only a few carriers were tested, meaning that there is no sufficient evidence to assume a direct correlation between these advantageous traits and the carriers of schizophrenia. Although this hypothesis has not yet been substantiated, the advantageous traits that these carriers express could provide a reasonable explanation for why the genes for schizophrenia have not been eliminated. Positive selection is another mechanism that has allowed for the selection of genes contributing to the presence of schizophrenia. Positive selection is a mechanism of natural selection in which beneficial traits are selected for and become prevalent over time in a population. In a study conducted using phylogeny-based maximum-likelihood (PAML), a method that was used to test for positive selection, significant evidence of positive selection was found in the genes associated with schizophrenia. An example of a beneficial trait that has been selected for through positive selection is creativity. Three allelic variants of creativity genes that are also associated with schizophrenia include SLC6A4, TPH1 and DRD2. The high inheritance of creative and cognitive characteristics by these allelic variants in individuals expressing schizophrenia confirms evidence of positive selection within some schizophrenia genes. Additional studies conducted using SNP analysis on the SLC39A8 gene, a gene associated with schizophrenia, found that the T-allele on the gene was associated with reduced blood pressure and a decreased risk of hypertension. These beneficial traits associated with schizophrenia genes provide an explanation for selection of these genes in human development. While promising evidence persists, additional evidence claims that the effect of positive selection may not play a significant role in the presence of schizophrenia. Studies conducted through the use of FST and methods based on sample frequency spectrum (SFS) failed to find convincing signals of positive selection on the CGC-type of the ST8SIA2 gene, another gene associated with schizophrenia. A 2013 systematic review and meta-analysis found that the siblings of schizophrenics had a slightly lower fertility rate than the general population while parents of schizophrenics had a fertility rate roughly similar, leading the researchers to conclude that a compensatory fitness advantage in siblings and parents cannot explain the maintenance of schizophrenia in the human population. Social brain hypothesis A social brain refers to the higher cognitive and affective systems of the brain, evolving as a result of social selection and serving as the basis for social interaction; it is the basis of the complexity of social interactions of which humans are capable. Mechanisms comprising the social brain include emotional processing, theory of mind, self-referencing, prospection and working memory. Patients display defects in various regions of the social brain, such as an inability to grasp social goals, which serves as an indication of a defect in theory of mind. This defect can be caused by the rapid selection for genes associated with language and cognitive ability within the human species. These rapid evolutionary changes, in some cases, may impede normal development within the social brain. As schizophrenia is foremost a disorder of the consciousness, it has been suggested that schizophrenia exists as an unwanted byproduct of the evolution of the prefrontal cortex and other brain regions constituting the social brain. Under increasingly selective pressure induced by increasingly complex social living, the regions of the brain have grown as a means of accommodation and in turn have given rise to vulnerable neural systems. One hypothesis suggests this vulnerability in neural systems has made it possible for changes in genes associated with the social brain that affect neurogenesis, neuronal migration, arborisation, or apoptosis. Although it is unclear which of these factors have exhibited gene changes, it is likely that these changes have contributed to the defect in neurodevelopment seen in schizophrenia patients. A second hypothesis suggests that disturbance in the brain's frontal circuits, a region that largely constitutes the social brain, can lead to a lack of regulation in cognitive control and processing. This defect in regulation could increase the susceptibility for a social disorder like schizophrenia. Social advantage hypothesis This hypothesis refers to the worship of psychics and seers in the times of early civilization; the hallucinatory behavior and delusions brought by schizophrenia may have been highly regaled and allowed the individual to be conferred the title of saint or prophet, raising him on the social spectrum and allowing for social selection to act on the behalf of the disorder. This hypothesis lacks evidence and has not aided in explaining the continued persistence of schizophrenia in modern-day society where people showing symptoms of schizophrenia are typically not identified as saints or prophets. Physiological advantage hypothesis This hypothesis maintains that people with schizophrenia possess a physiological advantage in the form of disease or infection resistance, a theory that has found basis in diseases such as sickle-cell anemia. In one particular study, NAD, an energy carrier found in animals and yeast, is found to be capable of diminishing infectivity of tuberculosis when present in large quantities; this is done by repressing gene expression. However, M. tuberculosis bacterium has been shown to be capable of acting as a drain on NAD supply. Studies in kynurenine pathway activation reveal that M. tuberculosis infection of the pathway causes niacin receptors in the pathway to indicate high levels of niacin, a precursor to NAD that makes de novo synthesis of NAD from tryptophan unnecessary. This change creates the illusion that NAD levels are adequate and that tryptophan conversion is unnecessary. Coevolution with M. tuberculosis has resulted in an attempt to overcome this illusion in a variety of manners, including the up-regulation of niacin receptors and up-regulation of de novo synthesis of NAD from tryptophan via the kynurenine pathway. An enzyme implicated in the initiation of the kynurenine pathway, tryptophan 2,3-dioxygenase (TDO2) is found to activate during niacin-deficient conditions and is also found to be in increased levels in schizophrenic brains. In the postmortem brain tissue of people with schizophrenia, the protein for the high affinity niacin receptor was significantly decreased and, as a result, would allow for the up-regulation of mRNA transcript for the niacin receptor. Shamanistic hypothesis This hypothesis purports that schizophrenia is a vestigial behaviour that was once adaptive to hunting and gathering tribes. Psychosis prompts shamans to communicate with the spirit world, which results in the formation of religious myths. The shamanistic theory posits that the universal presence of shamanism in all hunting and gathering societies is likely due to heritable factors – the same heritable factors that support the worldwide distribution of schizophrenia. One modern version of the theory has invoked the evolutionary mechanism of group selection in order to explain the apparent genetic-based task specialization of shamanism. Immune system Hypothesis Perinatal exposure It has been suggested that acute neuroinflammation during early fetal development may contribute to schizophrenia pathogenesis. The risk of schizophrenia is higher among those who experienced prenatal maternal viral infections like influenza, rubella, measles, and polio as well as bacterial or reproductive infections. The brain is highly sensitive to environmental insults during early development. Factors common to the immune response to a variety of pathogens are mediators in linking the commonalities between prenatal/perinatal infection and neurodevelopmental disorders. One hypothesis suggests that enhanced expression of proinflammatory cytokines and other mediators of inflammation in the maternal, fetal, and neonatal compartments may interfere with brain development, thereby increasing the risk for long-term brain dysfunction later in life. Increased Pro-inflammatory Cytokines Another hypothesis seeking to explain why schizophrenia occurs aim at understanding the activation of the immune system. The activation of the inflammatory response system mediated by cytokines may play a key role in the pathogenesis of schizophrenia. Evidence suggests that serum levels of IL-2, IL-6, IL-8, and TNF-α are significantly elevated in patients with chronic treatment-resistant schizophrenia. Nuclear factor-kappa B regulates the expression of cytokines and an increase in NF-κB levels leads to an increase in proinflammatory cytokine levels Brain-derived Neurotrophic Factor Individuals with schizophrenia have lower levels of brain-derived neurotrophic factor or BDNF. BDNF is responsible for promoting the proliferation, regeneration, and survival of neurons. It is also important for the regulation of cognitive function, something individuals with schizophrenia have trouble doing. Lower BDNF expression is associated with increased IL-6 expression, and increased cortisol levels. The more pro-inflammatory cytokines in circulation, the more the BDNF production decreases. This implies that an excess amount of pro-inflammatory cytokines negatively affects BDNF production. This, in turn, affects the presence and severity of psychosis in individuals with schizophrenia. Self-domestication hypothesis The theory of self-domestication asserts that during the late Pleistocene period, archaic humans split from their hominid ancestors and underwent behavioral changes that led to a reduction of aggression and an increase in "tameness". As a result of this transformation, changes to humans' biological, morphological, physiological, and genetic development occurred; leading to anatomical changes in size, craniofacial structure, and brain structural differences, as well as changes in behavior related reduced levels of stress hormones and delayed maturation of the adrenal glands. The self-domestication hypothesis for evolution of schizophrenia observes the importance our self-domesticated evolution, with emphasis on its contribution to the altered genetic development of the neural crest and our relaxed social cultural niche. Adaptations related these domesticated changes favored the emergence of complex cognitive abilities, including advanced linguistic cognition. The self-domestication hypothesis suggests that schizophrenia results from hypofunction of the neural crest development, triggered by the selection for domesticated "tameness", and emphasize the domestic characteristics that make up the clinical phenotype of schizophrenia. Deficits related to language production and processing are prevalent in both positive and negative symptoms of schizophrenia. In addition, schizophrenic patients often demonstrate more marked domesticated traits at the morphological, physiological, and behavioral levels; including craniofacial abnormalities, desensitized cortical response to stress, and disorganized speech. A study published in 2017 targeted various candidate genes (FOXD3, RET, SOX9, SOX10, GDNF) with overlapping function in relation to schizophrenia, domestication, and neural crest development, and found the largest number of brain area expressions include to be in the frontal cortex, associate striatum nucleus, and hippocampus. Although the results do not reflect the molecular events that occurred during early neural development or evolution, they provide insight into the molecular network that underlies the impaired cognitive and social scenarios that act in the schizophrenic brain, and further suggest that self-domestication, language processing, and schizophrenia have an intimately intertwined relationship. Sexual selection hypothesis This hypothesis builds upon Crespi and Badcock's imprinted brain hypothesis of autism and psychosis by suggesting that the behavioral traits associated with autism and schizophrenia have been beneficial for individual reproductive, mating, and parental strategies; and therefore, have been maintained throughout the human population via sexual selection. Under this hypothesis, autistic- and schizotypy-like traits exist as diametric opposites joined on the same spectrum of normal cognition, and most people display moderate degrees of one or both types of traits. When the spectrum of traits intertwine with the dynamics of genomic imprinting and principles of sexual selection within the context of bipaternal investment patterns, traits act as ornaments of mating behavior. Whereas autistic-like traits are selected for based on their display of mechanistic and practical intelligence for obtaining resources that indicate support for a long-term relationship, schizotypy-traits demonstrate verbal and artistic creativity that indicate strong genetic fitness for a short-term mating strategy. Therefore, variation in different cognitive traits remain adaptive life-history, reproductive, and paternal strategies according to the local ecological conditions and personal characteristics. Although the hypothesis proposes that the cognitive traits do not originate by means of sexual selection and likely evolved for reasons unrelated to mating, the behavioral effects dictated by the genetic autistic- and schizotypy-traits remain varied in the environment and remain under selection; only extreme variants of either of the traits result in their respective clinical condition. See also Evolutionary approaches to schizophrenia Evolutionary approaches to depression References Schizophrenia Evolutionary psychology

Prison healthcare

Prison healthcare is the medical specialty in which healthcare providers care for people in prisons and jails. Prison healthcare is a relatively new specialty that developed alongside the adaption of prisons into modern disciplinary institutions. Enclosed prison populations are particularly vulnerable to infectious diseases, including arthritis, asthma, hypertension, cervical cancer, hepatitis, tuberculosis, AIDS, and HIV, and mental health issues, such as Depression, mania, anxiety, and post-traumatic stress disorder. These conditions link prison healthcare to issues of public health, preventive healthcare, and hygiene. Prisoner dependency on provided healthcare raises unique problems in medical ethics. Scope of field Prison populations create specific medical needs, based on the communal nature of prison life and differing rates of imprisonment for different demographics. For example, general population ageing has increased the number of elderly prisoners in need of geriatric healthcare. In addition, treatment for mental health, sexually transmitted infections like HIV, and substance abuse are all important elements of prison healthcare, as well as knowledge of public health methods.Screening for STI's in prisons is prevalent and well-organized. Inmates infected with HIV have superior access to treatment and care than the general population. HIV infected prisoners typically see their condition improve while incarcerated and oftentimes reduce their HIV to the point that they have undetectable viral loads. The separation of prison healthcare from other medical specialties and healthcare systems leads to its isolation and stigmatization as a field, despite some countries' promise for "equivalence" in healthcare between prison and non-prison patients. Healthcare policy and services in prisons recognise the differences in health needs between women and men. Women in prison have specific needs in relation to menstruation, pregnancy, post-partum health, contraception mental health and menopause. The United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (2010) outline standards for care of women offenders and prisoners and are known as the 'Bangkok Rules'. History Before 1775, imprisonment was rarely used as a punishment for crime. Since that year, however, incarceration rates have grown exponentially, creating the need for physicians in correctional institutions. Aside from medical care, prisoners were often used by doctors to conduct medical research and conduct teaching, a practice amenable to evidence-based medical practices that prefer scientific analysis of pathology, rather than relying on self-reported patient accounts. Prison medicine began, in its most rudimentary form, in Victorian England, under the health reforms promoted by wealthy philanthropist and devout ascetic John Howard and his collaborator, well-to-do Quaker physician John Fothergill. Another early development in the history of prison healthcare was the work of Louis-René Villermé (1782–1863), a physician and pioneering hygienist whose study, Des Prisons, was published in 1820. Doctors often had to pass judgment on whether patients were malingering to avoid labor—a practice continued on slave plantations in the US. The work of Villermé and other French hygienists was an inspiration to German, American, and British public health leaders and spurred an overhaul in the conditions in which prisoners were held. Historically, prison healthcare services have been designed for the majority male prison population and frequently fail to meet basic needs of women. Training Prison healthcare is not currently a primary component of medical education, although academic medical centers are major providers of prison healthcare. In the 21st century, little has been published on curricula for prison healthcare, and few textbooks exist. Prisons are a complicated, stigmatized environment to practice medicine, which makes it difficult to develop specific training programs for them. It is also hard for prisoners to receive the best medical care because they are frequently relocated and often serve short sentences. In one pilot prison-healthcare rotation in the United States, students believed they benefited from exposure to a diverse patient population although the prison's remote location and lack of organized schedule made the experience difficult. Ethics and rights The secondary status of healthcare in prisons and the marginalization and dependency most prisoners experience as a "captive population" pose medical ethics dilemmas for doctors practicing in prisons. Feminist theorist and prison abolitionist Andrea J. Pitts argues that the punitive purpose of prisons prevents most doctors from adequately treating and caring for prisoner patients.In addition, the press has recently become interested in uncovering the unequal treatment of prisoners, highlighting how some prisoners receive special treatment. As a result, any major and costly improvements to prison health initiatives may face backlash from the public, who see prisoners as undeserving of such advantages. Doctors' and medical centers' increased reliance on prisons for providing access to patients ultimately creates a dual loyalty problem, as doctors are forced to balance the medical needs of their patients against the institutional needs of prisons and hospitals. These dilemmas, like organ donation in the United States prison population, make it difficult for doctors to provide patient-centered care in prisons. The UN Nelson Mandela Rules hold that prison healthcare should be provided by national health services and not by "prison authorities or judicial institutions". Oftentimes, medical research and studies conducted by doctors on prisoners were unethical and led to detrimental health effects for these prisoners. A prime example occurred from 1913 to 1951 when Doctor Leo Stanley—a member of the eugenicist movement—served as the chief surgeon at San Quentin State Prison. Stanley had an interest in the field of endocrinology, and he believed that the effects of aging consequently lead to a higher propensity for criminality, weak morality, and undesirable physical attributes. Stanley thus decided to test his theory that by transplanting testicles from younger men into older men, these older men's manhood would be restored. He began by using the testicles of younger executed prisoners—before moving onto using the testicles of livestock such as goats and deer—and grafting these into the bodies of living San Quentin prisoners. By the end of his time at San Quentin, Stanley performed around 10,000 testicular procedures. Another example of the unethical experimentation on prisoners is the case of Doctor Albert Kligman, a famous dermatologist at the University of Pennsylvania who is more known for his discovery of Retin-A. Kligman experimented on prisoners for 20 years, starting in 1951. In 1965, Kligman exposed 75 prisoners at Holmesburg Detention Center and House of Correction in Pennsylvania to high doses of dioxin, the main poisonous ingredient in Agent Orange—a military herbicide and defoliant chemical. Kligman exposed these prisoners to a dosage 468 times greater than that in the Dow Chemical Protocol (it is important to note that Dow Chemical paid Kligman to conduct these experiments in order to analyze the effects of this Vietnam War-era chemical warfare agent). While the records of these experiments were destroyed, there is proof that this was not the only time Kligman experimented on prisoners. Kligman, luring prisoners with compensation ranging from $10 to $300, used prisoners as subjects in wound healing studies by exposing them to unapproved products such as deodorants and foot powders. These prisoners were not fully informed about the potential side effects of these experiments and reported experiencing long-term pain, scars, blisters, cysts, and rashes from these experiments. In many instances, the incarcerated also received prison plastic surgery; approximately 500,000 people were operated on between 1910 and 1995. By 1990, 44 states and eight federal prisons offered plastic surgery in some form. Many of these surgeries were considered "cosmetic" operations, and involved facelifts, blepharoplasties, chin augmentation, scar removal, and more, the goal being to reduce recidivism, based on psychological theories surrounding lookism. They also offered a way to subvert the "ugly laws" that discriminated against people based on their appearance, which intersected with racism and poverty. These surgeries were supported by the government, and, to begin with, by the public. Another relevant case of the unethical experimentation on prisoners involves the case of Sloan-Kettering Institute oncologist Doctor Chester Southam, who recruited prisoners during the 1950s and 1960s and injected HeLa cancer cells into them in order to learn about how people's immune systems would react when directly exposed to cancer cells. Some of the results include the growth of cancerous nodules in these individuals. Lastly, in a study involving Oregon State Penitentiary prisoners between 1963 and 1973, endocrinologist Carl Heller experimented on prisoners by designing a contraption that would radiate their testicles at varying amounts in order to test what effects radiation has on male reproduction. Prisoners were compensated for their participation, but it was discovered that they were not fully informed about the risks of the experiment—such as significant pain, inflammation, and a risk of acquiring testicular cancer. Countries Ghana Like other countries, prisoners in Ghana are at high risk for HIV and hepatitis C. The relationship between prisons and the national Ghana Health Service is also weak, leading to disorganized care. United Kingdom Within the last several decades, the number of prisoners in England and Wales has almost doubled. As a result, the prisons are overcrowded and the health of the prisoners is at a higher risk. Health care in prisons has been commissioned by NHS England since 2013, yet it still remains a work in progress. Before that, it was locally commissioned by primary care trusts. Guidelines produced in 2016 by the National Institute for Health and Care Excellence recommended that on admission there should be a health check with confidential testing for hepatitis B, hepatitis C and HIV. In 2016, there were more than 4,400 prisoners aged 60 or over in England and Wales, and the number was increasingly rapidly. "They are sicker and more likely to have complex health needs than people of an equivalent age who are living in the community". The House of Commons Health Select Committee produced a report on prison healthcare in November 2018. They found that difficulties in getting prescribed medication had led to prisoners being hospitalised. They had to make an appointment for medication which outside prison was freely available and they could only get one day's supply at a time. Possession of medication could lead to bullying. Transfers from prison to secure beds in psychiatric hospitals in London were taking up to a year in 2019. In the UK women represent just 5% of the prison population, however 65% of them have depression. This is more than the male population at 37%. 23% of all prisoners who self-harm are women. In 2018 the UK Government published standards for the provision of services to improve the health and well-being of women in prison. The guidelines recognize that interventions must take account of gender as well as circumstances while inside prison and when they are released back into the community particularly with regard to their children. The UK Government estimates that 24% - 31% of women prisoners have one or more dependents. The UK has practiced some privatization for its prison healthcare. For example, Care UK provides healthcare for people in about 30 prisons. LloydsPharmacy won a contract for pharmacy services in the 15 Scottish prisons in May 2019. The contract for £17 million runs until April 2022. United States Before the 1960s, prisons determined what healthcare they would provide with little state or federal oversight, due to the US' "hands-off" doctrine. Psychological treatment often included moral-uplift bibliotherapy from prison libraries. Modern US prison healthcare arose after events like the Arkansas prison scandal of 1968 revealed the corruption of the Trusty system and unethical medical research conducted on prisoners. Spates of prison uprisings and campaigns for prisoners' rights pressured the US prison system to change. In the 1970s, widespread intervention by federal courts improved conditions of confinement, including health care services and public health conditions, and stimulated investment in medical staff, equipment, and facilities to improve the quality of prison and jail medical services. Guidelines issued by the American Public Health Association and the creation of the National Commission on Correctional Health Care also improved prisoner healthcare. With increased care came increased costs. Compared to the UK, the US now uses more partnerships with universities and the private sector to provide healthcare to prison populations. Cutting costs from public health crises, like mental health, AIDS, tuberculosis, and other infectious diseases within American prisons is a primary motivation. These partnerships are supported for the improvements they make to public health and the training opportunities they provide for medical students, although specialized medical training in prison settings is rare. The outsourcing of prison healthcare has led to controversies with companies like Corizon or Prison Health Services providing substandard or negligent care to prisoners. Prison is often the first place that people in the USA are able to receive medical treatment that they couldn't afford outside. Inmates often receive more medical treatment in prison than they do in the outside world, largely because many ex-prisoners lose federal benefits such as Medicaid after incarceration. However, upon release, inmates do not continue to receive the treatment they need and oftentimes their condition reverts to pre-incarceration level severity. Although US prisoners are entitled to medical care and receive more treatment than they do in the outside world, the marginal nature of prison healthcare and US mass incarceration means that many prisoners also go untreated . Following the mass closure of mental health hospitals in the 1960s, Mental health services in US prisons often aren't available for criminals; most prisoners have an untreated mental disorder and psychiatric care or treatment is expensive for the mentally ill. 64 percent of jail inmates, 54 percent of state prisoners, and 45 percent of federal prisoners in the US report having mental health concerns. Health care in American women's prisons often does not meet the needs of women prisoners, such as in the areas of pregnancy and prenatal care, menstrual hygiene and gynecological services, and mental health, especially associated with past trauma or sexual abuse. Despite offering quality medical assistance to certain prisoners with specific illnesses, prison clinics do not meet the needs of all and often presume the continuation of the US prison–industrial complex. The Society of Correctional Physicians is a non-profit physician organization founded in August, 1992 as national educational and scientific society for the advancement of correctional medicine, and became the American College of Correctional Physicians in 2015. See also Healthcare for LGBT prison patients Correctional nursing Experimentation on prisoners Forensic nursing Menopause in incarceration Mental health among female offenders in the United States Mental health court Mentally ill people in United States jails and prisons Prison plastic surgery Prisoner suicide References Further reading Penology Women's health Equality rights Health policy Men's health

Adaptive performance

Adaptive performance in the work environment refers to adjusting to and understanding change in the workplace. An employee who is versatile is valued and important in the success of an organization. Employers seek employees with high adaptability, due to the positive outcomes that follow, such as excellent work performance, work attitude, and ability to handle stress. Employees, who display high adaptive performance in an organization, tend to have more advantages in career opportunities unlike employees who are not adaptable to change. In previous literature, Pulakos and colleagues established eight dimensions of adaptive performance. Dimensions Pulakos et al. proposed the following dimensions for adaptive performance: Handling emergencies and crisis situations: making quick decisions when faced with an emergency. Handling stress in the workforce: keeping composed and focused on task at hand when dealing with high demand tasks Creative problem solving: thinking outside the boundary limits, and innovatively to solve a problem. Dealing with uncertain and unpredictable work situations: able to become productive despite the occurrence of unknown situations. Learning and manipulating new technology, task, and procedures: approach new methods and technological constructs in order to accomplish a work task. Demonstrating interpersonal adaptability: being considerate of other people's points of view when working in a team to accomplish a certain goal. Demonstrating cultural adaptability: being respectful and considerate of different cultural backgrounds. Demonstrating physically oriented adaptability: physically adjusting one's self to better fit the surrounding environment. Measurement Pulakos et al. developed a scale for adaptive performance based on their eight-dimension model. This scale, the Job Adaptability Inventory (JAI), contains 132 questions (15 – 18 questions per dimension). Another similar tool is the I-ADAPT measure (I-ADAPT-M) developed by Ployhart and Bliese, based on their I-ADAPT theory. They focused on adaptability as a personality-like trait which describes individual's ability to adapt to organizational changes. Therefore, there is a difference between I-ADAPT-M and the JAI which measures adaptive performance as behaviors. The I-ADAPT-M also has eight dimensions (crisis adaptability, stress adaptability, creative adaptability, uncertain adaptability, learning adaptability, interpersonal adaptability, cultural adaptability, and physical adaptability), with 5 items for every dimension. Predictors Several predictors of adaptive performance have been examined systematically, including cognitive abilities, Big Five personality traits, and goal orientation. According to the meta-analytic evidence, cognitive abilities promote adaptive performance. Cognitive abilities are particularly important when dealing with complex dynamic tasks. Other examined antecedences of adaptive performance seem to be less important than cognitive abilities. To illustrate, personality traits like Big Five are weakly related to adaptive performance. Only emotional stability and conscientiousness seem to be somewhat relevant. Motivational predictors have been examined too. However, goal orientation (e.g., learning goal orientation) is only relevant when predicting subjective (e.g., self-reported) adaptive performance. Thus, goal orientation is not useful when predicting objective adaptive performance (e.g., task outcomes). Work stress Work stress has been considered as a major factor of many work outcomes, like performance, nonproductive behavior and turnover. An employee being able to adapt to change within an organization is more focused, and able to deal with stressful situations. An employee who is unable to [absolve their strain] is unable to focus on what is occurring in the organization, such as organizational change. Not only can work stress predict adaptive performance to a considerable extent, there are also a lot of overlaps between adaptive performance and stress coping. Stress appraisal It has been long recognized that work stress generally has a negative effects on job performance, but there is differential influence resulting from different perceptions of stressors. When faced with a new situation, individuals would spontaneously begin to evaluate their own abilities and skills as compared with the requirements of the situation, which is referred to as stress appraisals. Such stress appraisal has two stages: primary appraisal and secondary appraisal. In the primary appraisal stage, individuals evaluate what potential threats there will be, concerning the demands from situation and the goals and values of themselves. In the secondary appraisal stage, individuals evaluate the resources they have to deal with those requirements. The results of appraisal, after two stages, are indicated to fall on a continuum between two extremes of being challenged and threatened. Challenge appraisals mean that individuals feel their resources, like abilities and social support to be abundant sufficient to fulfill requirements of the situation. Threat appraisals, on the other hand, mean that individuals are not confident about their abilities or other resources to respond to the situation demands. Threat appraisals and challenge appraisals could influence job performance distinctively. As for adaptive performance, the more challenging (i.e., the less threatening) one's stress appraisals are, the more adaptive performance he/she would have. This relationship is mediated by self-efficacy, which is a belief about one's capacities for certain tasks. Challenging rather than threatening appraisals would lead to higher levels of self-efficacy, and thus benefit individuals' adaptive performance. Stress coping Coping, as a form of response to stressors, describes how individuals handle stressful events. It is very close to one dimension of adaptive performance by definition (i.e., the Handling Work Stress dimension), and coping has been suggested to be another form of adaptation. However, they are still different constructions. Stress coping could be divided into several styles and strategies based on several theories. One general idea is to divide coping as active coping and avoidant coping. Active coping means to proactively address and resolve stressful events, like quitting a stressful job and changing into a less overwhelming one. Avoidant coping means to reduce stress by ignoring it, like involving in problematic drinking. Another set of coping strategy types includes problem-focused coping and emotion-focused coping. Problem-focused coping involves using skills and knowledge to deal with the cause of their problems. Emotion-focused coping involves releasing negative emotions by ways like distracting or disclaiming. Adaptive performance involves a mixture of different coping strategies. Because adaptive performance concerns positive aspects of behaviors, it is more closely related to coping strategies that have positive effects, such as active coping and problem-focused coping. Therefore, adaptive performance is more likely to contain such behaviors in stressful situations. Team adaptive performance In addition to individual adaptive performance, psychologists are also interested in adaptive performance at team level. Team adaptive performance is defined as an emergent phenomenon that compiles over time from the unfolding of a recursive cycle whereby one or more team members use their resources to functionally change current cognitive or behavioral goal-directed action or structures to meet expected or unexpected demands. It is a multilevel phenomenon that emanates as team members and teams recursively display behavioral processes and draw on and update emergent cognitive states to engage in change. Team adaptive performance is considered as the core and proximal temporal antecedents to team adaptation, which could be seen as a change in team performance in response to a salient cue or cue stream that leads to a functional outcome for the entire team. Along with the definition of team adaptive performance, researchers came up with a four-stage model to describe the process of team adaptive performance. The four core constructs characterizing this adaptive cycle include: (1) situation assessment; (2) plan formulation; (3) plan execution, via adaptive interaction processes; and (4) team learning, as well as emergent cognitive states (i.e., shared mental models, team situational awareness, psychological safety), which serve as both proximal outcomes and inputs to this cycle. Team adaptive performance differs from individual adaptive performance from several aspects. Team adaptive performance reflects the extent to which the team meets its objectives during a transfer performance episode, whereas individual adaptive performance reflects the extent to which each member effectively executes his or her role in the team during the transfer episode. Team adaptive performance also has different antecedents compared with individual adaptive performance. Predictors People have identified several dispositional and contextual factors that would affect team adaptive performance. The most obvious and natural predictor of team adaptive performance is characteristics of team members, or team composition. Team composition with respect to members' cognitive ability is positively associated with team adaptive performance, with a moderation effect of team goals. Teams with difficult goals and staffed with high-performance orientation members are especially unlikely to adapt. Teams with difficult goals and staffed with high-learning orientation members are especially likely to adapt. Moreover, team members' self-leadership, conscientiousness, and attitudes could also influence team adaptive performance. Other factors are more related to interactions between team members and team environment, like team learning climate. Among them coordination of team members has been proved to be a most influential factor. Teams' ability to adapt their coordination activities to changing situational demands is crucial to team performance. A stronger increase in the teams' adaptive coordination was found to be related to better performance. Researchers have posited that the maintenance of coordinated effort and activities ("coordination maintenance") is necessary for high team adaptive performance. This is because even with well-adapted individual performance, workflow at the team level often becomes disrupted, "overflowing" in particular directions. Overflow may create excessive work demands for some team members, while encouraging social loafing among those who are in the ebb of the workflow (see social loafing). This suggests that, although team members may have their own task boundaries, and individual adaptive performance may depend on each member's individual capabilities, however to the team, each employee's adaptive performance may result in successful completion of the team task only if all activities are coordinated and synchronized in a holistic fashion. Team learning climate also displays a significant, positive relationship with team adaptive performance. Leadership Studies show that for an individual to show leadership, they must not only perform well but the individual would need to be an adaptive learner as well. An individual who displays adaptive qualities and productivity in a team will most likely also display strong leadership characteristics. Organizations value adaptive performance in the leadership characteristics an individual possess, as it has proven to help workers maintain productivity in a dynamic work environment. For leaders to successfully perform their roles, they must be able to effectively address tasks and also be able to overcome social challenges. Adaptive performance is a critical characteristic to have when being the leader of an organization because it aids in successfully handling any workplace situations that may arise and helping an organization progress. Instead of resisting change in the workplace, a team leader with adaptive performance establishes a new behavior appropriate to the situation to shift a potential problem into a positive outcome. The correct type of leadership makes a positive change in the characteristics of a team's adaptability to assist in maintaining a healthy and positive workforce. Employees who display adaptive performance in leadership set an example for their colleagues specifically in showcasing the best way to prepare and handle adaptation in occurring organizational changes. Adaptive performance in leadership is valued by employers because an employee who displays those two characteristics tends to exemplify and motivate adaptive behavior within other individuals in the workforce. Transformational leadership In organizational situations where adaptability to the environment and difficult challenges occur often, an individual who possess transformational leadership is preferred. Transformational leadership is a leadership style that encourages team members to imagine new ideas of change and to take action on these ideas to help handle certain situations. This particular leadership style is commonly used in organizations, due to its positive outcomes such as higher work engagement, motivation, and creativity in employees. Parker and Mason's 2010 study introduced a relationship between transformational leadership with work adaptation and work performance. The study stated that transformational leadership relates to adaptive performance by having team members become creative in the different strategies that can be used when approaching a certain situation which eventually leads to a higher performance. Being creative and handling stressful situations the team leader as well as the team exemplifies the dimensions of adaptive performance. This particular leadership style has also been shown as a motivator to increase the behavior of performance and adaptability in employees. An individual showcasing transformational leadership has the ability to encourage more adaptive and productive behavior within team members through presenting new ideas and possible outcomes in the workplace. Leadership and adaptive decision making An individual who displays leadership adaptability is one who is able to adjust their thoughts and behavior to attain appropriate responses to complex situations helping them make appropriate decisions. A leader must make decisions and be adaptable to any organizational changes in order for the team to collectively continue workplace productivity. An adaptive leader makes decisions to perform a specific action to better fit the organization and help it become productive. By a leader displaying adaptive performance when making a decision, the team leader shows their awareness of a situation leading to new actions and strategies to reestablish fit and effectiveness. Organizations value the characteristic of adaptive decision making in an individual as it displays an individual's understanding and adjusting capabilities to a difficult situation further aiding in the decision making process. See also Flexibility (personality) Integrative complexity Openness to experience Organisation climate Psychological resilience Situation awareness Turnover (employment) Workplace Occupational burnout References Human resource management Industrial and organizational psychology Life skills Psychological adjustment

Content validity

In psychometrics, content validity (also known as logical validity) refers to the extent to which a measure represents all facets of a given construct. For example, a depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. An element of subjectivity exists in relation to determining content validity, which requires a degree of agreement about what a particular personality trait such as extraversion represents. A disagreement about a personality trait will prevent the gain of a high content validity. Description Content validity is different from face validity, which refers not to what the test actually measures, but to what it superficially appears to measure. Face validity assesses whether the test "looks valid" to the examinees who take it, the administrative personnel who decide on its use, and other technically untrained observers. Content validity requires the use of recognized subject matter experts to evaluate whether test items assess defined content and more rigorous statistical tests than does the assessment of face validity. Content validity is most often addressed in academic and vocational testing, where test items need to reflect the knowledge actually required for a given topic area (e.g., history) or job skill (e.g., accounting). In clinical settings, content validity refers to the correspondence between test items and the symptom content of a syndrome. Measurement One widely used method of measuring content validity was developed by C. H. Lawshe. It is essentially a method for gauging agreement among raters or judges regarding how essential a particular item is. In an article regarding pre-employment testing, proposed that each of the subject matter expert raters (SMEs) on the judging panel respond to the following question for each item: "Is the skill or knowledge measured by this item 'essential,' 'useful, but not essential,' or 'not necessary' to the performance of the job?" According to Lawshe, if more than half the panelists indicate that an item is essential, that item has at least some content validity. Greater levels of content validity exist as larger numbers of panelists agree that a particular item is essential. Using these assumptions, Lawshe developed a formula termed the content validity ratio: where content validity ratio, number of SME panelists indicating "essential", total number of SME panelists. This formula yields values which range from +1 to -1; positive values indicate that at least half the SMEs rated the item as essential. The mean CVR across items may be used as an indicator of overall test content validity. provided a table of critical values for the CVR by which a test evaluator could determine, for a pool of SMEs of a given size, the size of a calculated CVR necessary to exceed chance expectation. This table had been calculated for Lawshe by his friend, Lowell Schipper. Close examination of this published table revealed an anomaly. In Schipper's table, the critical value for the CVR increases monotonically from the case of 40 SMEs (minimum value = .29) to the case of 9 SMEs (minimum value = .78) only to unexpectedly drop at the case of 8 SMEs (minimum value = .75) before hitting its ceiling value at the case of 7 SMEs (minimum value = .99). However, when applying the formula to 8 raters, the result from 7 Essential and 1 other rating yields a CVR of .75. If .75 was not the critical value, then 8 of 8 raters of Essential would be needed that would yield a CVR of 1.00. In that case, to be consistent with the ascending order of CVRs the value for 8 raters would have to be 1.00. That would violate the same principle because you would have the "perfect" value required for 8 raters, but not for ratings at other numbers of raters at either higher or lower than 8 raters. Whether this departure from the table's otherwise monotonic progression was due to a calculation error on Schipper's part or an error in typing or typesetting is unclear. , seeking to correct the error, found no explanation in Lawshe's writings nor any publications by Schipper describing how the table of critical values was computed. Wilson and colleagues determined that the Schipper values were close approximations to the normal approximation to the binomial distribution. By comparing Schipper's values to the newly calculated binomial values, they also found that Lawshe and Schipper had erroneously labeled their published table as representing a one-tailed test when in fact the values mirrored the binomial values for a two-tailed test. Wilson and colleagues published a recalculation of critical values for the content validity ratio providing critical values in unit steps at multiple alpha levels. The table of values is the following one: See also Construct validity Criterion validity Test validity Validity (statistics) Face Validity References External links Handbook of Management Scales, a Wikibook containing previously used multi-item scales to measure constructs in the empirical management research literature. For many scales, content validity is discussed. Validity (statistics)

Legitimate peripheral participation

Legitimate peripheral participation (LPP) describes how newcomers become experienced members and eventually old timers of a community of practice or collaborative project. LPP identifies learning as a contextual social phenomenon, achieved through participation in a community practice. According to LPP, newcomers become members of a community initially by participating in simple and low-risk tasks that are nonetheless productive and necessary and further the goals of the community. Through peripheral activities, novices become acquainted with the tasks, vocabulary, and organizing principles of the community's practitioners. Gradually, as newcomers become old timers and gain a recognized level of mastery, their participation takes forms that are more and more central to the functioning of the community. LPP suggests that membership in a community of practice is mediated by the possible forms of participation to which newcomers have access, both physically and socially. In the case of a mentor-mentee relationship between older timers and newcomers, the old timer has both the power to confer legitimacy to the newcomer, and to control the newcomer's level of access to different community practices and experiences. If newcomers can directly observe the practices of experts, they understand the broader context into which their own efforts fit. Conversely LPP suggests that newcomers who are separated from the experts have limited access to their tools and community and therefore have limited growth. As participation increases, situations arise that allow the participant to assess how well they are contributing through their efforts, thus legitimate peripheral participation provides a means for self-evaluation. LPP is not reserved for descriptions of membership in formal organizations or professions whose practices are highly defined. For example, O'Donovan and Kirk suggest that young people's participation in sport can be compared to a Community of Practice related to physical education. In his later work on communities of practice, Wenger abandoned the concept of legitimate peripheral participation and introduced the idea of a duality instead; however, the term is still widely used in relation to situated learning. See also Community of practice Cultural-historical activity theory (CHAT) Knowledge sharing Online participation References Further reading Bryant, Susan, Andrea Forte and Amy Bruckman, Becoming Wikipedian: Transformation of participation in a collaborative online encyclopedia, Proceedings of GROUP International Conference on Supporting Group Work, 2005. pp 1-10 Educational psychology Sociology of education

Harm avoidance

Harm avoidance (HA) is a personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued. In MRI studies HA was correlated with reduced grey matter volume in the orbito-frontal, occipital and parietal regions. Harm avoidance is a temperament assessed in the Temperament and Character Inventory (TCI), its revised version (TCI-R) and the Tridimensional Personality Questionnaire (TPQ) and is positively related to the trait neuroticism and inversely to extraversion in the Revised NEO Personality Inventory and the Eysenck Personality Questionnaire. Researchers have contended that harm avoidance represents a composite personality dimension with neurotic introversion at one end of the spectrum and stable extraversion at the other end. Harm avoidance has also been found to have moderate inverse relationships with conscientiousness and openness to experience in the five factor model. The HA of TPQ and TCI-R has four subscales: Anticipatory worry (HA1) Fear of uncertainty (HA2) Shyness/Shyness with strangers (HA3) Fatigability/Fatigability and asthenia (weakness) (HA4) It has been suggested that HA is related to high serotonergic activity, and much research has gone into investigating the link between HA and components of the serotonin system, e.g. genetic variation in 5-HTTLPR in the serotonin transporter gene. References External links Personality traits

Bennett scale

The Bennett scale, also called the Developmental Model of Intercultural Sensitivity (DMIS), was developed by Milton Bennett. The framework describes the different ways in which people can react to cultural differences. Bennett's initial idea was for trainers to utilize the model to evaluate trainees' intercultural awareness and help them improve intercultural sensitivity, also sometimes referred to as cultural sensitivity, which is the ability of accepting and adapting to a brand new and different culture. Organized into six stages of increasing sensitivity to difference, the DMIS identifies the underlying cognitive orientations individuals use to understand cultural difference. Each position along the continuum represents increasingly complex perceptual organizations of cultural difference, which in turn allow increasingly sophisticated experiences of other cultures. By identifying the underlying experience of cultural difference, predictions about behavior and attitudes can be made and education can be tailored to facilitate development along the continuum. The first three stages are ethnocentric as one sees his own culture as central to reality. Climbing the scale, one develops a more and more ethnorelative point of view, meaning that one experiences one's own culture as in the context of other cultures. By the fourth stage, ethnocentric views are replaced by ethnorelative views. Developmental model of intercultural sensitivity (Six stages of Bennett scale) 1-3 stages reflect ethnocentrism in cross-cultural communication. During these three phases, a person sees their original culture as the most superior one and takes it as the criteria to judge other cultures. Denial of difference Individuals experience their own culture as the only "real" one, while other cultures are either not noticed at all or are understood in an undifferentiated, simplistic manner. People at this position are generally uninterested in cultural difference, but when confronted with difference their seemingly benign acceptance may change to aggressive attempts to avoid or eliminate it. Most of the time, this is a result of physical or social isolation, where the person's views are never challenged and are at the center of their reality. Members of dominant culture are more likely to have a denial orientation towards cultural diversity. Defense of difference Differences are acknowledged, but they are denigrated rather than embraced. Rather, one' s own culture is experienced as the most "evolved" or best way to live. This position is characterized by dualistic us/them thinking and frequently accompanied by overt negative stereotyping. They will openly belittle the differences among their culture and another, denigrating race, gender or any other indicator of difference. People at this position are more openly threatened by cultural difference and more likely to be acting aggressively against it. Minimization of difference People recognize superficial cultural differences in food, customs, etc. and have somewhat positive view about cultural differences. But they still emphasize human similarity in physical structure, psychological needs, and/or assumed adherence to universal values. People at this position are likely to assume that they are no longer ethnocentric, and they tend to overestimate their tolerance while underestimating the effect (e.g. “privilege”) of their own culture. They usually assumes that our own set of fundamental behavioral categories are absolute and universal. Acceptance of difference One's own culture is experienced as one of a number of equally complex worldviews. People at this position appreciate and accept the existence of culturally different ways of organizing human existence, although they do not necessarily like or agree with every way. They can identify how culture affects a wide range of human experience and they have a framework for organizing observations of cultural difference. We recognize people from this stage through their desire to be informed or proactively learn about alien cultures, and not to confirm prejudices. Adaptation to difference Individuals are able to expand their own worldviews to accurately understand other cultures and behave in a variety of culturally appropriate ways. In this stage, multicultural participants start to develop intercultural communication skills, change their communication styles, and effectively use empathy or frame of reference shifting, to understand and be understood across cultural boundaries. At this stage, one is able to act properly outside of one's own culture. Integration of difference One's experience of self is expanded to include the movement in and out of different cultural worldviews. People at this position have a definition of self that is "marginal" (not central) to any particular culture, allowing this individual to shift rather smoothly from one cultural worldview to another. At this point, a will to comprehend and adopt various beliefs and norms begins to emerge, demonstrating a high level of intercultural sensitivity. 4-6 stages reflect ethnorelativism in cross-cultural communication. During these three phases, a person gradually treats all culture as reasonable and try to understand every behavior from the aspect of cultures behind. Evolutionary strategies In his theory, Bennett describes what changes occur when evolving through each step of the scale. Summarized, they are the following: From denial to defense: the person acquires an awareness of difference between cultures From defense to minimization: negative judgments are depolarized, and the person is introduced to similarities between cultures. From minimization to acceptance: the subject grasps the importance of intercultural difference. From acceptance to adaptation: exploration and research into the other culture begins From adaptation to integration: subject develops empathy towards the other culture. Application of Bennett scale for the study of various topics Diversity in education Schools play an important role in shaping the multicultural perspective of students. A study published in 2011 by Frank Hernandez and Brad W. Kose found that the Bennett Scale provides a robust measure of principals' cultural competence in terms of how they understand differences. Principals' DMIS orientation how they could influence their understanding of social justice and further make them implement different leadership practices for diverse schools. Specifically, the researchers provided various explanations of the pervasive performance gap that sees white children outperforming their black or Latino classmates on standardised tests, academics, and school completion based on the Bennett Scale as a theoretical framework. Education professionals may rationalize school policies and activities for cultural diversity and help achieve cultural equality in the educational environment by determining which of the six phases of intercultural sensitivity the particular principal is in. For instance, a principal in minimization phase may organize international cuisine festivals in the school, or use cultural and heritage festivals as opportunities for intercultural education. But since it overlooks cultural distinctions, the school might not consider to launch a multicultural program or make curriculum changes that respect students' cultural nuances. Another study applied Bennett Scale to the curriculum of university general education courses. In the current context of globalization and growing diversity in schools, experiencing and learning about cultural differences in the school environment is an important instructional method. This study used Bennett Scale as an analytical model, coded and quantitatively analyzed data of cross-cultural sensitivity among 48 students from multicultural backgrounds receiving university general education. According to the findings, a diversity curriculum that motivates students to share and practice their viewpoints on social issues is more likely to foster empathy and raise levels of cross-cultural sensitivity than one that only emphasizes information comprehension with assignments including material reading and essay writing. Intercultural communication Bennett Scale has mostly been applied to analysis on people's cross-cultural sensitivity, but some scholars have expanded its application to organizational communications. Informed by Bennett Scale and Botan's Five steps in Issue Management model, Radu Dumitrascu developed a new corporate adaption model and follow-up intercultural communication approaches for international business. According to how they handle cultural diversity and cultural affiliations and localize themselves through communication, structural adjustments, strategies, and tactics, five types of organizations are defined: denying/intransigent, minimizing/resistant, minimizing/cooperative, adaptive/cooperative, integrative. Critiques of Bennett scale Bennett Scale is recognized for defining clear ethnocentric and ethnorelative stages, however, it is also considered by some scholars to be too idealistic to be practiced in the reality. Primary critiques include: Does not apply to short-term cultural adaptation because of its progressive nature Neglect the relationship between interculturality and language Assume monocultural origin and no previous contact with other cultures, which does not take into account people from multicultural backgrounds Besides, several researchers report a struggle to determine participants' orientation within the six stages of Bennett Scale due to the lack of transitional middle ground between stages. The model is also critiqued for working well in nations where multiculturalism is easily embraced, like the United States, but its practical applicability in isolated or undeveloped nations where people have little exposure to other cultures is still questioned. References Cultural anthropology

Sexual abuse and intellectual disability

Research published from 2000 to 2020 illustrates increased prevalence rates of sexual violence against people with intellectual disabilities, compared to the general population.:61 The World Health Organization (WHO) funded a study which concluded that 15% of the adult population worldwide in 2012 had a disability, putting them at increased risk of physical, sexual, and intimate partner violence. Of that 15%, 6.1% had intellectual disability with 5.5% experiencing sexual violence. In another 2012 report, the WHO found that worldwide, children with intellectual disabilities experienced a 4.6 times greater risk of sexual violence than those without disability. In the United States, the Bureau of Justice Statistics reported in the National Crime Victimization Survey the rate of sexual violence for those with an intellectual disability is five times higher than for those without any disability. Both men and women with intellectual disabilities experience sexual violence that includes rape, sexual coercion without physical force, and sexual experiences without physical contact. Perpetrators of sexual violence are not only strangers but can be caregivers, acquaintances, and intimate partners. The perpetrator of the assault often determines if the crime will be reported. While people with intellectual disabilities experience sexual violence in many of the same ways as the general population,:73 those with intellectual disability may be more vulnerable to sexual violence because of their dependence on others for economic support, personal care, and support with tasks associated with daily living such as bathing and eating. They often encounter additional issues related to their disability and the environments in which they live. These additional issues can include questions around the ability to consent to sexual activities, differential treatment before the law, and restricted access to proper support and recovery services. Societal attitudes and beliefs about the sexuality of those with intellectual disabilities and the validity or accuracy of their claims of abuse are additional risk factors. Finally, racial and ethnic discrimination with disability discrimination increase the risk of sexual violence. Prevalence and incidence There are large differences between the prevalence and incidence estimates from independent sources of research as it relates to this topic. Results are often impacted by many factors such as: Differences in how sexual abuse is defined, and which experiences are counted as abuse for research purposes. Who is asked about the abuse: reported prevalence and incidence are lower if service managers, staff or case notes are consulted, and higher when people with intellectual disabilities are asked directly. Whether abuse rates for men and women are combined or calculated separately. Differences between the groups of people selected to take part in the research. Morris (1999) reported that incidence data on sexual abuse of disabled children can be difficult to compile because: Parties reporting the incident may not agree on the impairment of the disabled child. Information may not be recorded consistently. Some children with mild or moderate intellectual disabilities may not be registered with the services that usually record abuse incidents. The highest rate of occurrence of abuse happens within the place of residence of the persons with intellectual disabilities. Other areas of frequency where abuse occurs were at the perpetrator's home and in other public places, such as public toilets. Understanding race and ethnicity factors in sexual assault incidence among those with an intellectual disability are vital for addressing differences between white and minority populations in victimization and intervention. As in other health issues, intellectually disabled people from historically disadvantaged racial and ethnic groups face health disparity with poorer health outcomes than white populations with a disability. However, race and ethnicity are often not reported in study samples looking specifically at sexual violence and intellectual disability. United States In 2002, David Sorensen wrote that Americans with intellectual disabilities were four to ten times more likely to have acts of violence committed against them. In 1996 Dick Sobsey, associate director of the JP Das Developmental Disabilities Centre and Director of the John Dossetor Health Ethics Centre at the University of Alberta, concluded that 80% of 162 people with developmental and substantial disabilities who had been sexually assaulted had been sexually assaulted more than once. Sobsey estimated that between 15,000 and 19,000 individuals with intellectual disabilities experience rape each year. According to 1995 guidance from the US Department of Justice, more than 90% of Americans with intellectual disabilities experienced some form of sexual abuse at some time in their lives; 49% experienced 10 or more abusive incidents. In his 1994 book Violence and abuse in the lives of people with disabilities: the end of silent acceptance?, Sobsey wrote that 68% of girls with intellectual disabilities and 30% of boys with intellectual disabilities will be sexually abused before their 18th birthday. Sullivan and Knutson concluded in 2000 that children with intellectual disabilities were at slightly greater risk of sexual abuse than disabled children in general, who in turn were at 3.14 times greater risk of experiencing sexual abuse than non-disabled children. In 2007, Americans with intellectual disabilities were victims of approximately 47,000 rapes and sexual assaults. Statistical data from 2009 to 2014 drawn from the Bureau of Justice Statistics, the rate of serious violent crime as in rape or sexual assault for persons with intellectual disabilities was more than three times the rate for persons without intellectual disabilities including a correlation of 40% of the time the victim was being taken care of by the person who sexually assaulted them. A 2010 study concluded that the largest group of identified perpetrators of sexual abuse is developmental disability service providers or caregivers. 87% of a sample from 874 surveys of individuals with intellectual disabilities reported that they had been sexually abused, and 67% had experienced vaginal or anal penetration. The study also concluded that these service providers lacked basic knowledge about abuse, perpetrator characteristics, and facts about potential victims. In some cases, people with developmental disability are unable to disclose sexual abuse due to the physical or emotional limitations imposed by their disability, leading to the caregivers taking advantage of their intellectual disabilities. Britain A study by McCarthy and Thompson in 1997 found a prevalence rate of 25% for men and 61% for women. A survey by Brown et al. of senior managers in 1992 found an incidence rate of 0.5 per thousand people with intellectual disabilities each year. The Republic of Ireland A study by Dunne and Power in 1990 found an incidence rate of 2.88 per thousand people with intellectual disabilities per year. Spain A study by Gil-Llario, Morell-Mengual, Ballester-Arnal and Díaz-Rodríguez in 2017 found a prevalence rate of 2.8% for men and 9.4% for women. Among the women who were abused, only 52.9% trusted someone enough to tell them about what had happened. Of these, 28.6% preferred to tell a close relative, 57.1% told an educator and 14.3% talked to a friend about it. Of the men, 80% decided to talk about their experience of abuse. Half of them (50%) told their father or mother, 25% talked to an educator and 25% discussed the matter with a close relative. Another Spanish study indicates that the prevalence of sexual abuse is 6.10% when it is self‐reported (9.4% in women and 2.8% in men) and 28.6% when it is reported by professionals (27.8% in women and 29.4% in men). Risk factors A number of factors put people with intellectual disabilities at an increased risk of sexual violence. Medical models of disability emphasize risks connected with the person's disability, while social models of disability focus on risks caused by the socially-created environment of the intellectually disabled person. Not all factors will apply to all people with intellectual disabilities, and some are not exclusive to people with intellectual disabilities. Lack of understanding. Lack of social awareness and training that would help identify and anticipate abusive situations. Ingrained reliance on the caregiver authority figure. Long-term dependence on services and personal care. Emotional and social insecurities. Lack of capacity to consent to sexual activity. Lack of knowledge and training in sex education. Powerless position in society. Low self-esteem, contributing to powerlessness. Not realizing that sexual abuse can cause harm. Not being able to tell anyone about the abuse. Learned behaviour not to question caregivers or others in authority. Communication difficulties that hinder reporting abuse. Fear of not being believed, leading to non-reporting of abuse. Feelings of guilt or shame that prevent reporting of abuse. Difficulty identifying an appropriate person to report the abuse to. Low risk of prosecution for perpetrators. Routine prescription of contraceptives to women with intellectual disabilities, leading to reduced risk of detection for perpetrators. People with moderate to severe intellectual disabilities, and those with additional physical disabilities, form the majority of learning-disabled people experiencing sexual violence. Detection of sexual abuse risk Detection of Sexual Abuse Risk Screening Scale (DSARss) The DSARss is a brief screening measure designed to assess the risk of experiencing SA for people with ID. The scale consists of 19 items, which are grouped into four factors: (1) the denial of the risk of SA by people in the victim's immediate environment (“Acceptance of the abuse due to affection” e.g., “My father takes care of me, so it is okay to have sexual relationships with him”), (2) the perception of invulnerability to SA associated with places (“Denial of the risk associated with places” e.g., “It is impossible to be sexually abused in the street”), (3) the presence of risk indicators associated with drug use or lack of parental supervision and mastery of coping skills (“Risk factors and self-protection skills” e.g., “It is better not to say anything if someone touches my privates without my consent”), and (4) the person's knowledge about what constitutes a potential threat to personal space (“Lack of awareness of intimacy rules” e.g., “It is okay if someone I know touches my butt”). All items are dichotomous (true or false) and include an illustration exemplifying the content of the question in order to help people with ID understand the content of the item. Reliability analysis of the DSARss found an internal consistency for the total scale of r = 0.52 and for the four factors it ranged between r = 0.50 and r = 0.70. Perpetrator profile Research suggests that 97% to 99% of abusers are known and trusted by the victim who has the intellectual disability. According to Sobsey and Doe's 1991 analysis of 162 reports of sexual abuse against people with intellectual disabilities, the largest percentage of offenders (28%) were service providers (direct care staff members, personal care attendants, psychiatrists). In addition, 19% of sexual offenders were natural or stepfamily members, 15.2% were acquaintances (neighbors, family friends), 9.8% were informal paid service providers (babysitters), and 3.8% were dates. Further, 81.7% of the victims were women, and 90.8% of the offenders were men. Law United States Cases of sexual abuse are considered in many states to qualify as "sexual assault" under the law; sexual assault is often prosecuted through rape or sexual battery statutes. Cases of sexual assault are prosecuted differently according to individual state laws and statutes. States often have statutes for the intellectually disabled people separate from the general sex offense statutes. Such separate statutes often hold the intellectually disabled person at a "higher standard" for consent than the non-intellectually-disabled person; that is, the legal standards used to prove sexual consent will be stricter for the intellectually disabled individual. As Deborah W. Denno of the Fordham University School of Law explains: Capacity to consent Six tests are used as such a standard to assess the legal capacity of the intellectually disabled individual to consent to sexual conduct. These are the tests of "nature and consequences", "morality", "nature of the conduct", "totality of the circumstances", "evidence of mental disability", and "judgment". Forty-nine American states use one of these six tests in reviewing cases of sexual abuse, but Illinois uses two tests. Australia Special protection Intellectually disabled people get special protection under Australian law. In the penal code, a person is defined as mentally defective if they have "a mental disease or defect which renders him or her incapable of appraising the nature of his or her conduct." The special protection granted to those with intellectual disabilities in these cases is akin to the statutory protection given to children. In cases of sexual abuse, actual consent is irrelevant, because the person is incapable of giving legal consent. England and Wales The Sexual Offences Act 2003 defines sexual offences in general, including those perpetrated against or by adults or children. The Act includes specific crimes against adults with intellectual disabilities or mental health conditions: Reported crimes In 2002 Daniel D. Sorensen, Chair of the Victims of Crime Committee, Criminal Justice Task Force for People with Developmental Disabilities estimated that less than 4.5% of crimes against people with intellectual disabilities in California were reported compared to the 44% of the general public who experience crimes. In the same year, the Seattle Rape Relief Project program for victims of sexual assault with intellectual disabilities concluded that there was under-reporting of sexual assaults of victims with intellectual disabilities that exceeded under-reporting with other populations. In 1990, several studies suggested 80–85% of criminal abuse of residents of institutions never reached the proper authorities. The studies concluded that 40% of those criminally abused and 40% of non-abusing staff of care facilities studied were reluctant to come forward with criminal abuse issues for fear of reprisals or retribution from administrators. Effects of sexual violence Sexual violence harms people with intellectual disabilities like those without intellectual disability (ID). The harm is often worse when the violence occurs over a long period or if the individual has experienced multiple traumatic events throughout their lives. A lower developmental level can increase the risk of harm and if the perpetrator is known to the survivor. The following effects have been reported, but may not be experienced by all learning disabled survivors of sexual violence: Psychological and emotional damage, such as depression, guilt, self-blame and low self-esteem. Physical injury. Pregnancy. Sexually transmitted disease. Damage (possibly permanent) to relationships of trust with caregivers, friends and family. Disturbed, challenging, or otherwise changed behaviour, particularly for those who cannot communicate. Post-traumatic stress disorder (PTSD). Those with intellectual disabilities face the same challenges reporting incidents of sexual assault as those without ID. Survivors of sexual assault experience fear of retaliation or of not being believed. They may lack knowledge of sex and so are unsure of what happened to them. Society continues to perpetuate the myth that the survivor is to blame for the crime committed upon their body. Additionally, individuals with intellectual disabilities can find it challenging to communicate when sexual abuse occurs or has occurred in the past due to impairments with understanding and expressing language. Barriers to communication and a lack of validated measures to assess for sexual assault in developmentally and intellectually disabled adults makes it imperative for medical providers, family members, and caregivers to recognize some of the behavioral changes that could indicate sexual abuse is occurring or has occurred. The following are behavioral changes that have been seen in some but not all victims of sexual abuse with ID: Sleep disturbances including nightmares without related traumatic content Decreased school performance Poor concentration Enuresis and Encopresis Aggression Social withdrawal Suicidal ideation Eating disturbances Self-injury Repetitive play in children and those with lower levels of intelligence Acting out the trauma Isolation Treatment Treatment of sexual assault starts with awareness that those with disabilities, predominantly intellectual disabilities, are at higher risk and, therefore, more vulnerable to violent crime. Understanding that individuals with intellectual disabilities are at increased risk for sexual assault, health professionals can screen for sexual violence when treating clients. Screening for sexual assault improves health outcomes with timely intervention and treatment. Individuals with intellectual disabilities who have experienced trauma such as sexual assault are at greater risk for more severe trauma-related distress, including PTSD. Effective treatments focus on teaching individuals to cope with the trauma and overcome fear, anxiety, isolation, and reduce the cumulative effects of reliving the event. Evidence-based recommendations for treating trauma-related distress and Post-traumatic stress disorder for adults and children with developmental and intellectual disabilities are interdisciplinary treatment approaches. Clinicians should be trained in sexuality, intellectual disability, and treating abuse. Pharmacological treatments are effective. Psychotherapy using cognitive behavioral therapy and eye movement desensitization have been useful in populations with intellectual disabilities. One intervention that was most effective at reducing trauma symptoms was establishing changes in a person's daily environment to avoid traumatic cues. Screening and training of caregivers, clinicians, and care staff improve prevention. Sexual education and sexually appropriate behavior and assertiveness training can increase sexual abuse prevention. Clinicians and caregivers can advocate and educate others on disability and sexual abuse prevention to improve outcomes for preventing and treating sexual assault for those with intellectual disabilities. See also Facilitated communication Disability abuse Sexuality and disability Sexual abuse Sexual assault References Sexual abuse Intellectual disability Disability and sexuality

Child and Adolescent Mental Health

Child and Adolescent Mental Health (CAMH) is a quarterly peer-reviewed medical journal published by Wiley-Blackwell in Britain on behalf of the Association for Child and Adolescent Mental Health. The journal publishes peer-refereed child and adolescent mental health services research relevant to academics, clinicians and commissioners internationally. CAMH publishes reviews, original articles, and pilot reports of innovative approaches, interventions, clinical methods and service developments. The journal has regular sections on Measurement Issues, Innovations in Practice, Global Child Mental Health and Humanities. According to the Journal Citation Reports, the journal has a 2018 impact factor of 1.439. Publication history The Association's clinical journal started off in 1977 as  an informal  publication -  'The News' - before  becoming metamorphosing into the Newsletter (1984), the Newsletter and Review (1993),  the  Child Psychology and Psychiatry Review (CPPR) (1996) and finally CAMH (2002). It's evolution saw the development of features and columns such as Journal Monitor and Book Reviews, Personal Profiles, Thoughts from Abroad, Points of Law and Measurement Issues. Abstracting and indexing information The journal is abstracted and indexed in the following: Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Academic Search Premier (EBSCO Publishing) Criminal Justice Abstracts (EBSCO Publishing) Current Contents: Clinical Medicine (Clarivate Analytics) Current Contents: Social & Behavioral Sciences (Clarivate Analytics) Embase (Elsevier) Health Research Premium Collection (ProQuest) Hospital Premium Collection (ProQuest) ProQuest Central (ProQuest) ProQuest Central K-107 ProQuest Central K-108 Psychology & Behavioral Sciences Collection (EBSCO Publishing) Psychology Collection (GALE Cengage) Psychology Database (ProQuest) PsycINFO/Psychological Abstracts (APA) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier) Social Sciences Citation Index (Clarivate Analytics) Web of Science (Clarivate Analytics) See also Journal of Child Psychology and Psychiatry Emanuel Miller Memorial Lectures References External links Wiley-Blackwell academic journals English-language journals Academic journals established in 1996 Quarterly journals Clinical psychology journals Child and adolescent psychiatry journals

Social hygiene movement

The social hygiene movement in the United States was an attempt by Progressive era reformers to control venereal disease, regulate prostitution and vice, and disseminate sexual education through the use of scientific research methods and modern media techniques. Social hygiene as a profession grew alongside social work and other public health movements of the era. Social hygienists emphasized sexual continence and strict self-discipline as a solution to societal ills, tracing prostitution, drug use and illegitimacy to rapid urbanization. The movement remained alive throughout much of the 20th century and found its way into American schools, where it was transmitted in the form of classroom films about menstruation, sexually transmitted disease, drug abuse and acceptable sexual behavior in addition to an array of pamphlets, posters, textbooks and films. History The social hygiene movement of the late 19th and early 20th was rooted in the reformist zeal of the Progressive-era. Its aims were the diminishment if not elimination of vice, including prostitution, and venereal disease via educating the public about sex. A mental hygiene movement also developed, partly separately and now generally known as mental health, although the older term is still in use, e.g. in New York state's law. The social hygiene movement represented a rationalized, professionalized version of the earlier social purity movement. Many reformers, such as Marie Stopes, were also proponents of eugenics. Inspired by Charles Darwin's theory of natural selection, they argued for the sterilisation of certain groups, even racial groups, in society. Indeed, by the 1930s thousands of forced sterilizations of people deemed undesirable took place in America and other countries each year. This continued for several more decades in some countries, though after 1945, the movement was largely discredited. Social hygiene movement Social hygiene as a profession grew alongside social work and other public health movements of the era. Social hygienists emphasized sexual continence and strict self-discipline as a solution to societal ills, tracing prostitution, drug use and illegitimacy to rapid urbanization. The social hygiene movement began to gain momentum and in 1913 making the movement part of publishings such as the American Journal of Public Health. The American Social Hygiene Association was officially formed in 1913. It was later renamed to the American Social Health Association and, in 2012, the American Sexual Health Association. The movement remained alive throughout much of the 20th century and found its way into American schools, where it was transmitted in the form of classroom films about menstruation, sexually transmitted disease, drug abuse and acceptable sexual behavior in addition to an array of pamphlets, posters, textbooks and films. Soviet Union The Social hygiene approach was adopted in medical schools in the Soviet Union in the 1920s and was supported by the Commissariat of Public Health. The definition adopted by Commissar Nikolai Semashko was less focussed on eugenics and more in line with what is now regarded as public health: “study of the influence of economic and social factors on the incidence of disease and on the ways to make the population healthy”. The State Institute for Social Hygiene opened in 1923. This approach was not popular with educators or with medical students. In 1930 the institute was renamed the Institute of Organisation of Health Care and Hygiene. American Social Hygiene Association The American Social Hygiene Association partnered with the government during World War I. The American Social Hygiene Association provided social hygiene health and sexual health information to the soldiers in hopes that this education would help take fewer soldiers out of action from venereal diseases. The idea of prostitution was considered a “necessary evil” in light of an artificial demand that had been created through various forms including political corruption and advertising. With further investigation into the business of prostitution cities that did not contain commercialized prostitution had less crime and appeared to be in better shape than those who contained such. Most prostitutes that had been examined were found to have venereal diseases, but with that included a negative social stigma which stopped people from getting examined and so there became a campaign involving several organizations to suppress prostitution and begin educating people about sex and venereal diseases. The two organizations that had developed were the American Vigilance Association, fighting prostitution, and the American Federation for Sex Hygiene. Finally, the two organizations had realized their mutual interest and called a meeting in Buffalo, New York which the term “social hygiene” was coined. By 1914 the organizations formed into one, calling themselves, “The American Social Hygiene Association”. Progressive Era The social hygiene movement helped with the development of the management of prostitution in the Progressive Era. The Progressive Era was the turning point in the state's regulations of sexuality. It was said that the Progressive Era had physicians and women moral reformers working together to help manage prostitution and educate the people on social hygiene. Racial Hygiene Association This link between racial hygiene and social hygiene movements can be seen in Australia, where the Racial Hygiene Association of New South Wales is now named The Family Planning Association. Negro Project In the 1940s during World War II, ASHA (American Social Hygiene Association) launched a new project called the Negro Project, also known as the Negro Venereal Disease Education Project. The aim of this project was to address the widespread presence of venereal diseases among African Americans. In the early 1940s, ASHA drafted a grant proposal and in 1942 it was sent to prospective funding agencies. The proposal emphasized two main aspects of the Negro Project, “that the higher rate of prevalence of venereal diseases among the black population was alarming; and two, that this higher prevalence rate was not the fault of the black community.” (A. Sharma) The main purpose of the Negro Project was to provide educational materials and methods for instruction regarding syphilis. Some of the intended materials to be produced were pamphlets, posters, and motion pictures specifically aimed at the African American community. After being rejected by private funding organizations, the project found support from the Social Protection Division of the Federal Security Agency. In November 1943, in New York City, the Negro Project held its first major activity which was the National Conference on Wartime Problems in Venereal Disease Control. This conference was held so that they could form a committee and create an action plan for the Negro Project. After the national conference in 1943, project officials held meetings at regional level, predominantly in Southern states. However, in 1945 the records of the project suddenly go silent and no further activity for this project was documented in ASHA records. It has been speculated that due to the Social Protection Division of the Federal Security Agency being dissolved in the 1940s, the funds for the project dried up causing the project to end. Mental hygiene movement In regards to the mental hygiene movement, it helped providers realize that the problems of mental health and prevention of disease goes beyond providers in hospitals. The movement helped healthcare train their providers properly. It also helped with studies of more sympathetic treatment for mental health patients. See also Commission on Training Camp Activities Comstock laws History of condoms La Follette–Bulwinkle Act Mann Act Mental health Racial hygiene Timeline of reproductive rights legislation United States obscenity law References External links American Social Hygiene Posters - Online repository of social hygiene posters from the University of Minnesota The Prelinger Archives at the Internet Archive Progressive Era in the United States Health movements Hygiene Compulsory sterilization in the United States Social history of the United States

Femi Oyebode

Femi Oyebode is a retired Professor and Head of Department of Psychiatry at the University of Birmingham. He has investigated the relationships between literature and psychiatry. His research has considered descriptive psychopathology and delusional misidentification syndrome. He was awarded the 2016 Royal College of Psychiatrists lifetime achievement award. Early life and education Oyebode was born in Lagos. He was initially interested in literature and poetry, but encouraged to become a physician by his father. He attended a boarding school where he had to decide between specialising in science or the humanities. He eventually settled on biology. He studied medicine at the University of Ibadan and moved to Newcastle upon Tyne in 1979. Here he completed his higher training under the supervision of Allan Ker, Hamish McClelland and Kurt Schapira. He earned his MRCPsych (membership of the Royal College of Psychiatrists) in 1983, and was soon appointed a Consultant Psychiatrist in the University Hospitals Birmingham NHS Foundation Trust. Research and career In 2005 Oyebode took over writing Sim's Symptoms in the Mind from its original author Andrew Sims (psychiatrist). Sim's Symptoms in the Mind is a textbook that has become a leading introduction in clinical psychopathology that has been translated into Estonian, Korean, Portuguese and Italian. It is currently in its sixth edition. His MD thesis, which he completed in 1989, was supervised by Ken Davison. He was appointed medical director of the South Birmingham Mental Health Trust in 1997. He completed a further doctorate in the philosophy of mind at Swansea University in 1998. Oyebode was a Consultant Psychiatrist at the National Centre for Mental Health Birmingham until his retirement in 2021. He was made Director of the South Birmingham Mental Health Trust in 1997. In 2002 he was appointed Chief Examining Officer at the Royal College of Psychiatrists. His research considers the neuropsychiatry of delusional misidentification syndrome. He served as Head of the Department of Psychiatry at the University of Birmingham from 2003 to 2009. In 2016 he was awarded the Royal College of Psychiatrists Lifetime Achievement Award. Poetry Alongside his research career, Oyebode is interested in the intersection of psychiatry of literature. He has written about the need for humanities in postgraduate medical education. He has published over seven volumes of poetry. He was given Legend Recognition at the Creativity and Arts Awards in 2017. Selected publications His publications include; He has served as Associate Editor of the British Journal of Psychiatry. References Scientists from Lagos 1954 births Living people Academics of the University of Birmingham University of Ibadan alumni

Metacognitive training

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years (see below). It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles (cognitive biases) that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+). Background Metacognition can be defined as "thinking about thinking". Over the course of the training, cognitive biases subserving positive symptoms are identified and corrected. The current empirical evidence assumes a connection between certain cognitive biases, such as jumping to conclusions, and the development and maintenance of psychosis. Accordingly, correcting these problematic/unhelpful thinking styles should lead to a reduction of symptoms. Intervention In eight training units (modules) and two additional modules, examples of "cognitive traps", which can promote the development and maintenance of the positive symptoms of schizophrenia, are presented to patients in a playful way. Patients are instructed to critically reflect on their thought patterns, which may contribute to problematic behaviors, and to implement the contents of the training in everyday life. MCT deals with the following problematic styles of thinking: monocausal attributions, jumping to conclusions, inflexibility, problems in social cognition, overconfidence for memory errors and depressive thought patterns. The additional modules deal with stigma and low self-esteem. Individualized metacognitive training (MCT+) targets the same symptoms and cognitive biases as the group training, but is more flexible in that it allows discussion of individualized topics. The treatment materials for the group training can be obtained free of charge in over 30 languages from the website. Efficacy A recent meta-analysis found significant improvements for positive symptoms and delusions, as well as the acceptance of the training. These findings have been replicated in 2018 and 2019. An older meta-analysis based on a smaller number of studies found a small effect, which reached significance when newer studies were considered. Individual studies provide evidence for the long-term effectiveness of the approach beyond the immediate treatment period. A meta-analysis based on 43 studies (N = 1,816 individuals) showed that MCT improved delusions, hallucinations, cognitive biases, negative symptoms and functioning. MCT is recommended as an evidence-based treatment by the Royal Australian and New Zealand College of Psychiatrists as well as the German Association for Psychiatry, Psychotherapy and Psychosomatics. Adaptations to other disorders Since its introduction, MCT has been adapted to other mental disorders. Empirical studies have been carried out for borderline personality disorder, obsessive–compulsive disorder (self-help approach), depression, bipolar disorders, and problem gambling. References External links Metacognitive Training for Psychosis Link to training material and manual. Metacognitive Training for Psychosis, Individualized (MCT+) Link to training material and manual. Metacognitive Training for Obsessive-Compulsive Disorder (myMCT) Link to training material and self-help manual. Metacognitive Training for Depression Link to training material and manual. Metacognitive Training for Borderline Personality Disorder Link to training material and manual. Psychotherapy by type Cognitive behavioral therapy Schizophrenia

DSRP

DSRP is a theory and method of thinking, developed by systems theorist and cognitive scientist Derek Cabrera. It is an acronym that stands for Distinctions, Systems, Relationships, and Perspectives. Cabrera posits that these four patterns underlie all cognition, that they are universal to the process of structuring information, and that people can improve their thinking skills by learning to use the four elements explicitly. Cabrera distinguishes between the DSRP theory and the DSRP method. The theory is the mathematical formalism and philosophical underpinnings, while the method is the set of tools and techniques people use in real life settings (notably in education). History DSRP was first described by Derek Cabrera in the book Remedial Genius. In later writings, Cabrera describes D, S, R, and P as "patterns of thinking", and expands upon the implications of these thinking skills. The DSRP theory is a mathematical formalism of systems thinking and cognition, built on the philosophical underpinnings of constructivism and evolutionary epistemology. The DSRP method is used in education and has influenced educational reform as well as in management of learning organizations. In 2008, a special section of the journal Evaluation and Program Planning was dedicated to examining the DSRP theory and method. The 2015 self-published book Systems Thinking Made Simple is an updated treatment of DSRP. DSRP theory DSRP consists of four interrelated structures (or patterns), and each structure has two opposing elements. The structures and their elements are: Making Distinctions – which consist of an identity and an other Organizing Systems – which consist of part and whole Recognizing Relationships – which consist of action and reaction Taking Perspectives – which consist of point and view There are several rules governing DSRP: Each structure (D, S, R, or P) implies the existence of the other three structures. Each structure implies the existence of its two elements and vice versa. Each element implies its opposite (e.g. identity implies other). These rules illustrate that DSRP is a modular, fractal, nonlinear, complex systems process: the four DSRP structures do not occur in a stepwise, linear process but in a highly interdependent, complex way. DSRP theory states that these four structures are inherent in every piece of knowledge and are universal to all human thinking, and that any piece of information can be viewed using each of these structures to gain a deeper understanding of that information. The order in which the operations take place does not matter, as all four occur simultaneously. Gerald Midgley pointed out that the structures of DSRP have analogues in other systems theories: distinctions are analogous to the boundaries of Werner Ulrich's boundary critique; Stafford Beer's viable system model explores nested systems (parts and wholes) in ways analogous to the "S" of DSRP; Jay Wright Forrester's system dynamics is an exploration of relationships; and soft systems methodology explores perspectives. Example Any piece of information can be analyzed using each of these elements. For example, consider the U.S. Democratic Party. By giving the party a name, Democratic, a distinction is drawn between it and all other entities. In this instance, the Democratic Party is the identity and everything else (including the U.S. Republican Party) is the other. From the perspective of the Republican Party ("identity"), however, the Democratic Party is the other. The Democratic Party is also a system—it is a whole entity, but it is made up of constituent parts—its membership, hierarchy, values, etc. When viewed from a different perspective, the Democratic Party is just a part of the whole universe of American political parties. The Democratic Party is in relationship with innumerable other entities, for example, the news media, current events, the American electorate, etc., each of which mutually influence the Party—a relationship of cause and effect. The Party is also a relationship itself between other concepts, for example, between a voter and political affiliation. The Democratic Party is also a perspective on the world—a point in the political landscape from which to view issues. Formula The primary application of the DSRP theory is through its various methodological tools but the theory itself is a mathematical formalism that contributes to the fields of evolutionary epistemology and cognition. The formal theory states that DSRP are simple rules in a complex adaptive system that yields systems thinking: The equation explains that autonomous agents (information, ideas or things) following simple rules (D,S,R,P) with their elemental pairs (i-o, p-w, a-r, ρ-v) in nonlinear order (:) and with various co-implications of the rules (○), the collective dynamics of which over a time series j to n leads to the emergence of what we might refer to as systems thinking (ST). The elements of each of the four patterns follow a simple underlying logic as do the interactions between patterns. This logic underlies the unique ability of DSRP to be characterized as multivalent, but contain within it bivalency. DSRP method DSRP as a method is built upon two premises: first, that humans build knowledge, with knowledge and thinking being in a continuous feedback loop (e.g., constructivism), and second, that knowledge changes (e.g., evolutionary epistemology). The DSRP method builds upon this constructivist view of knowledge by encouraging users to physically and graphically examine information. Users take concepts and model them with physical objects or diagrams. These objects are then moved around and associated in different ways to represent some piece of information, or content, and its context in terms of distinctions, systems, relationships, or perspectives. Once a concept has been modeled and explored using at least one of the four elements of DSRP, the user goes back to see if the existing model is sufficient for his or her needs, and if not, chooses another element and explores the concept using that. This process is repeated until the user is satisfied with the model. The DSRP method has several parts, including mindset, root lists, guiding questions, tactile manipulatives, and DSRP diagrams. Mindset The DSRP mindset is the paradigmatic shift toward thinking about underlying structure of ideas rather than only the content of speech acts, curriculum, or information of any kind. The DSRP mindset means the person is explicating underlying structure. Root lists Root lists are simply lists of various concepts, behaviors, and cognitive functions that are "rooted in" D, S, R, or P. These root lists show the research linkages between the four universal structures and existing structures which users may be more familiar with such as categorization, sorting, cause and effect, etc. Guiding questions Guiding questions provide users with something akin to the Socratic method of questioning but using DSRP as the underlying logic. Users pose "guiding questions", of which there are two for each structure of DSRP. The guiding questions are: Distinctions What is __? What is not __? Systems Does _ have parts? Can you think of _ as a part? Relationships Is related to __? Can you think of as a relationship? Perspectives From the perspective of __, [insert question]? Can you think about from a different perspective? Tactile manipulatives and DSRP diagrams Users are encouraged to model ideas with blocks or other physical objects, or to draw (diagram) ideas in terms of D, S, R, and P. This aspect of the method is promoted as a form of nonlinguistic representation of ideas, based on research showing that learners acquire and structure knowledge more effectively when information is presented in linguistic and nonlinguistic formats. Educational outcomes With continued use, the method is supposed to improve six specific types of thinking skills: Critical thinking improves as people learn to examine the reasoning behind the distinctions they draw and the perspectives and relationships that influence how information is presented Creative thinking improves as people make connections (i.e. relationships) between new pieces of information. Systems thinking improves as one becomes increasingly fluent with all four elements of DSRP. Interdisciplinary thinking improves as people reconsider boundaries (i.e. distinctions) and make connections between new pieces of information. Scientific thinking improves as people learn to analyze information in a logical way. Emotional intelligence and prosocial behavior improves as people learn to take multiple perspectives—particularly to imagine the perspectives of other people. In addition, the DSRP method is supposed to improve teacher effectiveness. Applications Cabrera claims that DSRP theory, as a mathematical and epistemological formalism, and the DSRP method, as a set of cognitive tools, is universally applicable to any field of knowledge. Education The DSRP method has been used extensively in educational settings from preschool through post-secondary settings. The DSRP method, as applied in education, is intended to work with existing subject-specific curricula to build thinking skills and provide a way for students to structure content knowledge. Organizational learning As a universal theory of systems thinking, DSRP method is in broad use as the basis for organizational learning. The link between organizational learning and systems thinking was made by Peter Senge. DSRP forms the basis of an organizational systems and learning model called VMCL. Physical, natural, and social sciences Because its creators claim that DSRP is both an epistemological and an ontological theory (that is, it is predictive not only of what is known but also how new things will come to be known and how those things are actually structured a priori), it could be used not only to deconstruct existing (known) knowledge about any phenomena but also can be used as a predictive and prescriptive tool to advance any area of knowledge about any physical, natural, or social phenomena. DSRP theory posits that the mind–body problem and symbol grounding problem that causes a disconnect between our knowledge of physical things and the physical world (the basis of systems thinking) is resolved because our universal DSRP cognitive structures evolved within the boundaries and constraints of the physical, chemical, and biological laws. That is, ontological underlying structure of physical things as well as the epistemological underlying structure of ideas is reconciled under DSRP. Evaluation and program planning DSRP has been used to apply systems thinking to the fields of evaluation and program planning, including a National Science Foundation-funded initiative to evaluate of large-scale science, technology, engineering, and math (STEM) education programs, as well as evaluations of the complexity science education programs of the Santa Fe Institute. Software DSRP provides the conceptual foundation for Plectica, a cloud-based application. The card structure and mapping features tacitly reference DSRP rules and provide an environment in which users can create visual maps of DSRP constructs on any topic or process. Criticism Not all experts agree that DSRP is definitive of systems thinking, as Cabrera claims. Gerald Midgley has argued that the "DSRP pattern that Cabrera et al. propose is an interpretation imposed on other perspectives, and they are prepared to dismiss concepts in those perspectives that do not fit." Midgley argued for pragmatic methodological pluralism against unification, and he advised: "Rather than seeking to rationalise the systems thinking field, arguably they [Cabrera et al.] would be better off acknowledging that theirs is one perspective amongst many. It is then up to them to argue its coherence and utility while still keeping the door open to insights from other perspectives." See also Creative problem-solving Critical systems thinking Conceptual model Double-loop learning Fallacy of misplaced concreteness Function model Higher order thinking Knowing and the Known Mental model Metamodeling Model-dependent realism Pattern language Pedagogical patterns Perspective (cognitive) Problem solving Structure chart Systems analysis Systems theory View model World Hypotheses References Further reading External links Cabrera Research Lab Systems analysis Systems theory

Psychiatric technician

A psychiatric technician is a mental health professional who works with psychiatrists and psychiatric nurses. They provide hands-on direct care to developmentally or emotionally disabled people, as well as those diagnosed with mental illnesses such as psychosis; or a brain disease such as dementia. Also they secure patients' compliance with personal hygiene routine, their medicines consumption, daily meal, and other everyday trivial matters, which might deviate in mental cases and require external help and sometimes even limited use of force. They are employed in public and private hospitals and long-term care facilities, and, in certain countries, also serve on the ambulance daily and nightwatches to provide assistance in case of handling potential mental patients, who conduct disorderly in public, when police interference is deemed inappropriate or unnecessary, or when detainees may not necessarily conduct themselves disorderly but still present obvious medical interest. Education Psychiatric technicians are trained in general and abnormal psychology, and in pharmacology which helps the technician learn to understand and safely administer medications. They assist in the implementation of various options, including psychoanalytic, somatic, behavioral, humanistic and/or psychopharmaceutical treatments of mental illness. Tasks Psychiatric technicians are relied upon to report changes in patient mental or physical health, as well as problems, issues, and/or concerns with patient reactions to medications being used. They may be called upon to consult with and counsel clients regarding the therapies and treatment options (including medication, behavioral interventions, counseling and group or individual therapy). Their job often includes recordkeeping for and monitoring of patients receiving medication; and they may be expected to keep up-to-date on safety issues with the medications used, changing practices regarding dosage requirements, and new medications being used in their field. Credentials In the United States, some states license professional psychiatric technicians. These include Arkansas, California, Colorado, and Kansas. References External links American Association of Psychiatric Technicians home page Mental health occupations Professional titles and certifications

Nomological network

A nomological network (or nomological net) is a representation of the concepts (constructs) of interest in a study, their observable manifestations, and the interrelationships between these. The term "nomological" derives from the Greek, meaning "lawful", or in philosophy of science terms, "law-like". It was Cronbach and Meehl's view of construct validity that in order to provide evidence that a measure has construct validity, a nomological network must be developed for its measure. The necessary elements of a nomological network are: At least two constructs; One or more theoretical propositions, specifying linkages between constructs, for example: "As age increases, memory loss increases". Correspondence rules, allowing each construct to be measured empirically. Such a rule is said to "operationalize" the construct, as for example in the operationalization: "Age" is measured by asking "how old are you?" Empirical linkages represent hypotheses before data collection, empirical generalizations after data collection. Validity evidence based on nomological validity is a general form of construct validity. It is the degree to which a construct behaves as it should within a system of related constructs (the nomological network). Nomological networks are used in theory development and use a modernist approach. See also Consilience Coherentism Nomology References External links http://www.socialresearchmethods.net/kb/nomonet.htm Validity (statistics)

Help-seeking

Help-seeking theory postulates that people follow a series of predictable steps to seek help for their inadequacies, it is a series of well-ordered and purposeful cognitive and behavioral steps, each leading to specific types of solutions. Help-seeking theory falls into two categories where some consider similarity in the process' (e.g. Cepeda-Benito & Short, 1998) while others consider it as dependent upon the problem (e.g. Di Fabio & Bernaud, 2008). In general help-seeking behaviors are dependent upon three categories, attitudes (beliefs and willingness) towards help-seeking, intention to seek help, and actual help-seeking behavior. Help-seeking was, «in the early studies of socialization and personality development», often viewed as an indicator of dependency and therefore took «on connotations of immaturity, passivity, and even incompetence». Now, there is general agreement that adaptive help-seeking is an important and effective self-regulated learning strategy. Definition The academic literature does not provide an agreed upon definition of help-seeking, and several attempts have been made to define the complex construct. Help-seeking has been studied both as a self-regulated learning strategy and as a coping strategy. In the mental health context, help-seeking can be defined as “an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern.” In the educational context, help-seeking can be "defined as a learning (or problem-solving) strategy where a learner attempts to obtain external assistance to deal with difficulties experienced while working towards one (or more) educational goal(s)." Adaptive vs. maladaptive help-seeking Help-seeking behavior is divided into two types, adaptive behavior and non-adaptive behavior. It is adaptive when exercised to overcome a difficulty and it depends upon the person's recognition, insight and dimension of the problem and resources for solving the same, this is valued as an active strategy. It is non-adaptive when the behavior persists even after understanding and experiencing the problem solving mechanism and when used for avoidance. Dynamic barriers in seeking help can also affect active process (e.g.: culture, ego, classism, etc. ). Nelson-Le Gall (1981) made a central differentiation between adaptive (i.e. instrumental) and maladaptive (i.e. executive) forms of help-seeking. While adaptive help-seeking focuses on mastery and understanding (i.e. to seek just enough help to be able to solve a problem or attain a goal), maladaptive help-seeking involves avoidance of work (i.e. to request someone else to solve a problem or attain a goal on one’s behalf). The help-seeking process model Several theoretical models have conceptualised help-seeking as a multistep process with distinct stages. The help-seeking process model categorises the complex help-seeking process as comprising eight distinct stages: (1) determine there is a problem; (2) determine that help is needed; (3) decide to seek help; (4) select the goal of the help-seeking; (5) select the source of help; (6) solicit help; (7) obtain the requested help; and (8) process the help received. Although the help-seeking process model presents the help-seeking process with distinct and logically sequential stages, in practice it is a dynamic and iterative hermeneutic process where the movements between the different stages are interrelated and non-linear. Deciding on a helping source could, for instance, precede the decision to seek help. The help-seeking process model can be mapped onto Zimmerman's (2000) model of self-regulated learning, which comprises three phases: forethought, performance, and self-reflection processes. The first five stages of the help-seeking process model comprise the forethought phase of Zimmerman's (2000) model, soliciting help and obtaining the requested help comprise the performance phase, while processing the received help is considered the self-reflection phase of the help-seeking process. Determine there is a problem The initial stage of the help-seeking process model involves recognising difficulties and defining them as a problem. The mere recognition of some difficulty is often insufficient to lead to action, and an individual must further identify the difficulty as problematic before seeking outside help. Implicit ideas about what constitutes comprehension or performance vary between individuals and groups of people. As a consequence, there is considerable variation across individuals to the types and qualities of problems that receive attention and generate sufficient concern to seek help. Determine help is needed Once identified, a problem must further be perceived as amenable to aid. The second stage of the help-seeking process model involves recognising that seeking help is an appropriate way of dealing with the problem at hand. In other words, a learner has to decide whether or not help is needed or wanted. Determining that help is needed depends on several factors, including the perception of insufficient personal resources, whether other strategies have been exhausted, and attributions for why problems exists that are help-relevant. Decide whether to seek help The decision stage of the help-seeking process involves deciding on whether or not to seek assistance by weighing different self-motivation beliefs, including self-efficacy (i.e. the belief that one can marshal the resources to seek the desired help), outcome expectations (i.e. the belief that doing so will result in the desired outcome), and task value. Several methods have been utilised to systematically investigate the decision stage of the help-seeking process, such as examining the attitudes and beliefs people have regarding help-seeking, underlying intentions and motivations for seeking help, as well as past help-seeking behaviour. Perceived benefits vs threats Unlike many other self-regulated learning strategies (e.g. memorisation, organisation, and elaboration), help-seeking may require a complex balancing of perceived enticing benefits and intimidating costs. The perceived benefits (or «positive attitudes») of help-seeking reflect a recognition of help-seeking as an instrumental and pragmatic means of learning (e.g. «I believe that asking my teachers questions helps me learn»). In contrast, the perceived threats (or «negative attitudes») of help-seeking reflect either a threat to self-esteem caused by the perceived inadequacy or the sociocultural norms that inveigh against seeking assistance (e.g. «I believe the teachers might think I am dumb if I ask a question in class»). Help-seeking is the only self-regulated learning strategy that is potentially stigmatising due to its perceived personal costs. Select the goal of the help-seeking Once the decision has been taken to seek help, a learner needs to assign a purpose or meaning to the assistance seeking. Help-seeking motives can take many forms, and consequently there are different ways of categorising help-seeking goals. Adaptive help-seeking involves improving one’s capabilities and/or increasing one’s understanding by seeking just enough help to be able to solve a problem or attain a goal independently. Adaptive help-seeking can, for example, involve students asking for hints about the solution to problems, examples of similar problems, or clarification of the problem at hand. Emotional help-seeking is a multifaceted construct, where the goal is to reduce or manage emotional distress, e.g. by getting moral support, sympathy or understanding. While adaptive help-seeking focuses on understanding and capabilities, the goal of maladaptive help-seeking is to avoid effort, i.e. requesting someone else to solve a problem or attain a goal on one’s behalf (e.g. by asking for solutions or answers to problems). Avoidance of help-seeking refers to instances when students require help but do not seek it, e.g. a student might skip a problem altogether or put down any answer rather than ask for help. Select the source of help A central part of the help-seeking process is identifying and considering available sources of help. Many factors, such as personal characteristics of the help-seeker and the helping source, as well as situational characteristics of the helping context can determine the perceptions help-seekers have of helping sources and subsequently influence which sources they choose to solicit aid from. Help can be sought from a wide variety of sources. As a consequence, there are multiple ways of categorising sources of help. Framework for distinguishing sources of help Makara and Karabenick’s (2013) proposed framework for distinguishing sources of help characterises helping sources according to four dichotomous dimensions: (1) role, i.e. formal versus informal; (2) relationship, i.e. personal versus impersonal; (3) channel, i.e. mediated versus face-to-face; and (4) adaptability, i.e. dynamic versus static. The role dimension indicates whether the source’s function requires help to be offered. The perceived relationship between the help seeker and the helping source can be distinguished into sources that are perceived to be personal and those judged to be more impersonal. The channel used to access the helping source distinguishes between sources in which the help is distributed face-to-face and those in which the distribution of help is mediated via some form of technology – that is, through any tool or instrument (e.g. books, phones, computers). The adaptability dimension categorises sources as either dynamic or static. Dynamic sources adapt or change over time based on a learner’s help-seeking needs (e.g. instructors), while static sources cannot (e.g. textbooks and encyclopaedias). The helping source framework acknowledges how various aspects of sources may influence help-seeking. Solicit help Once a potential helping source has been identified, the help-seeker must enlist the help. This stage of the help-seeking process concerns the content or form of the request for help – i.e. how to request help. Overt help-seeking involves the employment of various help-seeking strategies for engaging a source’s help (e.g. expressing a question at a particular time with a particular tone). Help-seeking is – apart from peer learning – the only self-regulated learning strategy that is potentially social in nature, and in many instances learners need to possess appropriate social skills for seeking help from a variety of sources. The help solicitation process requires social competencies, including the knowledge and skills to approach a helping source for the desired help in ways that are socially desirable. Obtain the requested help If a help-seeker is successful in soliciting help from a targeted helping source, the next stage of the help-seeking process involves gaining or acquiring the help that has been requested. Obtaining the requested help involves the help-seeker integrating the new information with existing knowledge and evaluating the quality of the received help. After having received help, a learner must decide to what degree the help is useful and addresses the experienced difficulties. If the assistance falls short in alleviating the difficulties, a learner must request further help or will possibly have to identify a new helper. Process the help received An important aspect of help-seeking – and self-regulated learning in general – is the utilising of skills and strategies in order to process the received help. In Zimmerman’s (2000) self-regulation model, this identified self-reflection phase is manifested by the two self-reflective processes self-judgment and self-reactions. While self-judgment entails self-evaluating one's performance and attributing causal significance to the outcome, self-reactions refer to the comparison of self-monitored information and a standard or goal. Public health Help-seeking behavior in public health is divided into following steps: Self-care: Self-evaluation and self-administration for the physical or psychological problem. Social networks: Seeking information to eradicate the problem through community resources. Helpers: Seeking help from informal (priest, holistic healers, pharmacists, etc.) and formal helpers (physicians, psychologists, social workers, etc.) related to the field. Gatekeepers: They are incoming form of help from the community by understanding the presence of problem and they are resourceful members of a community who can link/direct the person in need with potential sources of help. Psychological investigations With adaptive help-seeking, students can comprehend concepts and complete learning tasks, which are otherwise not achievable with their own efforts. It may therefore be taken for granted that students will ask for help when they experience academic difficulties that they cannot solve independently. However, many students do not seek help when they would benefit from it. Indeed, students who are expected to benefit the most from help are also the ones least likely to seek it. Multitudinous factors can influence a help-seeking process, such as the sociocultural context, individual differences, etc. Research has shown that culture may influence help-seeking. For example, many Asian cultures have cultural values rooted in Confucianism and Buddhism which emphasise interdependence and collectivism, as opposed to many Western cultures where independence and individualism is prevalent. Research has identified personality-related predispositions to be important predictors of help-seeking. Help-seeking has received a lot of research attention in academic contexts. Karabenick & Newman, 2006 Help-seeking behaviors are often linked to goal-orientation theory, with mastery-oriented students being more likely to manifest adaptive strategies and performance-oriented students being more likely to manifest non-adaptive strategies (Ames, 1983; Butler, 1999, 2006; Hashim, 2004; Ryan, Gheen, & Midgley, 1998). Several researchers have found that women have significantly more positive attitudes than men towards seeking help from professional psychologists. Shea & Yeh, 2008 When facing need, students with high self-efficacy tend to manifest high help-seeking behavior, whereas students with low self-efficacy are, under similar circumstances, more reluctant to seek help (Linnenbrink & Pintrich, 2003; Nelson & Ketelhut, 2008; Paulsen & Feldman, 2005; Pintrich & Zusho, 2007; Tan et al., 2008). In 2011 it was reexamined and peer reviewed that affiliation cues can prime people to seek help in closed group contexts. Adaptive help-seeking can result in benefits not only for help-seekers, but also for help-givers and potential bystanders. Help-seeking and help-giving can for example be in the form of elaboration, a cognitive learning strategy that involves making information meaningful and building connections between existing knowledge and the information one has been given. Elaboration strategies such as question-asking and question-answering can result in deeper processing of the learning material, thereby improving comprehension and learning. See also Helping behavior Helpfulness Social support Problem-solving References External links Financial Help-Seeking Behavior: Theory And Implications Encouraging Help-Seeking Behaviour Among Young Men:A Literature Review Learning Psychological theories Social work

Mad Travelers

Mad Travelers: Reflections on the Reality of Transient Mental Illnesses (1998) is a book by the Canadian philosopher of science Ian Hacking. The book provides an historical account of a medical condition that used to be known as fugue or mad travel. Fugue emerged as ‘a specific, diagnosable type of insanity’ (p. 8) in late nineteenth century France and then spread to Italy, Germany and Russia. The book was published in London nu: Free Association Books in, 1999. The disease According to Hacking, the fugue epidemic lasted twenty-two years, from 1887 to 1909. The disease never spread heavily in either Britain or America. It is characterised by a compulsion to travel, which, if fulfilled, manifests itself in impetuous travelling during which the traveller loses sense of their identity. Hacking gives as an example the case of the first officially diagnosed fuguer, Albert Dadas, and describes briefly his symptoms as follows: In his normal state, at home, in the factory, or as a cook in the army, he was a good worker, timid, respectful, shy with women. He never drank and when he was on a fugue had a particular hostility to alcohol. At home he would have a regular and uneventful life. Then would come about three days of severe headaches, anxiety, sweats, insomnia, masturbation five or six times a night, and then – he would set out.’(p.24). As Hacking (p. 196) reports, the fugue was introduced as a distinct disorder for the first time in DSM-III (1980) under the name ‘psychogenic fugue’ which was associated with: 'the predominant disturbance is sudden, unexpected travel away from home or ones’ customary place of work, with inability to recall one’s past’ ‘confusion about personal identity or assumption of new identity (partial or complete)’ ‘the disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy)’ ‘the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Hacking uses Albert Dadas as a case study of what he terms ‘transient mental illness’: ‘an illness that appears at a time and in a place, and later fades away. It may spread from place to place and reappear from time to time. It may be selective for social class or gender, preferring poor women or rich men.’ (p. 1). The concept of a transient mental illness has provoked debates as to whether the condition is real or socially constructed; Hacking, however, does not follow this line of argument but focuses instead on how knowledge, scientific practices and ordinary life in a particular context allow for socially permissible diagnoses and diseases to emerge. To aid his investigation of the major factors which may be involved in the emergence of a disease, Hacking applies the metaphor of an ‘ecological niche’ (p. 2) For a disease to emerge and thrive, it should first fit into the larger taxonomy of illnesses, which in this case is hysteria and epilepsy. Secondly, it should be situated somewhere between some virtuous and vicious elements of contemporary culture, which in this instance is what Hacking calls ‘romantic tourism versus criminal vagrancy’ (p. 81). Thirdly, it should be observable as a disorder – since travellers on the continent were obliged to have identification papers, fuguers could be easily identified and, if necessary, jailed or hospitalised. Fourthly, the disease should provide, alongside all the pain and suffering, some release: during their travels, fuguers could find consolation and escape from the pressures of daily life (p. 82). Hysteria or Epilepsy? Whereas Albert Dadas was diagnosed as an hysterical epileptic, Hacking mentions another fuguer, a man called "Mén", who was diagnosed by the prominent French neurologist Jean-Martin Charcot as being epileptic, but not hysterical. Having assumed that fugue is a kind of epilepsy, Charcot treated Mén with potassium bromide. As he said at the time, "This is plainly a special variety of epilepsy. Thanks to the bromide treatment, we have already helped him, and I hope that by the use of the same medication I shall continue to be of service to him" (p. 37). By entering the hysteria-epilepsy debate, fugue was accepted in the contemporary taxonomy of mental illnesses (Hacking’s first condition for the emergence of an ‘ecological niche’). In 1895, in an attempt to solve the debate whether fugue is a kind of hysteria or a kind of epilepsy, Fulgence Raymond investigated all the published cases and concluded that: ‘there were both epileptic and hysterical fugues, with the hysterical ones predominating’ (p. 47). According to Raymond, epileptic fugues were to be treated by chemical means and hysterical ones via hypnosis. Niches Hacking discusses why fugue did not spread in either Britain or America. Firstly, he argues, both countries had high rates of emigration – if there were some cases of fugue at all, the fuguers would be unlikely to return and thereby be diagnosed. Secondly, neither Britain nor America had conscript armies during this period. In other countries, such as France, which at the time did have conscription, and thereby their young men were more likely rigorously scrutinised while travelling and, if necessary, jailed or hospitalised (p. 64). Another reason why fugue did not spread in America was that the country did not have a degeneracy programme. France, in contrast, was notorious for low birth rates, vagrancy, insanity and homosexuality - what was at this time perceived as a state of degeneracy. Therefore, according to Hacking, fugue could more easily ‘thrive’ on the continent than in America. References 1998 non-fiction books Books about social constructionism Books by Ian Hacking Canadian non-fiction books

Prescriptive authority for psychologists movement

The prescriptive authority for psychologists (RxP) movement is a movement in the United States of America among certain psychologists to give prescriptive authority to psychologists with predoctoral or postdoctoral graduate-level training in clinical psychopharmacology; successful passage of a standardized, national examination (Psychopharmacology Examination for Psychologists - Second Edition; PEP-2); supervised clinical experience; or a certificate from the Department of Defense Psychopharmacology Demonstration Project; or a diploma from the Prescribing Psychologists Register (FICPP or FICPPM) to enable them, according to state law, to prescribe psychotropic medications to treat mental disorders. This approach is non-traditional medical training focused on the specialized training to prescribe for mental health disorders by a psychologist. It includes rigorous didactics and supervised clinical experience. Legislation pertaining to prescriptive authority for psychologists has been introduced over 180 times in over half of the United States. It has passed in seven states, due largely to substantial lobbying efforts by the American Psychological Association (APA), the largest professional organization of psychologists in the world with over 157,000 members. Prior to RxP legislation and in American states where it has not been passed, this role has been played by psychiatrists, who possess a medical degree and thus the authority to prescribe medication, but more frequently (60-80%) by primary care providers who can prescribe psychotropics, but lack extensive training in psychotropic drugs and in diagnosing and treating psychological disorders. According to the APA, the movement is a reaction to the growing public need for mental health services, particularly in under-resourced areas where patients have little or no access to psychiatrists. In states where RxP legislation has been passed, psychologists who seek prescriptive authority must possess a doctoral degree (PhD/PsyD), a license to practice independently, and completion of a Master of Science in clinical psychopharmacology (MSCP) degree or equivalent. Programs that offer the MSCP degree are: The California School of Professional Psychology at Alliant International University, The Chicago School of Professional Psychology, Drake University Fairleigh Dickinson University, Idaho State University, and New Mexico State University. Additional MSCP programs are in development. In some jurisdictions, completion of the training programs from the Department of Defense or the Prescribing Psychologists' Register Diplomate Certification also satisfies the licensing law requirements. The supervised clinical experience required after completing the MSCP and passing the PEP varies by jurisdiction, but typically requires a specific number of hours of supervised experience and/or a specific number of patients. Some jurisdictions then grant conditional prescribing psychology licenses or certifications, while others grant full prescribing authority after the supervised clinical experience has been successfully completed. The medications the psychologist may then prescribe are limited to those indicated for psychiatric problems; still, the specific medications that are able to be prescribed by prescribing or medical psychologists varies by jurisdiction. Psychologists' involvement in pharmacotherapy exists on a continuum, with psychologists serving as prescribers, collaborators, and information-providers in the medical decision-making process. Psychologists may prescribe in seven states: New Mexico, Louisiana, Illinois, Iowa, Idaho, Colorado, and Utah, as well as the Public Health Service, the Indian Health Service, the U.S. military, and the U.S. territory of Guam. When psychologists act only as collaborators, they lack the authority to make the final decision to prescribe; however, they may assist in the process by recommending clinically desirable treatment effects, certain classes of medications, specific medications, dosages, or other aspects of the treatment regimen. Psychologists also provide information that may be relevant to the prescribing professional. Psychologists may express concerns about treatment, refer patients for medication consultations, direct patients to referral or information sources, or discuss with patients how to address their concerns about medication with the prescriber. History The first bill seeking to authorize prescription privileges to psychologists was introduced in Hawai'i in 1985 under Hawaii State Resolution 159. The bill would have allowed licensed psychologists there to administer and prescribe psychotropic medication for the treatment of "nervous, mental, and organic brain disorders." Since then, a total of 88 prescriptive authority bills have been introduced in 21 jurisdictions. In 1988, the U.S. Department of Defense approved a pilot project to train psychologists in issuing psychotropic medications "under certain circumstances." Guam became the first U.S. territory to approve RxP legislation in 1999. New Mexico became the first state to approve RxP legislation in 2002, and Louisiana followed in 2004. In 2014, Illinois became the third state to approve RxP legislation. In 2016, Iowa became the fourth state to grant prescriptive authority, which was followed by Idaho in 2017. The rules and regulations for Illinois' RxP law were approved in 2018 and in 2019 in Iowa. In 2023, Colorado became the sixth state to pass prescriptive authority for psychologists legislation, followed by Utah in 2024. Many other states have introduced but have yet to approve RxP bills. As of 2024 there are approximately 250-300 active, prescribing psychologists across the United States, with over 240 graduate students and psychologists enrolled in an RxP training program. Nearly 1,500 individuals have completed a master's degree in clinical psychopharmacology and over 500 have passed the PEP. Since 2000, Division 55 of the American Psychological Association (the Society for Prescribing Psychology), has promoted prescriptive authority for psychologists across the country. Division 55 petitioned APA through its Commission for the Recognition of Specialties and Subspecialties in Professional Psychology (CRSSPP) for official recognition of clinical psychopharmacology as a specialty in psychology. At its meeting in August 2020, the APA Council of Representatives gave final approval to this petition, adding clinical psychopharmacology to 17 other APA-recognized psychological specialties. Division 55 is in the process of becoming a member of the Council of Specialties (CoS) in Professional Psychology, Council of Chairs of Training Councils (CCTC), and creating a board certification in clinical psychopharmacology through the American Board of Professional Psychology (ABPP). The State of New Mexico was the first to enact a Psychologists prescribing law. Louisiana's legislature went on to establish medical psychology as a separate and distinct healthcare profession and transferred the regulation of its practice to the Louisiana State Board of Medical Examiners. The entire practice of psychology for medical psychologists, including psychotherapy and psychological testing, was also transferred to the Louisiana Board of Medical Examiners, effectively making Louisiana the only state in the U.S. where, for some psychologists, a medical board has authority over their entire practice. Because of this, several national organizations, including the American Psychological Association and the Association of State and Provincial Psychology Boards have expressed concern over the practice of psychology being regulated by another profession (i.e., medicine). The Louisiana Psychological Association has strongly echoed such concerns. However, the Louisiana Academy of Medical Psychologists (LAMP), a Political Action Committee representing medical psychologists in the state, strongly endorsed the change of regulation. Prescribing rights for psychologists are being negotiated in South Africa, Canada, the United Kingdom, and Australia. APA Guidelines In December 2011, the American Psychological Association (APA) published a list of practice guidelines that apply to all prescribing activities, with some also applicable to collaborating and information providing activities. The list is categorized according to the area of psychologists' involvement in pharmacological issues (general, education, assessment, intervention and consultation). The following list summarizes the guidelines by section. These practice guidelines are in process of being revised and updated as of 2023. *General Guidelines 1 through 3 encourage psychologists to act within the scope of their practice with regards to prescribing psychotropic medications, which includes seeking consultation before recommending certain medications; emphasize that psychologists' evaluate their own views and opinions towards prescribing medications in light of how it may affect communication with patients; and expect that psychologists involved in medication prescription or collaboration be wary of developmental, age, educational, sex, gender, language, health status, and cultural factors involved in populations a psychologist may serve, with regards to pharmacotherapy. *Education Guidelines 4 through 6 require that psychologists attain a level of education specific to pharmacotherapy in order to serve their clients; expect that psychologists be wary of potential adverse side effects of psychotropic medications; and ask that psychologists that prescribe or collaborate with regards to medication prescription be aware of helpful technological resources that are available. *Assessment Guidelines 7 through 9 require that psychologists familiarize themselves with procedures for monitoring the physiological and psychological effects of medications; expect that psychologists who prescribe medications consider other physiological disorders or underlying diseases that the patient may have that could affect the effectiveness of medications; and encourage psychologists to consider issues about patient adherence and concerns about medications. *Intervention and Consultation Guidelines 10 through 15 require that psychologists employ a biopsychosocial approach when prescribing medications and that they also use informed consent procedures, act in the best interest of the patient, and consider current research; emphasize that psychologists be wary of commercial influences regarding medications; and encourage psychologists to consider the patient's interpersonal behaviors. *Relationships Guidelines 16 and 17 expect that psychologists maintain appropriate relationships with other providers of psychological services and biological interventions. Supporting arguments There are several core arguments put forth by RxP advocates, including the following: Other non-physicians have prescription privileges, such as pharmacists, optometrists, nurse practitioners, and physician assistants. Some advocates have asserted that the latter three professions receive less training in clinical pharmacology, therapeutics, and psychopharmacology than many clinical psychologists. The statistics point to multiple content areas in which other professions, such as psychiatric nurse practitioners or physician assistants, are relatively deficient in comparison to pharmacologically-trained psychologists’ preparation. The training model is supported by a complete lack of legal complaint after eight years regarding the practice of the initial ten psychologists trained by the U.S. Department of Defense. Legal complaints differ from legal suits, as military personnel cannot sue for redress. Access to medication would be improved in jurisdictions with long waiting times to see a psychiatrist or other qualified physician. The prescriptive authority would be enhanced by the psychologist's doctoral training in the science of psychology, assessment, and psychotherapy. This training is more extensive than that received by the average physician. In addition, the training program for psychologists would provide twice as much pharmacology training than nurse practitioners and physician assistants receive. It would address the fact that many lack access to psychiatrists (especially in rural areas). It would create a clearer distinction in psychology between doctoral and master-level practitioners, and between doctoral and post-doctoral level practitioners. In circumstances in which the psychologist decided not to collaborate with medical colleagues, it could allow the psychologist control of the entire treatment process. In some cases, this might reduce or eliminate complications arising from interprofessional collaboration and potentially save patients money. Psychologists with prescriptive authority would add competence to the overall mental health system by adding a resource for general practitioners who need professional consultation regarding psychological disorders and psychotropic medications when a psychiatrist is unavailable. Psychopharmacological training allows psychologists to provide better advocacy for their clients. According to a survey assessing the views of psychology interns, residents, and psychologists published in the journal Professional Psychology: Research and Practice, significant support exists regarding the APA's prescriptive authority initiative. Proponents of the prescriptive authority initiative believe that it would improve the economic stability of the profession, provide better opportunities to underserved populations, and enhance psychologists' clinical skills through a better understanding of biopsychosocial interactions. Support for the prescriptive authority initiative also appears higher amongst those with PsyDs and early career psychologists (within 10 years of receiving doctorate) than those with PhDs and mid- and late-career psychologists. Demographically, females and Caucasians expressed more willingness to seek prescription privileges. Also, those who attended a clinical or counseling graduate program, received a PhD degree, and those employed in a university counseling center, medical school hospital, or independent practice tend to demonstrate higher levels of support for the initiative. In terms of training, an overwhelming majority of those surveyed believe training should begin at the graduate level, but prior to completion of a doctorate. Accordingly, in February 2019, the APA Council of Representatives overwhelmingly voted to approve changes to APA policy that allows psychopharmacology training to begin at the graduate level; previously, APA policy only allowed for this training to occur at the postdoctoral level. In Illinois, one of the jurisdictions where RxP is law, there are already psychopharmacology programs in place that offer this education and training at the predoctoral level. Additionally, respondents preferred that training occur on a part-time basis, be completed within two to two-and-a-half years and cost $12,000-$18,000. Today, evidence exists to indicate a continual and growing level of support for the American Psychological Association's prescriptive authority initiative. Such support reflects psychologists' willingness to open their minds to learning about psychotropic medications, incorporating pharmacological treatment with therapy, and adapting to the demands of a rapidly changing health care world. Opposition Prescriptive authority for psychologists has been controversial, even within the healthcare community, which has created entire organizations dedicated to objecting to prescriptive authority for clinical psychologists. Specifically, critics within the medical profession have expressed concern that they have no medical training. The current RxP model explicitly states that this movement includes no medical training, but this can be accomplished with a master's degree in psychopharmacology, typically from a postdoctoral education program at a professional school. Some opponents claim this would culminate in substantially fewer years and hours compared to physician assistants and nurse practitioners, who are granted full prescriptive authority, and can elect to specialize in psychiatry, unlike the majority of psychologists. However, proponents have rebutted this assertion by describing their sequence of training (e.g., 4-year undergraduate degree, 5-year doctoral degree, 1-year internship, 1-year residency/fellowship, 2-year master's degree in psychopharmacology, national psychopharmacology exam, supervised clinical experience). In addition, survey research comparing prescribing psychologists' training against that of nurse practitioners and physician assistants has demonstrated that when presented with un-labeled training programs side-by-side, prescribing psychologists' training is perceived to be more rigorous overall than that of psychiatric nurse practitioners or physicians assistants in their ability to prescribe psychiatric medication. This perception was found to be true of physicians, mid-level providers, psychologists, non-prescribing therapists, and general members of the public. Psychologists who have extensively researched the effects of psychopharmacology Andrew Feldmár (1940) Bruce K. Alexander (1939) Betty Eisner (1915–2004) Charles R. Schuster (1930 - 2011) Corneliu E. Giurgea (1923–1995) Duncan B. Blewett (1920-2007) James Fadiman (1939) Neal M. Goldsmith Mitch Earleywine Rick Doblin (1953) Ralph Metzner (1936-2019) Sidney Durward Shirley Spragg (1909-1995) Timothy Leary (1920-1996) References Clinical psychology Mental health law in the United States Prescription of drugs Psychiatry

EFT

An eft is a newt in the terrestrial juvenile phase. EFT, EfT, or eft also may refer to: Places École Française de Téhéran, an international school in Iran Monroe Municipal Airport (FAA:EFT), Wisconsin, United States Science and technology Ecosystem Functional Type, in ecology Effective field theory, in physics Electrical fast transient, in electrical engineering Emotionally focused therapy, in psychotherapy Ewing family of tumors, in medicine Exploration Flight Test-1, a 2014 NASA test flight Other uses Electronic funds transfer, in banking Emotional Freedom Techniques, in alternative medicine Escape from Tarkov, a 2017 FPS video game Evangelical Fellowship of Thailand, in Christianity See also EFTS (disambiguation)

Feigned madness

"Feigned madness" is a phrase used in popular culture to describe the assumption of a mental disorder for the purposes of evasion, deceit or the diversion of suspicion. In some cases, feigned madness may be a strategy—in the case of court jesters, an institutionalised one—by which a person acquires a privilege to violate taboos on speaking unpleasant, socially unacceptable, or dangerous truths. Modern examples To avoid responsibility Vincent Gigante, American Mafia don, was seen wandering the streets of Greenwich Village, Manhattan in his bathrobe and slippers, mumbling incoherently to himself, in what he later admitted was an elaborate act. Allegedly, Shūmei Ōkawa, Japanese nationalist, on trial for war crimes after World War II. Garrett Brock Trapnell, a professional thief and confidence man, frequently pretended to be affected by schizophrenia or dissociative identity disorder in order to be sent to mental institutions rather than prison for his crimes. This strategy eventually failed when he was brought to trial for aircraft hijacking. He was later the subject of a book by Eliot Asinof, entitled The Fox Is Crazy Too. To examine the system from the inside Investigative journalists and psychologists have feigned madness to study psychiatric hospitals from within: American muckraker Nellie Bly; see Ten Days in a Mad-House (1887) The Rosenhan experiment in the 1970s also provides a comparison of life inside several mental hospitals. The Swedish artist Anna Odell created the project Okänd, kvinna 2009-349701 to examine power structures in healthcare, the society's view of mental illness and the victimhood imposed on the patient. Historical examples Lucius Junius Brutus, who feigned stupidity, causing the Tarquins to underestimate him as a threat until the time when he was able to drive the Roman people to insurrection. Ibn al-Haytham, also known as Alhazen, who was ordered by the sixth Fatimid Caliph, al-Hakim, to regulate the flooding of the Nile; he later perceived the insanity and futility of what he was attempting to do and, fearing for his life, feigned madness to avoid the Caliph's wrath. The Caliph, believing him to be insane, placed him under house arrest rather than execute him for failure. Alhazen remained there until the Caliph's death, thereby escaping punishment for his failure to accomplish a task that had been impossible from the beginning. Kamo, a Bolshevik revolutionary, successfully feigned madness when in a German prison in 1909, and then in a Russian prison in 1910. Ion Ferguson, an Irish psychiatrist in the British Army in a World War II German prisoner-of-war camp, successfully feigned madness to get himself repatriated. He also assisted two other prisoners in doing the same. Ephrem the Syrian, a prominent Christian theologian and writer of Christian literature, avoided presbyteral consecration by feigning madness because he thought he was unworthy of it. In fiction and mythology Shakespeare's Hamlet, who feigns madness in order to speak freely and gain revenge—possibly based on a real person; see Hamlet (legend). Madness in Valencia is a 1590s comedy by Lope de Vega in which the male lead gets himself into an asylum to escape prosecution for murder. Other characters also feign for love. Odysseus feigned madness by yoking a horse and an ox to his plow and sowing salt<ref>the story does not appear in Homer, but was apparently mentioned in Sophocles' lost tragedy The Mad Ulysses: James George Frazer, ed., Apollodorus: Library, Epitome 3.7:footnote 2; Hyginus, Fabulae 95 mentions the mismatched animals but not the salt.</ref> or plowing the beach. Palamedes believed that he was faking and tested it by placing his son, Telemachus right in front of the plow. When Odysseus stopped immediately, his sanity was proven. "Feign madness but keep your balance" is one of the Thirty-Six Stratagems One Flew Over the Cuckoo's Nest, Randle McMurphy feigns insanity in order to serve out his criminal sentence in a mental hospital rather than a prison. In Henry IV by Luigi Pirandello, the main character feigns insanity. In Goodbyeee, the last episode of BBC sitcom Blackadder, Blackadder feigns madness to try to avoid being sent into battle. The protagonist of the film Shock Corridor is a journalist who fakes insanity in order to gain access to an institution. In Ricochet, Denzel Washington plays an assistant district attorney who feigns madness to catch a criminal by extraordinary means. He remarks: "Going insane, it's strangely liberating, isn't it?" Another notable example is Primal Fear, adapted from the William Diehl novel of the same name. In the film, Martin Vail (Richard Gere) defends a timid, young altar boy named Aaron Stampler (Edward Norton) accused of murdering an archbishop. Halfway through, Vail discovers Stampler has dissociative identity disorder, with one sociopathic personality called "Roy," who was responsible for killing the Archbishop. However, after Stampler is released due to plea of insanity, Vail discovers Stampler faked the disorder in order to avoid execution. The film was Edward Norton's debut, which earned him an Oscar nomination for Best Supporting Actor. Jose Manalo and Wally Bayola's roles in Scaregivers feigned madness by eating peanut butter disguised as stool samples, which landed them in a mental facility. In Colditz'', a British television series about prisoners-of-war in WWII Germany, Wing Commander George Marsh feigns madness as a way of escaping. He successfully convinces his captors that he is insane and is duly repatriated. But there is a twist: after his return to Britain, Marsh becomes genuinely insane. See also Münchausen syndrome Malingering References David and king Achish Lucius Junius Brutus Hamlet Criminal law Factitious disorders

Epsom Cluster

The Epsom Cluster, also referred to as the Horton Estate, was a cluster or group of five large psychiatric hospitals situated on land to the west of Epsom. The hospitals were built by the London County Council to alleviate pressure on London's existing lunatic asylums, which had by this time become overcrowded. The County Council continued to manage them until they were nationalised, becoming part of the National Health Service in 1948. The cluster comprised: Horton Hospital Long Grove Hospital Manor Hospital St Ebba's Hospital West Park Hospital The Horton Light Railway transported building supplies and then coal and provisions to the hospitals in the cluster. The cluster was served by a central cemetery on the corner of Hook Road and Horton Lane until 1955 and a central waterworks and power station until the arrival of mains services. Present day Following changes in the provision of mental health care, including a greater emphasis on care in the community, most of the hospitals' patients were discharged in the 1990s and early 2000s. As of 2011, much of the estate had been redeveloped for housing, including most of The Manor and Horton sites and all of Long Grove. NHS psychiatric units remained operational at St. Ebba's, Horton Haven, West Park and the Manor while redundant areas at West Park and St. Ebba's were undergoing redevelopment. Notes External links A History of the Epsom Cluster Hospitals in Surrey Epsom Psychiatric hospitals in the United Kingdom

Clinical study design

Clinical study design is the formulation of trials and experiments, as well as observational studies in medical, clinical and other types of research (e.g., epidemiological) involving human beings. The goal of a clinical study is to assess the safety, efficacy, and / or the mechanism of action of an investigational medicinal product (IMP) or procedure, or new drug or device that is in development, but potentially not yet approved by a health authority (e.g. Food and Drug Administration). It can also be to investigate a drug, device or procedure that has already been approved but is still in need of further investigation, typically with respect to long-term effects or cost-effectiveness. Some of the considerations here are shared under the more general topic of design of experiments but there can be others, in particular related to patient confidentiality and ethics. Outline of types of designs for clinical studies Treatment studies Randomized controlled trial Blind trial Non-blind trial Adaptive clinical trial Platform Trials Nonrandomized trial (quasi-experiment) Interrupted time series design (measures on a sample or a series of samples from the same population are obtained several times before and after a manipulated event or a naturally occurring event) - considered a type of quasi-experiment Observational studies 1. Descriptive Case report Case series Population study 2. Analytical Cohort study Prospective cohort Retrospective cohort Time series study Case-control study Nested case-control study Cross-sectional study Community survey (a type of cross-sectional study) Ecological study Important considerations When choosing a study design, many factors must be taken into account. Different types of studies are subject to different types of bias. For example, recall bias is likely to occur in cross-sectional or case-control studies where subjects are asked to recall exposure to risk factors. Subjects with the relevant condition (e.g. breast cancer) may be more likely to recall the relevant exposures that they had undergone (e.g. hormone replacement therapy) than subjects who don't have the condition. The ecological fallacy may occur when conclusions about individuals are drawn from analyses conducted on grouped data. The nature of this type of analysis tends to overestimate the degree of association between variables. Seasonal studies Conducting studies in seasonal indications (such as allergies, Seasonal Affective Disorder, influenza, and others) can complicate a trial as patients must be enrolled quickly. Additionally, seasonal variations and weather patterns can affect a seasonal study. Other terms The term retrospective study is sometimes used as another term for a case-control study. This use of the term "retrospective study" is misleading, however, and should be avoided because other research designs besides case-control studies are also retrospective in orientation. Superiority trials are designed to demonstrate that one treatment is more effective than a given reference treatment. This type of study design is often used to test the effectiveness of a treatment compared to placebo or to the currently best available treatment. Non-inferiority trials are designed to demonstrate that a treatment is at least not appreciably less effective than a given reference treatment. This type of study design is often employed when comparing a new treatment to an established medical standard of care, in situations where the new treatment is cheaper, safer or more convenient than the reference treatment and would therefore be preferable if not appreciably less effective. Equivalence trials are designed to demonstrate that two treatments are equally effective. When using "parallel groups", each patient receives one treatment; in a "crossover study", each patient receives several treatments but in different order. A longitudinal study assesses research subjects over two or more points in time; by contrast, a cross-sectional study assesses research subjects at only one point in time (so case-control, cohort, and randomized studies are not cross-sectional). See also Conceptual framework Epidemiological methods Epidemiology Experimental control Meta-analysis Operationalization Academic clinical trials Design of experiments Research design References External links Some aspects of study design Tufts University web site Comparison of strength Description of study designs from the National Cancer Institute Clinical research Medical statistics Design of experiments Scientific method de:Forschungsdesign

Chemical restraint

A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perform surgery or to reduce agitation, aggression or violent behaviours; it may also be used to control or punish unruly behaviours. A drug used for chemical restraint may also be referred to as a "psychopharmacologic agent", "psychotropic drug" or "therapeutic restraint" in certain legal writing. In the UK, NICE recommends the use of chemical restraint for acute behaviour disturbances (ABD), but only after verbal calming and de-escalation techniques have been attempted. It is viewed as superior to physical restraint, with physical restraints only being recommended for the administration of a chemical restraint. In the United States, no drugs are presently approved by the U.S. Food and Drug Administration (FDA) for use as chemical restraints. Drugs that are often used as chemical restraints include antipsychotics, benzodiazepines, and dissociative anesthetics such as ketamine. A systematic review in 2019 advised the use of intravenous haloperidol (a short half-life, first-generation antipsychotic) alone or in conjunction with lorazepam or midazolam (short half-life benzodiazepines), but said more research was needed. The Human Rights Watch wrote a report on the use of chemical restraints amongst the elderly in the US. It concluded that antipsychotic drugs are sometimes used almost by default to control difficult-to-manage residents. The FDA estimates 15,000 elderly individuals in nursing homes die each year due to the unnecessary use of anti-psychotics. According to the Nursing Home Reform Act, individuals have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. The use of chemical restraint has been criticized. It is sometimes misused by health care workers for the convenience of the staff rather than the benefit of the patient, with workers using them to prevent patients from resisting care, rather than improving the health of the patient; it can cause more confusion in patients, slowing their recovery; and it can be unclear whether drugs used for chemical restraint are necessary to treat an underlying mental health condition or whether they are being used to sedate the patient. Patients can view chemical restraint as a violation of integrity and find the experience traumatic. Notes References Physical restraint

Transitional age youth

Transitional age youth (alternatively: TAY, Transition Aged Youth, Transition-Age Youth, Transitional Age Youth, Transitioning Youth, Transitional Youth, and Youth in Transition) can reference both a developmental period and be a descriptor regarding eligibility for certain services. While there are variations in definitions, the age ranges do consistently overlap and include late adolescence (15-16 years of age) to early adulthood (24-26 years). This range is considered a critical period in human development characterized by several changes socially, environmentally, and cognitively. During this time, individuals can experience changes in their social roles and function, family and peer supports, exposure to substance use, educational and vocational programs, as well as changes in healthcare providers from pediatric to adult settings. History The phrase transitional aged youth (TAY and the variations listed above) originated in the foster care system but has since taken on broad applicability to other (primarily healthcare) sectors. Specifically, youth “in transition” can refer to “aging out” or being ineligible for pediatric health care services after turning 18 years old, or being ineligible for children’s mental health services at 18 years old in certain places. The adult outcomes for youth involved in various child-serving systems (special education, pediatric primary care, child and adolescent mental health, child welfare, and juvenile justice) came under scrutiny in the 1980s. As a result, planning around the transition from child to adult services became a focus across many systems. In mental health systems, the term transitional aged youth (TAY) has historically been associated with youth and young adults at high risk of poor transition outcomes due to complex needs, lack of a support system, and multiple challenges. Earlier studies on young adult outcomes used the term to describe individuals from 16-25 years old who have, or are at risk of having, Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED), defined as serious emotional or behavioral difficulties that are psychological in origin, in combination with significant functional impairment, and arise by age 18 years. Terminology has since evolved, both in mental health and in federal initiatives. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) has broadened its scope to include TAY with SED and in the general public, through its Now Is The Time Healthy Transitions program. This expansion likely reflects the growing knowledge that all youth of transition age are at risk for mental health issues, substance abuse disorders, and suicide. Therefore, TAY is being used more often to refer to all individuals within an age range, regardless of presence of SED or service system involvement. Other terms which overlap with TAY include Emerging Adulthood (EA), coined by Arnett who proposes EA as a normal discrete developmental phase for all persons 18-25; Adolescents and Young Adults (AYAs), historically those with cancer but now more generally referring to all health needs of 10-25 year-olds; and Youth and Young Adults (YAYAs). Sometimes, the acquisition of tasks during this developmental phase has been colloquially termed, “adulting”. Developmental tasks Like many other developmental stages, the period of transition from adolescence to early adulthood is faced with many unique challenges. TAY must consolidate and build upon the tasks that they started in adolescence, including the enrichment of their identity, independence, and relationships. During this period, their bodies begin to reach physical and sexual maturity, while cognitive and psychological development often trail behind. Physically, TAY undergo puberty mediated by sex hormones, including increases in testosterone and estrogen, and begin to develop secondary sex and traditional gender role characteristics. Cognitively, they start to form a moral code, combining aspects of societal expectations and rights as well as universal ethical principles. As they work towards independence, TAY must acquire skills for adulthood, such as learning how to manage finances, housing, and medical and legal decision-making, in order to move away from reliance upon family for basic needs. Smaller steps needed to gain success include learning how to create and maintain a budget, identifying “needs versus wants,” and opening a bank account. Legally, many youth will continue to require their guardian’s consent/permission for many medical procedures, medications (including psychiatric), and services until they reach the age of majority. Independence also involves forming and maintaining fulfilling relationships outside of the family unit. As dependence on the family lessens, relationships shift to companionship, support, and intimacy with peers. Friendships become more important as TAY further individualize and psychologically discover who they are. Intimate relationships are often more challenging to develop, and many may not find a partner during this developmental period, as TAY navigate the stresses of biological and hormonal drives, psychological wants for intimacy and acceptance, and weigh potential negatives including parental disapproval, possible pregnancy, sexually transmitted diseases, and peer rejection. Population health In 2020, the global population of 15-24 year olds was estimated to be 1.2 billion, accounting for about 15% of the world’s total population. The health of adolescents is a critical component of a successful transition to adulthood. This period is marked by significant physical, cognitive, and psychosocial growth, and is an important time for building foundations for good health. While young people are typically seen as healthy, this period can correlate with a rise in health problems, including the emergence of mental health issues. In the last decade, depression, anxiety, and injuries (road injuries, self-harm, and interpersonal violence) were among the top ten causes of death in 10-24 year olds. Factors affecting health There are many factors that can affect the health of this population. As part of normal development, adolescents become increasingly independent and may experiment with adult behaviors that affect future patterns of adult health. Behaviors such as driving, sexual experimentation, tobacco, alcohol, and substance use, and diet and exercise habits can impact health in the short- and long-term. Since 2014, e-cigarettes (or “vaping”) have been the most commonly used nicotine product among youth. The high level of use in this population led the U.S. Surgeon General to declare e-cigarette use an epidemic. Concerns about the negative effects of nicotine on the adolescent brain include addiction, impact on learning, memory, and attention, toxic effects on lungs from aerosol, and use of e-cigarettes for marijuana. In addition to substance use, factors that affect health in this population should be considered from a comprehensive perspective and include sexual and reproductive health, HIV and other infectious diseases, nutritional deficiencies, injury and violence, chronic physical health problems, and mental health disorders. Barriers to transition of health care Significant barriers may impact the successful transition from pediatric to adult health care, which in turn can negatively impact health outcomes. Taking responsibility for managing one’s own health care can be a struggle for young adults. As youth transition to adulthood, responsibility shifts from the family to the youth. Some youth with pre-existing illnesses might decide that treatment is no longer necessary. The myth of invulnerability and fear of being ill may reduce a young adult’s motivation to seek treatment. Young adults who do seek treatment must learn how to obtain health insurance, schedule medical appointments, remember to take medication, and obtain refills. They must acquire these new skills while learning how to balance employment or increased academic demands (for those in college), wellness and social activities, and with decreased support. In some countries, there are financial burdens related to the costs of high-quality healthcare. Finally, transportation issues may impact access to care, and worries about money are also widespread in the young adult population and may limit treatment options. Risk factors for mental health disorders The transitional aged youth years coincide with the onset of many mental health conditions. Approximately 75% of serious psychiatric disorders present with symptoms before the age of 25 (i.e., schizophrenia, bipolar disorder, substance use disorders, etc.). Studies have shown that in the “transitional aged brain”, a mismatch occurs between the early maturation of the subcortical brain regions, and the delayed maturation of the prefrontal cortex and the white matter tracts connecting them. The subcortical areas, known as the amygdala and nucleus accumbens, influence motivation, passion, pleasure, and aversive experiences, while the prefrontal cortex and connecting white matter tracts are important for attention, emotional and impulse control, flexibility, planning, and judgment. Even with external control and expectations, this group remains at very high risk for morbidity and mortality associated with suicide, substance use, psychiatric illness, and accidents. At the same time that these youth and their maturing brains need more external regulatory support and lower risk environments, they instead have easier access to alcohol and drugs, high-risk social activities, and loss of close parenting and supervision. Exposure to toxins (e.g., drugs, infections, extreme stress, or hypoxia) and trauma (“toxic stress”) during childhood and adolescence can also affect adult functioning. For example, adolescent exposure to marijuana may increase the risk of psychosis in vulnerable youths. A growing body of literature implicates Adverse Childhood Experiences, including physical, sexual, and emotional abuse, in a broad range of negative health consequences including depression, anxiety, suicidality, and cardiovascular and immune disease. Special subgroups Serious mental illness According to the NIMH, in 2019 young adults aged 18-25 years had the highest prevalence of serious mental illness (SMI) (8.6%) compared to adults aged 26-49 years (6.8%) and aged 50 and older (2.9%). TAY with untreated mental health disorders are at high risk for substance abuse, physical assault, and encounters with the correctional system. Foster care Because of the early terminology applied to this population, there is a core body of research related to TAY and youth in foster care. Upwards of 80% of foster youth have developmental, behavioral, or mental health concerns. Foster care alumni have higher rates of mental health disorders than the general population, such as depression, PTSD and substance use disorders. Former foster youth with mental illness often have past trauma histories, such as being a victim of child abuse and neglect, that make it challenging for them to develop and maintain healthy adult relationships. Their mood may easily become dysregulated as a result of insecure attachments. Some researchers have shown that the more placements a child experiences, the higher risk of attachment issues which can lead to a high risk of psychiatric morbidity in adulthood. Compared to other Medicaid-eligible youth, foster youth have higher rates of behavioral health expenditures. Foster youth are prescribed psychotropic medications at 2-8 times the rate of other Medicaid-eligible youth (GAO, 2011). Foster youth are at risk for inappropriate prescribing because of limited access to youth behavioral health information and history, fragmented and/or inadequately coordinated care, insufficient time for assessment, treatment, and collaboration; un- or misdiagnosed trauma-related conditions, limited access to effective psychosocial and psychiatric treatments, and ineffective advocacy for foster youth. The prime importance of developing treatment approaches to engage and maintain TAY in psychiatric treatment has been well documented in the literature. According to the 2014 Substance Abuse and Mental Health Services Administration (SAMHSA) study report: one-fifth of young adults of age 18 to 25 had a mental health illness in the past year, yet two-thirds of those did not receive treatment. Youth with serious mental health conditions can have significant delays in their psychosocial development that can impair their ability to function as they enter adulthood. Programs and changes in programs Foster care is and was intended to be a temporary situation for children, however many children entering foster care, 25-30% (Kelly) remain there until the age of 18. According to the U.S. Census Bureau, in 2005, of the approximately 500,000 (was 550,000 in 2000) children in the foster care system in the United States, an estimated 24,000 foster youth age out of care each year and attempt to live independently. (Gardner) Homelessness for youth aging out could be lessened using the Chafee Independent Living Program of 1999. According to this program states are allowed to use up to 30% of their independent living funds on room and board for former foster youth who are at least 18 years old but not yet 21. It also requires states to use at least some portion of their funds to provide follow-up services to foster youth after they age out. (Dworsky) The previous program, Title IV-E Independent Living Program of 1990, did not allow the state to use any of its funding for room and board, independent living subsidies, or transitional housing for youth aging out. (Dworsky) The Fostering Connections to Success and Increasing Adoptions Act of 2008 contains several provisions aimed at promoting permanent family connections for youth in foster care. (Dworsky) The following are changes made by the Fostering Connections to Success and Increasing Adoptions Act of 2008 to improve the connection between foster youth and extended family members: Notice to Relatives When Children Enter Care. Increases opportunities for relatives to step in when children are removed from their parents and placed in foster care by ensuring they get notice of this removal. Kinship Navigator Programs. Guarantees funds for Kinship Navigator programs, through new Family Connection grants, to help connect children living with relatives, both in and out of foster care, with the supports and assistance they need. Subsidized Guardianship Payments for Relatives. Helps children in foster care leave care to live permanently with grandparents and other relative guardians when they cannot be returned home or adopted and offers federal support to states to assist with subsidized guardianship payments to families for these children, generally to age 18. In certain circumstances, children may continue to receive guardianship assistance to age 21. Clarifies that all children who, as of September 30, 2008, were receiving federally supported subsidized guardianship payments or services in states with Child Welfare Demonstration Waivers will be able to continue to receive that assistance and services under the new program. Clarifies that children who leave foster care after age 16 for kinship guardianship are eligible for independent living services and makes them eligible for education and training vouchers. Licensing Standards for Relatives. Clarifies that states may waive non-safety related licensing standards for relatives on a case-by-case basis and requires the Department of Health and Human Services (HHS) to report to Congress on the use of licensing waivers and recommendations for increasing the percentage of relative foster family homes that are licensed. New Family Connection Grants. Increases resources for Kinship Navigator programs, as described above. Also provides grants for Family Group Decision-making Meetings, Intensive Family Finding activities, and Residential Family-Based Substance Abuse Treatment, all of which can help children stay safely with family members and out of foster care or, once in care, return safely to their parents or find permanence with other relatives. Keeping Siblings Together. Preserves the sibling bond for children by requiring states to make reasonable efforts to place siblings together when they must be removed from their parents’ home, provided it is in the children's best interests. In the case of siblings not placed together, states must make reasonable efforts to provide for frequent visitation or other ongoing interaction, unless such interaction would be harmful to any of the siblings. (Children's Defense Fund) This Act helps youth who turn 18 in foster care without permanent families to remain in care, at state option, to age 19, 20, or 21 with continued federal support to increase their opportunities for success as they transition to adulthood. (Children's Defense Fund) This Act also assists foster youth with extra support surrounding their education and healthcare needs as the age out. 24,000 youth age out of foster care every year. The majority of them will be dependent on government assistance at some point whether it is for medical care because of the lack of insurance, food assistance because of the lack of income, housing assistance because of the lack of income, or in some cases their children will be in the foster care system perpetuating the foster care cycle. Society as a whole needs to recognize the consequences of foster youth aging out without the education, experience, knowledge, or skills needed to become a successful adult. Changes to the foster care system can be made, but it will take time, patience, endurance, persistence, and ingenuity from not only the workers in the system and the foster youth, but from a society that recognizes the impact foster youth aging out will make on the future. Outcomes for transitional age youth in foster systems Foster care youth are more likely to experience a lack of social support before they enter the system and are more likely to come from low income households with higher rates of physical and verbal abuse (Lindquist & Santavirts, 2014). Their experiences therefore shape their journey throughout the foster care system and into adulthood. When foster youth leave the system, they are more likely to face disadvantages and challenges when compared to their peers in the general population (Gypen et al., 2017). Foster care youth are less likely to graduate from high school than their peers in the general population (Gypen et al., 2017). Those who are able to attain a high school diploma often find struggles when it comes to higher education. Foster care youth who enroll in college are twice as likely to drop out in their first year compared to their peers in the general population (Gypen et al., 2017). They are also less likely to complete 2-year degrees, and those who do make it to a 4-year university are more likely to drop out after 2 years (Gypen et al., 2017). This can then impact their ability to find employment as they are less likely to find stable employment once they exit the foster care system (Gypen et al., 2017). Although around 80% of former foster youth do find employment within 2 years of leaving the system, most of these jobs are part time and often require little skill or minimal pay (Dworsky, 2005). This then impacts their earnings, as they are more likely to earn less than non-foster care youth, and are more likely to live in poverty due to the low earnings (Gypen et al., 2017). When it comes to housing, the low earnings and lack of support then makes foster care youth more likely to experience unstable housing situations and, in some cases, homelessness. Around 28% of former foster care youth can secure their own place, while around .3% end up homeless, and most of the transitional youth end up in some sort of supported household (i.e. extended relative, foster parent, friend) (Gypen et al., 2017). Mental health issues, substance abuse and alcohol abuse issues are also challenges that many transitional age youth face once they exit the foster care system. Foster care alumni are more likely to come from a past of neglect and/or physical/verbal abuse. Therefore, they are more likely to suffer from mental health issues such as disruptive disorders, depression, and PTSD (Gypen et al., 2017). Up to 63% of former foster care youth are likely to qualify for some sort of psychiatric disorder at some point in their lifetime (Gypen et al., 2017). In addition, foster care youth, particularly men, are more likely to suffer from substance abuse and mental health issues, and their chances of suffering from these issues increase as they get older (Gypen et al., 2017). See also Child development Coming of Age Adolescence Erikson's Stages of pychosocial development References Dworsky, A. (2005). The economic self-sufficiency of Wisconsin’s former foster youth. Children and Youth Services Review, 27, 1085-1118. . Gypen, L., Vanderfaeillie, J., Maeyer, S. D., Belenger, L., & Holen, F. V. (2017). Outcomes of children who grew up in foster care: Systematic-review. Children and Youth Services Review, 76, 74-83. Lindquist, M.J., & Santavirta, T. (2014). Does placing children in foster care increase their adult criminality? Labour Economics, 31, 72-83. . American Academy of Child and Adolescent Psychiatry (2017). FAQs for Child, Adolescent and Adult Psychiatrists Working with Transitional Age Youth.https://www.aacap.org/AACAP/Clinical_Practice_Center/Systems_of_Care/FAQs_for_Child__Adolescent_and_Adult_Psychiatrists_Working_with_Transitional_Age_Youth.aspx. External links American Academy of Child and Adolescent Psychiatry UMass Chan Medical School Transition Age Youth Resources Stand Up For Kids: Organization Serving Transitional Age Youth LifePortal Foster care Social work

Intermetamorphosis

Intermetamorphosis is a delusional misidentification syndrome, related to agnosia. The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality. The disorder is usually comorbid with neurological disorders or mental disorders. The disorder was first described in 1932 by Paul Courbon (1879–1958), a French psychiatrist. Intermetamorphosis is rare, although issues with diagnostics and comorbidity may lead to under-reporting. Signs and symptoms Individuals experiencing intermetamorphosis, as well as the other delusional misidentification syndromes (DMS), tend to misidentify those people that are both physically and emotionally close to them; the most commonly misidentified people are parents, siblings and spouses. There are instances of individuals misidentifying people not known to them, however, they still held an affective importance, such as celebrities or politicians. The explanations for the inauthenticity of the misidentified people are associated with the individual experiencing the delusions' cultural background. Example An example from medical literature is a man who was diagnosed with Alzheimer's disease. He mistook his wife for his deceased mother and later for his sister. He explained that he had never been married or that his wife had left him. Later he mistook his son for his brother and his daughter for another sister. Visual agnosia or prosopagnosia were not diagnosed, as the misidentification also took place during phone calls. On several occasions he mistook the hospital for the church he used to go to. Violence There is an association in the literature between misidentification syndromes and violent or aggressive behavior. In several case studies, individuals with misidentification syndromes acted aggressively towards the object of misidentification, which has the potential for criminal behavior. This may be because the delusions cause individuals to view the misidentified object with suspicion, and they become paranoid about the inauthenticity of the object, leading to an act of presumed preemptive self-defense. Although gender differences in the occurrence of intermetamorphosis are not pronounced, the research demonstrates that a majority (70%) of occurrences with violent behavior involves males. The issue of violent and aggressive behavior within this set of syndromes continues to play an important role in the discussion of criminal responsibility and risk assessment. Comorbidity Intermetamorphosis and other DMSs often occur together or interchange. DMSs are also often comorbid with psychiatric disorders, such as schizophrenia, schizoaffective disorder, bipolar disorder, and PTSD. Paranoid schizophrenia is most commonly associated with DMSs. They are also associated with neurological conditions or diseases, including dementia, Alzheimer's disease and alcohol- or drug-induced cognitive impairment. Among comorbid symptoms, paranoid psychotic symptoms, depressive psychotic symptoms and auditory hallucinations are the most often present. Cause Explanations for the occurrence of intermetamorphosis were first given by psychodynamic theorists. These theories typically involve a psychotic resolution towards an individual's feelings of intense ambivalence about the misidentified object. These theories may also involve the egos and identity-forming, as well as defense mechanisms involving splitting the negative and positive aspects of the self. Despite their initial popularity, there is not much empirical support for these psychodynamic explanations. Recent advancements in neuroimaging and structural studies have provided evidence of an organic etiology. Neurological dysfunction and neuropsychiatric abnormalities, in various forms, are now believed to be a central feature in DMSs. Neuropsychological findings suggest that symptoms are produced in some aspect by brain dysfunction or damage, specifically in the right hemisphere. Lesions in the right frontal lobe and adjacent areas have been found through neuroimaging in case reports of intermetamorphosis. In studying over 20 patients with misidentification syndromes, Christodoulou found electroencephalographic abnormalities in over 90%. In one case of intermetamorphosis, Joseph reported electroencephalographic abnormalities with right temporo-parietal predominance. Impaired connectivity or dysconnectivity between the right fusiform and right parahippocampal areas and the frontal lobes and the right temporolimbic regions have also been seen in case reports of this syndrome, which are thought to be implicated in deficits in face recognition, visual memory recall, and identification processes. While impairments in facial processing are experienced by most DMSs, it appears to be experienced more consciously in intermetamorphosis than in other DMSs. Cortical atrophy is also sometimes present, although this may be due to co-occurring dementia and other organic mental syndromes. Overactivity in the perirhinal cortex appears to be associated with the loss of familiarity in intermetamorphosis. Depersonalization has also been postulated as a contributing factor to the development of intermetamorphosis; under conditions like the presence of a paranoid element, a charged emotional relationship to the principal misidentified person, and cerebral dysfunction, depersonalization and derealization symptoms may develop into a full delusional misidentification syndrome. Diagnosis How to define intermetamorphosis and other delusional misidentification syndromes is frequently debated in the literature. Some believe that misidentification is a symptom, and that the overlapping nature of these syndromes suggests that they are "states" associated with other psychiatric or neurological disorders, but that they're not diagnostic in themselves. As their name suggests, many professionals consider them syndromes, because misidentification appears to occur more often in association with certain symptoms, like depersonalization, derealization, and paranoia. Lastly, some believe that they should be discrete diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. Treatment Results regarding the efficacy of treatments for intermetamorphosis are mixed. Treatment of any co-occurring mental disorder or substance abuse is necessary. There have been no controlled studies about pharmacological treatments of intermetamorphosis. However, both atypical and typical antipsychotics are often used, and have been found to be effective in patients with both organic and functional disorders. Some that have been effective in case studies are clozapine, olanzapine, risperidone, quetiapine, sulpiride, trifluoperazine, pimozide, haloperidol and carbamazepine. Clorazepate, a benzodiazepine used in the treatment of anxiety and seizure disorders, has also been used effectively. Occasionally, antidepressants and lithium have been used, especially in the instance of a co-occurring mood or bipolar disorder. Reverse Intermetamorphosis A proposed variant of intermetamorphosis is the syndrome of "reverse" intermetamorphosis, in which there is the delusional belief that an individual is undergoing radical changes in both physical and psychological identities. References Psychosis Delusional disorders Delusions

Neofunctionalism (sociology)

Neofunctionalism is the perspective that all integration is the result of past integration. The term may also be used to literally describe a social theory that is "post" traditional structural functionalism. Whereas theorists such as Jeffrey C. Alexander openly appropriated the term, others, such as the post-structuralist philosopher Michel Foucault, have been categorized as contemporary functionalists by their critics. History Functionalism in international relations theory was developed by David Mitrany. International relations neofunctionalism was developed by Ernst Haas in the 1960s to give a formal explanation to the work of Jean Monnet (1888–1979). Parsonian thinking In sociology, neofunctionalism represents a revival of the thought of Talcott Parsons by Jeffrey C. Alexander, who sees neofunctionalism as having five central tendencies: to create a form of structural functionalism that is multidimensional and includes micro as well as macro levels of analysis to push functionalism to the left and reject Parsons's optimism about modernity to argue for an implicit democratic thrust in functional analysis to incorporate a conflict orientation, and to emphasize uncertainty and interactional creativity. While Parsons consistently viewed actors as analytical concepts, Alexander defines action as the movement of concrete, living, breathing persons as they make their way through time and space. In addition he argues that every action contains a dimension of free will, by which he is expanding functionalism to include some of the concerns of symbolic interactionism. Neil J. Smelser sets out to establish the concept of ambivalence as an essential element of understanding individual behaviour and social institutions. His approach, based on Sigmund Freud's theory, takes intrapsychic processes rather than roles at the starting point. He sees ambivalence (to hold opposing affective orientations toward the same person object or symbol) as most applicable in situations where persons are dependent on one another. The common element of dependency is in his opinion that freedom to leave is restricted because it is costly either politically, ideologically or emotionally. Thus dependence entails entrapment. Following his views on ambivalence, Smelser argues that attitude surveys should be seen as distorted structures of reality that minimize and delegitimizes ambiguity and ambivalence. Niklas Luhmann's objection Niklas Luhmann sees Parsons' theory as missing the concepts of self-reference and complexity. Self-reference is a condition for the efficient functioning of systems. It means that a system is able to observe itself, can reflect on itself and can make decisions as a result of this reflection. In Luhmann's theory, the chief task performed by social systems is to reduce complexity, which brings more choices and more possibilities; it takes more noes to reach a "yes". Religion or functional equivalents in modern society can provide actors with shared standards of action accepted on faith, which allow complex sets of interactions to proceed in a world that would otherwise be chaotic and incomprehensible. Furthermore Luhmann makes the distinction between risk, a potential harm threatening an individual that is based on a decision made by the individual, and danger, a potential harm to which an individual is passively exposed. The critical difference between the decision maker and the people affected by the decision is that what is a risk for one is a danger for the other. Whereas people in primitive societies were threatened primarily by dangers, people in modern society are threatened primarily by risks caused by our dependency on the decision makers. See also Marxism Critical theory Positivism Antipositivism Structure and agency Auguste Comte Émile Durkheim Herbert Spencer Bronisław Malinowski Anthony Giddens Jürgen Habermas References Anthropology Social philosophy Sociological theories Functionalism (social theory)

Social thinking

Social thinking or thinking socially refers to a methodology created by Michelle Garcia Winner; it is described as a piece we all go through in our minds as we try to make sense of our others’ thoughts, feelings, and intentions in a situation, whether we are merely present, actively interacting, or observing (noticing) what is happening from a distance (e.g., which also includes interpreting media, literature, etc.). Our ability to think socially is part of social learning that begins at birth and evolves across our lifetime. Social thinking in this context is also referred to as social cognition. The social thinking is a developmental, language-based and thinking-based (metacognitive) methodology that gives visual frameworks, unique vocabulary, strategies, and activities to build social competencies, flexible thinking, and social problem solving. The methodology has assessment and teaching components suitable for educators, interventionists, psychologists, social workers, and caregivers. The methodology shares ideals with components of other well-known and evidence based interventions such as Social Stories, Hidden Curriculum, 5-point scale, central coherence theory, and others, etc. Social Thinking resources support individuals' social, emotional, and academic learning, and fosters the development of self-regulation, executive functioning, central coherence issues, and perspective-taking. History The social thinking methodology was originally developed by Michelle Garcia Winner as an intervention and assessment framework dedicated to tackling the complex social emotional learning needs of individuals with social learning differences, difficulties, or disabilities. At its inception 20+ years ago, there were relatively few treatment-based research studies available to guide interventionists in how to teach individuals about their own social learning process. This relative lack of treatment research, while not as stark today, continues to be limited. The underlying motivation for the creation of the Social Thinking Methodology was, and is, that of, for to, individuals with social learning needs access to interventions and strategies that support both their individual learning abilities and participation in their school, home, and community environments. While the tools and strategies within the methodology were developed while working with mainstream students in a high school district, Michelle Garcia Winner‘s practical approach to teaching social competencies was quickly adopted by parents and teachers working with those in the ADHD community and autism spectrum community. The social thinking methodology teaches social learners to consider the points of view, emotions, and intentions of others. In this methodology, social thinking and social skills are dynamic and situational. So, the decision to use discrete social skills (e.g. smiling versus “looking cool”, standing casually versus formally, speaking informally versus speaking politely) are not based on memorizing specific social rules (as often taught in our social skills groups), but on a cognitively based social decision-making process that includes social attention, social interpretation, problem solving, and consideration of one’s own personal goals. Social thinking and evidence base The social thinking methodology embraces what literature says about working directly with neurotypical and neurodivergent children, teens and adults who have social learning differences, difficulties, or disabilities (e.g., Autism Spectrum levels 1 and 2, ADHD, social communication differences or anxiety, etc. or no diagnoses) and promotes the use of a variety of curricula, visual supports, modeling, naturalistic teaching, and self-regulation. Also, the methodology anchors to the research in fields that study how social learners evolve and develop to function in society: anthropology, cultural linguistics, social psychology, child development, and others. Many of the components of Social Thinking fit well into the multi-tiered research-based implementation framework of Positive Behavioral Intervention and Supports (PBIS). And while PBIS is not an approach, it is a framework that encourages schools to consider the uptake of a variety of practices where the "mutually beneficial relationship between academic and social behavior student success is highlighted (Chard, Harn, Sugai, & Horner, 2008; Sugai, Horner, & Gresham, 2002). In the same vein, CASEL's five Social and Emotional Learning (SEL) Core Competencies (http://www.casel.org/social-­‐and-­‐emotional-­‐learning/core-­‐competencies) are reflected within and throughout the social thinking methodology. Social thinking theorizes that successful social thinkers are able to consider the points of view, emotions, thoughts, beliefs, prior knowledge and intentions of others (this is often called perspective-taking). Social Thinking™ also demonstrates the link between one’s social learning abilities and his or her related ability (or disability) when processing and responding to school curriculum based in the use of the social mind (e.g., reading comprehension of literature, some aspects of written expression, etc.). Winner and colleagues argue that individuals who share a diagnostic label (e.g., Autism Spectrum, ADHD, etc.) nonetheless may have different social learning needs and characteristics, and should have unique teaching trajectories, such as those based in cognitive-behavioral therapy (CBT). Teaching social competencies: more than social skills The social thinking methodology is not a single entity. It is not a set of behaviors that one can teach. It is not a step-by-step “cookbook”, nor is it one single program or approach. Social thinking is a language- and cognitive-based methodology that focuses on the dynamic and synergistic nature of social interpretation and social communication skills, both of which require social problem solving. The methodology is developmental, utilizing aspects of behavioral and cognitive behavioral principles, as well as input from supporting adults as a way to translate evidence-based concepts into conceptual frameworks, strategy-based frameworks, curricula, activities, and motivational tools. The components of the methodology continue to evolve based on the latest research and feedback from clients and the community. Many Social Thinking resources have been co-developed by Michelle Garcia Winner and her longtime professional collaborator and partner, Pamela Crooke, PhD, CCC-SLP. The methodology addresses the fact that first interventionists (both professionals and parents) need to build knowledge about the social learning process and what it means to engage “socially” before teaching individuals with social challenges. Understanding how people share space together and engage across context, culture and varying ideas and opinions, motives and intentions is absent from most social "skills‐based” approaches. The methodology ascribes to the notion that the key to understanding individual social learning needs requires that interventionists gain insight into the variables that contribute to their own “social self” as well as the related expectations of others. This unique view toward developing social competencies, combined with the many layers of the methodology, means that the components of social thinking do not fit neatly into any single traditionally defined social skill intervention. Nor is social thinking linked to a specific diagnosis. It can be helpful for neurotypical and neurodivergent children, teens and adults, including those with autism spectrum levels 1 and 2, ADHD, social communication differences, social anxiety, twice-exceptional, hyperlexia, etc. or no diagnoses. Notes References Tarshis, N., Winner, M. G., & Crooke, P. (2020). What Does It Mean to Be Social? Defining the Social Landscape for Children With Childhood Apraxia of Speech. "Perspectives of the ASHA Special Interest Groups", 1-10. . Baker-Ericzén, M.J., Fitch, M.A., Kinnear, M., Jenkins, M.M., Twamley, E.W., Smith, L., Montano, G., Feder, J., Crooke, P.J., Winner, M.G. and Leon, J. (2018). Development of the Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills program for adults on the autism spectrum: Results of initial study. Autism, 22(1), pp. 6–19 . Crooke, P. J., Winner, M. G., & Olswang, L. B. (2016). Thinking socially: teaching social knowledge to foster social behavioral change. Topics in Language Disorders, 36(3), 284-298 . Crooke, P.J., Winner, M.G. (2016), Social Thinking Methodology: Evidence-Based or Empirically Supported? A Response to Leaf et al. (2016), Behavior Analysis in Practice, 9(4), 403-408 . Crooke, P. J., & Olswang, L. (2015). Practice-based Research: Another Pathway for Closing the Research-Practice Gap. Journal of Speech, Language, and Hearing Research . Lee, K. Y. S., Crooke, P. J., Lui, A.L.Y, Kan, P.P.K, Luke, K.L, Mak, Y.M, Cheung, P.M.P, Cheng, L., & Wong, I. (2015). The outcome of a social cognitive training for mainstream adolescents with social communication deficits in a Chinese community, International Journal of Disability, Development and Education, 0 Winner, M.G. & Crooke, P. J. (2014). Executive functioning and social pragmatic communication skills: Exploring the threads in our social fabric. Perspectives on Language Learning and Education, Vol. 21 (2), pp. 42–50 . Winner, M. G. & Crooke P.J. (2013). Social Learning and Social Functioning: Social Thinking's  Cascade of Social Functioning. Attention Magazine . Lee, K.Y.S., Lui, A.L.Y., Kan, P.P.K., Luke, K.M., Mak, Y.M., Cheung, P.M.P., Cheng, L. & Wong, I. (2009). A case series on the social thinking training of mainstreamed secondary school students with high-functioning autism. Hong Kong Journal of Mental Health, 35(1), 10–17. Winner, M. & Crooke, P. (2011) Thinking about Thinking: Social Communication for adolescents with Autism. ASHA Leader Magazine, MD. Winner, M., Crooke, P, & Madrigal (2010) It’s a Girl Thing or Is it?: Social Thinking and Social Skills in Girls, Teens, and Women with Social Learning Issues, Autism Asperger Digest Winner, M. & Crooke, P. (2009) Social Thinking: A Training Paradigm for Professionals and Treatment Approach for Individuals with Social Learning/Social Pragmatic Challenges. Perspectives on Language Learning and Education, 16 62–69. Cognition Cognitive psychology Developmental psychology Emotional intelligence Human development Learning Life skills Mental processes Perception Social psychology concepts

Hypomnema

Hypomnema (Greek. ὑπόμνημα, plural ὑπομνήματα, hypomnemata), also spelled hupomnema, is a Greek word with several translations into English including a reminder, a note, a public record, a commentary, an anecdotal record, a draft, a copy, and other variations on those terms. Plato's theory of anamnesis recognized the new status of writing as a device of artificial memory, and he developed the hypomnesic principles for his students to follow in the Academy. According to Michel Foucault, "The hypomnemata constituted a material memory of things read, heard, or thought, thus offering these as an accumulated treasure for rereading and later meditation. They also formed a raw material for the writing of more systematic treatises in which were given arguments and means by which to struggle against some defect (such as anger, envy, gossip, flattery) or to overcome some difficult circumstance (a mourning, an exile, downfall, disgrace)." Modern usage Michel Foucault uses the word in the sense of "note", but his translators use the word "notebook", which is anachronistic (see codex and wax tablet). Concerning Seneca's discipline of self-knowledge, Foucault writes: "In this period there was a culture of what could be called personal writing: taking notes on the reading, conversations, and reflections that one hears or engages in oneself; keeping kinds of notebooks on important subjects (what the Greeks call 'hupomnemata'), which must be reread from time to time so as to reactualize their contents." In an excerpt from an Interview with Michel Foucault in The Foucault Reader, he says: "As personal as they were, the hypomnemata must nevertheless not be taken for intimate diaries or for those accounts of spiritual experience (temptations, struggles, falls, and victories) which can be found in later Christian literature. [... T]heir objective is not to bring the arcana conscientiae to light, the confession of which—be it oral or written—has a purifying value." See also Commonplace book Commentarii Memex Mnemonic Silva rerum References Concepts in the philosophy of language Greek words and phrases

Kai T. Erikson

Kai Theodor Erikson (born February 12, 1931) is an Austrian-born American sociologist, noted as an authority on the social consequences of catastrophic events. He served as the 76th president of the American Sociological Association. Life and career Erikson was born in Vienna, the son of Joan Erikson (née Serson), a Canadian-born artist, dancer, and writer, and Erik Erikson, a German-born famed psychologist and sociologist. His maternal grandfather was an Episcopalian minister, and Erikson was raised a Protestant. Erikson graduated from The Putney School in Vermont, Reed College in Oregon and earned a PhD at the University of Chicago. He joined the faculty of the University of Pittsburgh in 1959 where he held a joint appointment at the School of Medicine and in the Department of Sociology. There he met his future wife Joanna Slivka, who became Joanna Erikson. In 1963 he moved to Emory University, and followed that with a move to Yale University in 1966. He now holds the title of William R. Kenan, Jr. Professor Emeritus of Sociology and American Studies. Erikson edited the Yale Review from 1979 to 1989. Wayward Puritans Wayward Puritans is the title of his first book (1966) which contains a chapter on sociology of deviance and a chapter on the Massachusetts Bay Colony before three illustrations of deviance within the colony. The first was associated with Anne Hutchinson and Governor Vane and called the Antinomian Controversy. The second was concerned with an intrusion of Quakers, while the third was the Salem witch trials. The book notes the deviation from the City upon a Hill ideal set by John Winthrop. H. Lawrence Ross described the book as "fascinating and superbly written". The sociological premise explored is from Émile Durkheim: "a function of deviance is to define the normative boundaries of the group." He notes that it is "a remarkable exception to the well-known tendency of sociological research to focus on the here and now." On the statistical analysis Ross comments: "the reasons to expect constancy of deviance over time, such as the limited capacity of the control system, would seem to predict stability of convictions as much as stability of offenders, and in consequence the analysis here seems unsatisfactory.” Aftermaths of disasters Erikson subsequently studied a number of disasters in the context of their sociological implications, including the nuclear fallout in the Marshall Islands in 1954; the Buffalo Creek flood in West Virginia in 1972 (resulting in the award-winning 1978 book Everything In Its Path); the Three Mile Island nuclear accident in 1979; the Exxon Valdez oil spill in 1989; and the genocide in Yugoslavia of 1992 to 1995. Bibliography Wayward Puritans: A Study in the Sociology of Deviance (1966) Everything in its Path: Destruction of Community in the Buffalo Creek Flood (1978) A New Species of Trouble: Explorations in Disaster, Trauma, and Community (1994) References 1931 births Living people Austrian emigrants to the United States American social sciences writers American sociologists Environmental sociologists Presidents of the American Sociological Association Reed College alumni University of Chicago alumni University of Pittsburgh faculty Yale University faculty The Putney School alumni

Semashko model

The Semashko model is a single-payer healthcare system where healthcare is free for everyone, and is funded funded from the national budget. It has been extensively modified since its introduction and a number of ex-soviet countries have now abandoned much of it. It was highly centralised and prescriptive in its design and had a very strong focus on specialist medicine so that family medicine and primary care was underdeveloped. The Bolsheviks began to establish universal healthcare as soon as they came to power in late 1917. The system is named after Nikolai Semashko, a Soviet People's Commissar for Healthcare. The model is largely continued in Russia, most other post-Soviet states (exceptions are: Turkmenistan, Kyrgyzstan and the Baltic states) and some other formerly Soviet-aligned states (such as North Korea and Cuba) is regarded as one of the most influential ones. Features In the Semashko model, medical services are provided by a hierarchy of state institutions under the supervision of Ministry of Healthcare and are financed from the national budget. For the country's citizens, medical services are free and equal, with an emphasis on social hygiene and prevention of infectious diseases. The model features publicly owned medical facilities, salaried health workers, large providers of primary healthcare and an exceptionally high degree of governmental administration, providing a universal healthcare. The Semashko model does not allow private medical practices, as all physicians in it are state employees. In the Soviet Union under this model all of the country's territory was divided into districts, with outpatient hospitals and local physicians assigned to each of them. These physicians were multi-special, able to treat most common diseases, while more complicated cases were referred to regional hospitals. A special feature of the Semashko model is the "method of dynamic dispensary surveillance", which holds that every detected case of a serious disease should be subjected to a certain set of guidelines, including planning curative activities, documenting them, ensuring the required number of contacts with specialists, a monitoring process and outcome indicators. Such guidelines were developed at a later stage, in the late 1960s. History The Semashko model originated in the aftermath of the 1917 October Revolution. In the United Kingdom, the National Insurance Act 1911 provided coverage for primary care (but not specialist or hospital care) for wage earners, covering about one-third of the population. The Russian Empire established a similar system in 1912, and other industrialized countries began following suit. The Semashko model was established in Soviet Russia in 1920. However, it was not a truly universal system at that point, as rural residents were not covered. The model substantially improved the population health relative to the starting point of its implementation in the late 1920s. However, the model was less effective against non-communicable diseases and as such failed to advance the population health further. In the 1970s, with the availability of new medical technologies and popular demand for better care, the Soviet Union put greater emphasis on specialization in outpatient care, moving away from the Semashko model. With that, the significance of the district physician has considerably reduced. See also Bismarck model References Health in Russia Health in the Soviet Union Publicly funded health care Universal health care

Functional Skills Qualification

The Functional Skills Qualification is a frequently required component of post-16 education in England. The aim of Functional Skills is to encourage learners to develop and demonstrate their skills as well as learn how to select and apply skills in ways that are appropriate to their particular context in English, mathematics, ICT and digital skills. They provide a foundation for progression into employment or further technical education and develop skills for everyday life. Functional Skills are generally available in sixth form colleges, further education colleges, and tertiary colleges. Functional Skills qualifications provide reliable evidence of a student’s achievements against demanding content that is relevant to the workplace. They need to provide assessment of students’ underpinning knowledge as well as their ability to apply this in different contexts. Subjects English Entry Level Functional Skills English qualifications at these levels indicate that students should be able to speak, listen, communicate, read and write with increasing clarity, accuracy and effectiveness at each level. They should be able to listen, understand and respond to verbal communication in a range of familiar contexts; acquire an understanding of everyday words and their uses and effects, and apply this understanding in different contexts; read with accuracy straightforward texts encountered in everyday life and work, and develop confidence to read more widely; and write straightforward texts and documents with clarity and effectiveness, and demonstrate a sound grasp of spelling, punctuation and grammar. English Level 1 and 2 Functional Skills English qualifications at these levels indicate that students should be able to speak, listen, communicate, read and write clearly, accurately, confidently and with effectiveness. They should be able to listen, understand and make relevant contributions to discussions with others in a range of contexts; apply their understanding of language to adapt delivery and content to suit audience and purpose; read a range of different text types confidently and fluently, applying their knowledge and understanding of texts to their own writing; write texts of varying complexity, with accuracy, effectiveness, and correct spelling, punctuation and grammar; and understand the situations when, and audiences for which, planning, drafting and using formal language are important, and when they are less important. Mathematics Entry Level Functional Skills Mathematics specifications should enable the student to gain confidence and fluency in and a positive attitude towards, and to develop behaviours such as persistence and logical thinking as they apply mathematical tools and approaches. Functional Skills mathematics qualifications at these levels should enable students to become confident in their use of fundamental mathematical knowledge and skills; indicate that students can demonstrate their understanding by applying their knowledge and skills to solve simple mathematical problems or carry out simple tasks. Mathematics Level 1 and 2 Achievement of the qualification demonstrates a sound grasp of mathematical skills at the appropriate level and the ability to apply mathematical thinking effectively to solve problems successfully in the workplace and in other real life situations. Functional Skills mathematics qualifications at these levels should indicate that students can demonstrate their ability in mathematical skills and their ability to apply these, through appropriate reasoning and decision making, to solve realistic problems of increasing complexity; introduce students to new areas of life and work so that they are exposed to concepts and problems which may be of value in later life; and enable students to develop an appreciation of the role played by mathematics in the world of work and in life. Digital Skills Entry Level Digital FSQs enable students to gain confidence and fluency in their use of digital knowledge and skills, and develop a positive attitude towards the use of digital skills; enable students to develop an appreciation of the importance of digital skills in the workplace and in life. At this level, digital FSQs should: enable students to increase their confidence and fluency in their use of digital knowledge and skills, and develop a positive attitude towards the use of digital skills; enable students to demonstrate their knowledge and skills by applying these to complete tasks and activities; introduce students to areas of life and work which may be new or unfamiliar, and tasks and activities that they may encounter in future; enable students to develop an appreciation of the importance of digital skills in the workplace and in life generally; and provide a basis for further study, work and life Digital Skills Level 1 and Level 2 Digital FSQs enable students to initiate and participate in digital and online activities safely in the workplace and in other real-life contexts. At this level, digital FSQs should enable students to increase their confidence and fluency in their use of digital knowledge and skills, and develop a positive attitude towards the use of digital skills; enable students to demonstrate their knowledge and skills by applying these to complete tasks and activities; introduce students to areas of life and work which may be new or unfamiliar, and tasks and activities that they may encounter in future; enable students to develop an appreciation of the importance of digital skills in the workplace and in life; provide a basis for further study, work and life. Digital FSQs will provide reliable evidence of a student’s achievements against content that is relevant to the workplace and real life; provide assessment of a student’s knowledge and skills as well as their ability to apply these in different contexts; and provide a foundation for progression into employment or further education and develop skills for everyday life. References Educational qualifications in England

Mental health in the United Kingdom

Mental health in the United Kingdom involves state, private and community sector intervention in mental health issues. One of the first countries to build asylums, the United Kingdom was also one of the first countries to turn away from them as the primary mode of treatment for the mentally ill. The 1960s onwards saw a shift towards Care in the Community, which is a form of deinstitutionalisation. The majority of mental health care is now provided by the National Health Service (NHS), assisted by the private and the voluntary sectors. Incidence of mental health problems Most mental health problems are not easily defined. The American Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems are most generally used. A 2017 survey found that 65% of Britons have experienced a mental health problem, with 26% having had a panic attack and 42% saying they had suffered from depression. Surveys have found that mental health problems have been on the rise since 2000, although growing awareness may also be a factor, and there are some counter trends such as a decline in suicide. One survey found that the number of responders who had reported having suicidal thoughts in the past year increased from 3.8 per cent in 2000 to 5.4 per cent in 2014. 2018 was the first year that mental health factors like stress and anxiety caused over half of all absences from work. According to a survey of 3,500 participants by the Office for National Statistics (ONS), the number of adults in Britain with depression has doubled during the coronavirus pandemic with 19.2% experiencing depression in June 2020. According to a 2023 study conducted by The Dawn, a nationwide investigation into the mental health of 1,000 professionals in executive roles in the UK revealed significant challenges within the professional sphere. Among C-suite executives, 69% reported experiencing work-related stress, with over half (54%) facing burnout or exhaustion, leading to 16% taking extended leaves of up to three months. Work-induced stress manifested as regular anxiety and panic attacks for 54% of respondents, while 47% reported physical symptoms such as heart palpitations and headaches. Additionally, 29% of high-earning professionals admitted to having suicidal thoughts. Furthermore, the study found that 72% of executives surveyed reported suffering from depression, with 34% experiencing severe depression. Benefit cuts and sanctions "are having a toxic impact on mental health" according to the UK Council for Psychotherapy. Rates of severe anxiety and depression among unemployed people increased from 10.1% in June 2013 to 15.2% in March 2017. In the general population the increase was from 3.4% to 4.1%. England Estimates to the prevalence of mental illnesses can vary significantly, depending on how the question is presented. The 2014 Adult Psychiatric Morbidity Survey found that 1 in 6 respondents had shown the symptoms of a common mental disorder in recent days, and 1 in 8 reported seeing mental health treatment. In the same year, the Health Survey for England found that 25% of respondents had been diagnosed with a mental illness at some point in their life and a further 18% had had one that was not diagnosed. Children and adolescents In 2020, it was reported that one in six 5-16 year olds in England had a probable mental health difficulty. One in five children and young people aged 8-25 in England had a probable mental disorder in 2023. The restrictions as a response to the COVID-19 pandemic negatively impacted on the mental health of children and young people. Between 2005 and 2017, the number of adolescents (12 to 17 years) who were prescribed antidepressants has doubled. However, antidepressant prescriptions for children aged 5-11 decreased between 1999 and 2017. From April 2015, prescription increased for both age groups (for people aged 0 to 17) and peaked during the first COVID-19 lockdown in March 2020. Between 1998 and 2017, children and adolescents living in deprived areas were more often prescribed antidepressants while Black, Asian and minority ethnic (BAME) teenagers were less likely to receive prescriptions than their White peers. Males were slightly more likely to report incidences of depression, but only 34.1% are prescribed antidepressants, 65.9% to females. Scotland A survey in Scotland found 26% of respondents reported having experienced a mental health problem at some point in their life, but the figure increased if respondents were shown a list of conditions. LGBTQ+ people LGBTQ+ people suffer disproportionately higher mental health problems and risk of suicide than non-LGBTQ+ people in the UK. Reports have found greater degrees of self-harming, suicidal thoughts and suicide attempts among UK LGBTQ+ people than among heterosexual non-trans people in the UK. Suicide 6,045, 5,608 and 5,675 people aged 15 and over died by suicide in the time from 2009–2011 respectively. In 2022 there were 5,642 registered deaths by suicide in England and Wales. In Scotland there were 762 probable suicides in 2022. In Northern Ireland there were 203 suicide deaths registered in 2022. Suicide is the biggest killer of men under the age of 50 in the UK. Mental health treatment In the UK, Child and Adolescent Mental Health Services (CAMHS) provide mental health care for people under the age of 18 who have difficulties with their emotional well-being or are deemed to have persistent behavioural problems. CAMHS offer children, young people and their families access to support for mental health issues from third sector (charity) organisations, school-based counselling, primary care as well as specialist mental health services. The exact services provided may vary, reflecting commissioning and providing arrangements agreed at local level. CAMHS operate in four-tier framework. Tiers 1 offers universal mental health services with the aim of prevention. Tier 2 provides early help and more targeted care by professionals specialised in mental health. Tier 3 covers specialist CAMHS that offer service for more severe disorders. Tier 4 is for children and young people with serious problems and care takes place in day and inpatient units. England The numbers of patients attending accident and emergency departments due to psychiatric problems rose by 50% between 2011 and 2016 and reached 165,000 in that year, amounting to as many as 10% of A&E visits in some trusts. There were calls in 2017 for increased provision of in patient psychiatric services and community psychiatric services. A&E is stressful and far from ideal for people in a mental health crisis but many patients in mental distress, some suicidal have nowhere else to go. In some areas of England, people experiencing a mental health crisis may now receive short-term care at a psychiatric decision unit as an alternative to an extended wait at an emergency department or being admitted to a psychiatric hospital. The new units assess the severity of the crisis and may offer therapy; they signpost and refer people to other services. However, as of 2019, units are rare, they often do not reduce emergency department visits or psychiatric admissions and generally cost more to run than the savings they generate in the short term. Some mental health services have increased but many have been cut. 40% of mental health trusts have seen their budget reduced. Marjorie Wallace of mental health charity Sane, said "cuts to services across the country continue and people seeking help are still being failed". In December 2019 the Voluntary Organisations Disability Group reported that 2,250 people with special needs were detained in long-stay NHS accommodation. 463 had been there for more than five years and 355 for more than 10 years. Effective provision of care in the community appeared a remote prospect for these patients. The number of NHS mental health hospital beds fell by 25% between 2011 and 2021. There were 23,447 consultant-led mental health beds in 2011 and 17,610 in 2021. Children and adolescents In 2019 it was reported that many children with autism in England were waiting 137 days or more following referral for a diagnosis, against a target of 91 days. In 2021 children with mental health needs faced very long delays before receiving treatment. 51% waited under four weeks, 29% waited four to twelve weeks, 20% waited over twelve weeks. Some children with mental health problems had to go to A&E because a crisis developed while they were waiting. Some children were admitted to inappropriate adult wards through lack of room on children's wards. According to National Institute for Health and Care Excellence (NICE) guidelines, antidepressants for children and adolescents with depression and obsessive compulsive disorder (OCD) should be prescribed together with therapy and after being assessed by a child and adolescent psychiatrist. However, between 2006 and 2017, only 1 in 4 of 12-17 year olds who were prescribed an SSRI by their GP had seen a specialist psychiatrist and 1 in 6 has seen a paediatrician. Half of these prescriptions were for depression and 16% for anxiety, the latter not being licensed for treatment with antidepressants. Among the suggested possible reasons why GPs are not following the guidelines are the difficulties of accessing talking therapies, long waiting lists and the urgency of treatment. According to some researchers, strict adherence to treatment guidelines would limit access to effective medication for young people with mental health problems. Medical restraints in the UK The Millfields Charter is an electronic charter which promotes an end to the teaching to frontline healthcare staff of all prone (face down) restraint holds. Organisations opposed to restraints include Mind and Rethink Mental Illness. YoungMinds and Agenda claim restraints are "frightening and humiliating" and "re-traumatises" patients, especially women and girls who have previously been victims of physical and/or sexual abuse. In June 2013 the UK government announced that it was considering a ban on the use of face-down restraint in English mental health hospitals. They are particularly opposed to face-down restraints, which are used disproportionately on female patients. Regulation Mental health treatment is regulated in England and Wales by the Mental Health Act 1983 (amended by Mental Health Act 2007) and the Mental Capacity Act 2005, in Scotland by the Mental Health (Care and Treatment) (Scotland) Act 2003, and in Northern Ireland by the Mental Health (Northern Ireland) Order 1986, which has been amended by the Mental Health (Amendment) (Northern Ireland) Order 2004. In England, legislation includes the power to admit those accused of crimes to be detained as restricted patients if certain conditions are met. Proposals NHS Improvement began plans to help trusts in England integrate mental and physical health care in June 2017. Claire Murdoch said that more than 10,000 staff would be required to deliver the promised service improvements. History The Madhouses Act 1774 was the first legislation in the United Kingdom addressing mental health. Privately funded lunatic asylums were widely established during the nineteenth century. The County Asylums Act 1808 permitted, but did not compel, Justices of the Peace to provide establishments for the care of "pauper lunatics", so that they could be removed from workhouses and prisons. The Lunacy Act 1845 established the Board of Commissioners in Lunacy. Justices were required to build lunatic asylums financed by the local rates. In 1859, there were about 36,000 people classified as lunatics in all forms of care in England and Wales. About 31,000 were classed as paupers and 5,000 were private patients. Over 17,000 of the paupers were in county asylums or on contract in licensed houses, about 7,000 were in workhouses, while a similar number were living 'with friends or elsewhere'. Ten per cent of workhouse infirmaries provided separate insane wards. The Lunacy Act of 1862 permitted voluntary admission. Any person who had been a patient in any type of mental hospital during the previous five years could enter a licensed house as a voluntary boarder. The Lunacy Commissioners could remove lunatics from workhouses to county asylums, and the harmless chronic insane could be moved from the overcrowded asylums to the workhouses. The Metropolitan Asylums Board, established by the Metropolitan Poor Act 1867 (30 & 31 Vict. c. 6) built two large asylums for London, Leavesden Mental Hospital and Caterham Asylum. They were built to similar designs by the same architect and each was intended to accommodate 1560 patients in six three-storey blocks for 860 females and five blocks for 700 males. They were both extended by around 500 places within five years. In 1870 there were about 46,500 poor law mental health cases: 25,500 in county asylums, 1,500 in registered establishments, 11,500 in workhouses and the remainder boarded out with relatives. In 1876, there were nearly 65,000 people classified as mentally disordered in England and Wales. It is not clear that there was actually an increase in the prevalence of mental illness. From around 1870 there were moves to separate what was then called idiot children from adults. Darenth School for 500 children with learning disabilities was opened by the Metropolitan Asylums Board in 1878 and a separate institution next to the school, with accommodation for 1,000 adults, was opened in 1880. The Lunacy Act 1890 placed an obligation on local authorities to maintain institutions for the mentally ill. By 1938 131,000 patients were in local authority mental hospitals in England and Wales, and 13,000 in District Asylums in Scotland, where there were also seven Royal Mental Asylums. Mental hospitals were overcrowded and understaffed. Mental health services were not integrated with physical health services when the NHS was established in 1948. Shortages of money, staff and buildings continued. Confederation of Health Service Employees organised an overtime ban in 1956, the first national industrial action in the NHS. Iain Macleod increased capital spending from 1954, hoping to increase bed numbers by 2,800. Rising numbers of patients, especially the elderly, caused a shift in policy away from institutions and towards day centres and community care. In 1961 Enoch Powell, then Minister of Health, made his Water Tower Speech. He said "in fifteen years time there may well be needed not more than half as many places in hospitals for mental illness as there are today". This marked a shift towards Care in the Community, the British version of deinstitutionalisation, which was given further impetus by a series of scandals over long-stay hospitals from 1968 onwards. In 1998, Child and Adolescent Mental Health Services (CAMHS) began to be established, taking over from an earlier multidisciplinary child guidance approach. Children, generally until school-leaving age, are supported by CAMHS organised locally often by local government area, operated by the NHS but jointly financed by the NHS and local government. On World Mental Health Day 2018, the Prime Minister, Theresa May appointed Jackie Doyle-Price as the UK's first suicide prevention minister. This occurred while as the government hosted the first ever global mental health summit. In September 2023, Labour Party leader Keir Starmer scrapped the position of mental health minister from his Shadow Cabinet. Rosena Allin-Khan, who formerly held the role in his cabinet, said that Starmer does "not see a space for a mental health portfolio in a Labour cabinet". The CEO of the British Association for Counselling and Psychotherapy (BCAP), Anna Daroy, responded saying that it, "shows a disappointing disregard for the nation's mental health and a worrying lack of foresight about one of the major issues facing the UK now and over the coming years, particularly among young people". See also Crisis cafe Health in the United Kingdom Improving Access to Psychological Therapies List of asylums commissioned in England and Wales Mental Health Research UK Praxis Care References Further reading Tory manifesto promises to tackle 'injustice' of mental health but will give no extra funding for services. The Independent. Author – Katie Forster. Published 18 May 2017. Retrieved 25 August 2017. Mental health still losing out in NHS funding, report finds. The Guardian. Author – Denis Campbell. Published 16 January 2018. Retrieved 26 January 2018. External links Mental health services on the NHS website United Kingdom

Athymhormic syndrome

Athymhormic syndrome (from Ancient Greek θυμός thūmós, "mood" or "affect", and hormḗ, "impulse", "drive" or "appetite"), psychic akinesia, or auto-activation deficit (AAD) is a rare psychopathological and neurological syndrome characterized by extreme passivity, apathy, blunted affect and a profound generalized loss of self-motivation and conscious thought. For example, a patient spent 45 minutes with his hands on a lawn mower, totally unable to initiate the act of mowing. This "kinetic blockade" disappeared instantaneously when his son told him to move. The existence of such symptoms in patients after damage to certain structures in the brain has been used in support of a physical model of motivation in human beings, wherein the limbic loop of the basal ganglia is the initiator of directed action and thought. It is a disorder of diminished motivation. First described by French neurologist Dominique Laplane in 1982 as "PAP syndrome" (, or "loss of psychic autoactivation"), the syndrome is believed to be due to damage to areas of the basal ganglia or frontal cortex, specifically the striatum and globus pallidus, responsible for motivation and executive functions. It may occur without any preexisting psychiatric condition. Symptoms It is characterized by an absence of voluntary motion without any apparent motor deficit, and patients often describe a complete mental void or blank. This is accompanied by reduced affect or emotional concern (athymhormy) and often by compulsions, repetitive actions, or tics. After stimulation from the outside, such as a direct command, the patient is able to move normally and carry out complex physical and mental tasks for as long as they are prompted to continue. The symptoms may be differentiated from depression because depression requires the existence of sadness or negative thoughts, while athymhormic patients claim to have complete lack of thoughts, positive or negative. Diagnosis See also Aboulia Akinetic mutism Athymhormia Huntington's disease Progressive supranuclear palsy Avolition References Symptoms and signs of mental disorders Psychopathological syndromes Disorders of diminished motivation

Sexual anomalies

Sexual anomalies, also known as sexual abnormalities, are a set of clinical conditions due to chromosomal, gonadal and/or genitalia variation. Individuals with congenital (inborn) discrepancy between sex chromosome, gonadal, and their internal and external genitalia are categorised as individuals with a disorder of sex development (DSD). Afterwards, if the family or individual wishes, they can partake in different management and treatment options for their conditions (e.g. hormone therapy). Infants born with atypical genitalia often cause confusion and distress for the family. Psychosexual development is influenced by numerous factors that include, but are not limited to, gender differences in brain structure, genes associated with sexual development, prenatal androgen exposure, interactions with family, and cultural and societal factors. Because of the complex and multifaceted factors involved, communication and psychosexual support are all important. A team of experts, or patient support groups, are usually recommended for cases related to sexual anomalies. This team of experts are usually derived from a variety of disciplines including pediatricians, neonatologists, pediatric urologists, pediatric general surgeons, endocrinologists, geneticists, radiologists, psychologists and social workers. These professionals are capable of providing first line (prenatal) and second line diagnostic (postnatal) tests to examine and diagnose sexual anomalies. Overview In the normal prenatal stages of fetal development, the fetus is exposed to testosterone - albeit more in male fetuses than female ones. Upon the presence of the 5α-reductase enzyme, testosterone is converted to dihydrotestosterone (i.e. DHT). If DHT is present, the male external genitalia will develop. Development of male external genitalia: Genital tubercle forms the penis Urethral folds form the penile raphe Genital swellings form the scrotum On the other hand, if maternal placenta estrogen is present without DHT, then the development of female external genitalia occurs. Development of female external genitalia (the vulva): Genital tubercle forms the clitoris Urethral folds form the labia minora Genital swellings form the labia majora However, in abnormal cases, sexual anomalies occur due to a variety of factors that lead to an excess of androgens in the fetus. The effects of excessive androgens differ in fetuses with XX chromosome (female) and XY chromosomes (male). In XX chromosome fetuses, excess androgens result in ambiguous genitalia. This makes identification of external genitalia as male or female difficult. Additionally, the individual may have clitoromegaly, a shallow vagina, early and rapid growth of pubic hair in childhood, delayed puberty, hirsutism, virilisation, irregular menstrual cycle in adolescence and infertility due to anovulation. In XY chromosome fetuses, excess androgens result in a functional and average-sized penis with extreme virilisation, but the inability for sperm production. Additionally, the individual will also experience early and rapid growth of pubic hair during childhood and precocious puberty stages. Classification Differences/disorders of sexual development (DSD) are classified into different categories: chromosomal variation, gonadal development disorders, abnormal genital development and others. Chromosomal variation DSDs caused by chromosomal variation generally do not present with genital ambiguity. This includes sex chromosome DSDs such as Klinefelter syndrome, Turner syndrome and 45,X or 46,XY gonadal dysgenesis. Males with Klinefelter syndrome usually have a karyotype of 47,XXY as a result of having two or more X chromosomes. Affected patients generally have normal genital development, yet are infertile and have small, poor functioning testes, breast growth and delayed puberty. The incidence for 47,XXY is 1 in 500 males, but severe and rare cases of Klinefelter syndrome presents as three or more X chromosomes. Turner syndrome is classified as aneuploidy or structural rearrangement of the X chromosome. Signs and symptoms of affected females vary among them, such as low birth weight, low-set ears, short stature, short neck and delayed puberty. The incidence is 1 in 2500 live-born females, while most patients do not survive for more than one year after birth. Gonadal development disorders Gonadal development disorders form a wide spectrum, classified by their cytogenetic and histopathological features. However, unsolved diagnosis and malignancy still represent difficulties in the sex determination of these patients. Such disorders include partial or complete gonadal dysgenesis, ovotesticular DSD, testicular DSD and sex reversal. Abnormal genital development Genital abnormality can occur in the penis, scrotum or testes in males; and vagina and labia in females. Sometimes, ambiguous genitalia could occur, where the clear distinction of external genitalia is absent in both male and female. Hence, examination (typically at birth) is carried out where the sex of the patient will be determined through imaging and blood tests. Abnormal genital development includes disorders of fetal origin, disorders in androgen synthesis or action, disorders in anti-Müllerian hormone synthesis or action. Others In addition to the aforementioned sexual anomalies, there are other unclassified sexual anomalies. In males, this includes severe early-onset intrauterine growth restriction, isolated hypospadias, congenital hypogonadotropic hypogonadism, hypogonadism and cryptorchidism. In females, this includes Malformation syndromes, Müllerian agenesis/hypoplasia, uterine anomalies, vaginal atresia and labial adhesions. Causes Sexual anomalies often generate from genetic abnormalities caused by many factors, leading to different sexual development. These genetic abnormalities occur during the prenatal stage of an individual's fetal development. During this stage, genetic mutations can result from endocrine disrupters in the mother's diet or environmental factors. The general causes of sexual anomalies can not be outlined due to the high variability of each individual's situations. Thus, the cause of each specific anomaly has to be studied independently. Sexual differentiation occurs through various processes during the prenatal development period of the fetus. These processes are initiated and regulated by biological metabolites such as DNA, hormones and proteins. The initial steps of sexual differentiation begin with the development of the gonads and genitals. This process is consistent with both genders spanning over the course of the first 6 weeks following conception, during which the embryo remains pluripotent. Differentiation of the gonads begins after the 6th week, which is determined by the sex-determining region Y (SRY) gene in the Y chromosome. The SRY gene plays an important role in developing the testes of a male individual. Following the development of the testes, hormones synthesized within the testes regulate the differentiation of both internal and external parts of the genitals. The absence of the testicles or the hormones synthesized may lead to irregular differentiation of the genitals. Genetic abnormalities or environmental factors that influence these procedures may lead to the incomplete development of the gonads and the genitals. These malformations can occur any time during the development or the birth of the embryo, manifesting as ambiguous genitals or dissonance within the genotypic and phenotypic sex of the individual, leading to a late onset of puberty, amenorrhea, a lack of or excess virilization, or later in life, infertility or early occurrence of menopause. Diagnosis and symptoms First line diagnostic tests (prenatal) Family history Symptoms such as infertility, early menopause, amenorrhea or sudden infant death syndrome (SIDS) could be a sign. Hence, an early check-up should be conducted. Analysis of karyotype Peripheral blood is collected for karyotyping. This helps classify the patient in one of the three main categories of DSD: chromosomal variation, gonadal development disorders and abnormal genital development. Abdominal ultrasounds The presence of gonads, uterus and vagina should be monitored. This can be done through abdominal ultrasounds. However, the absence of these sex organs will lead to difficulties in gender identification. Second line diagnostic tests (postnatal) Physical Examination Inspection of the genitalia with care and palpation must be conducted with the following points in mind. Determining the degree of virilization or masculinisation: In a female fetus, the Prader scale should be used to assess the extent of the virilisation if the karyotyping results are not out yet. In males, the external masculinization score should be used. Palpation of gonads from the labioscrotal fold to the abdomen (inguinal canal). Hydration and blood pressure assessment should be conducted. Additional dysmorphic features should be ruled out because genitalia malformations would occur if the patient has multiple malformation syndromes. Evaluation of hormones 48 hours after birth 17-Hydroxyprogesterone can be used to screen for congenital adrenal hyperplasia (CAH). This is commonly found in patients with 46, XX DSD. Dehydroepiandrosterone (DHEA) in addition to progesterone allows for the diagnosis of more uncommon forms of CAH and other inherited disorders. Base testosterone, follicle stimulating hormone (FSH) and luteinising hormone (LH) levels are precursors in individuals with 46,XX DSD. These tests are conducted within the timeframe of thirty hours post-birth to anywhere between fifteen and ninety days post-birth. This data collected within time frame can be used to gauge the growth of the fetus when it reaches six months of age. Basal cortisol levels and adrenocorticotropic hormone (ACTH) is essential in diagnosing panhypopituitarism and enzymatic disorders affecting adrenal steroidogenesis. The anti-Müllerian hormone is used for evaluating the function of Sertoli cells. A urinary steroid profile shows the ratio of precursor metabolites within measured urine concentrations and the resultant products produced indicates the enzyme is the cause of a sexual defect. This is a more specific procedure in the detection of the defect in comparison to analysing blood. Treatment and management The treatment and/or management of DSDs with atypical genitalia will vary from person to person. This may include gender affirmation surgery, medical treatment and surgical treatment. Gender affirmation surgery Gender affirmation plays a critical role in the management of sexual anomaly cases. Ultimately, the parents and a multidisciplinary team are responsible for assigning the sex that is affirmative the gender of the concerned person. The current guidelines of gender affirmation include the psychosocial effects in adults with etiological diagnosis, the potential for fertility, surgical opportunities and hormone replacement therapy in the course of puberty. There are other factors considered during this process. This may include cultural and religious factors as well as the implications it has on the individual in later life. It is regulated by reference centers with groups specialised in managing cases of sexual anomalies. Medical treatment Hormonal treatment is an accepted and standardised approach to treat different congenital sexual anomalies. Patients that are deficient in hormones produced by the adrenal glands require immediate medical attention. They are given a hormone called hydrocortisone, a form of hormone replacement therapy, with the objective to induce puberty. Utilizing sex steroids as hormonal therapy is deemed controversial with concerns of its duration of initiation, dosage and regimen. However, it is agreed amongst most clinicians that low doses of hormonal treatment should begin around the age of 11 to 12 years old and should be increased progressively. Surgical treatment Surgical procedures are an alternative to hormonal treatment available for patients to address genital anomalies and improve the body's sexual functions. However, a common dilemma in these procedures is that they are often derived from the patient's expectation of 'normal' genitals from an aesthetic and functional standpoint. Oftentimes, this leads to extensive surgical interventions. In most cases, surgical procedures result in permanent changes to the appearance and function of the patient's body. Therefore, the decision to proceed with this arrangement must be a joint agreement between the family and the multidisciplinary team. The most ideal situation would be to include the patient as part of the decision-making process. However, cases where surgical treatments were performed at an early age are recognised as mutilation of the body. Subsequently, it has become increasingly common to defer surgical treatments until the patient is of appropriate age to be involved in the decision-making process. Controversy and implications Even though the term disorder of sex development (DSD) is widely accepted by the medical community, its suitability and adequacy to represent these individuals are criticised by many support and advocacy groups. Firstly, the word 'disorder' carries negative connotations. Secondly, with current nomenclature, DSD is an overly generalised term for conditions that do not have differences in genital appearance or gender identity (e.g. Klinefelter syndrome and Turner syndrome). Thirdly, the term 'DSD' lacks specificity and clarity; and therefore unhelpful in the diagnosis process. Hence, many support groups and advocates believe that the medical community should discontinue the use of 'DSD' as a designation tool. Furthermore, people who live with conditions regarding sexual abnormalities may encounter various mental and physical health problems. This may include traumatic experience with their own bodies, dissatisfaction with body image, low-self esteem, anxiety, depression, bipolar disorders, eating disorders, personality disorders, schizophrenia disorders, trauma and stress-related disorders, etc. See also Intersex medical interventions Patient support group References Sexuality Sex organs Diseases and disorders

Hippology

Hippology (from Greek: ἵππος, hippos, "horse"; and λόγος, logos, "study") is the study of the horse - a domesticated, one-toed, hoofed mammal belonging to the taxonomic family Equidae. Today, hippology is the title of an equine veterinary and management knowledge contest that is used in 4-H, Future Farmers of America (FFA), and many horse breed contests. Hippology consists of four phases: horse judging, written examination and slide identification, ID stations, and team problem-solving. Many youths across the United States and in other countries compete in hippology annually, showing their knowledge of all things "horse". Items covered in the contest may cover any equine subject, including reproduction, training, parasites, dressage, history and origins, anatomy and physiology, driving and harnessing, horse industry, horse management, breeds, genetics, western games, colors, famous horses in history, parts of the saddle, types of bits, gaits, competitions, poisonous plants, and nutrition. Judging The judging phase generally includes judging both a halter class and an "under saddle" class (such as western pleasure, hunter under saddle, etc.). The classes involve four horses and contestants are given a judging card to place the horses. Unlike the horse judging competitions, hippology competitors are not expected to give reasons, but only place the classes. Written examination and slide identification The written examination is a multiple-choice, 50-question test. The written examination can cover any of the topics and any of the information from the designated sources. The slide identification is composed of 25 slides. ID stations The ID station phase includes 10 stations, each with 10 pictures or objects to be identified along with a list of multiple-choice answers. Each station has a theme (anatomy, poisonous plants, tack, etc.). A time limit exists allotting only 2 minutes per station. Team problem solving The team problem solving phase requires a team, with three or four members, to present their solution for a problem to a judge or judges. The team is given 10–15 minutes to discuss the problem, form a solution, and prepare their presentation. No written materials are allowed. They then have an average of 5 minutes to present their solution. Members are judged on their teamwork (especially during the discussion phase), the accuracy of their solution, and their presentation skills. No coaches or any adults are allowed in the room during the team problem. Hippology in 4-H In 4-H, hippology teams consist of 3 or 4 members. (In the case of a team with 4 members, the lowest score is dropped.) Teams compete at a regional level, where the first place team advances to compete against the other region winners at a state level. The winner of the state level then advances to either Eastern Nationals in Kentucky, or Western Nationals in Colorado, depending on the state. See also Horse breeding Horse training Sources Information for the hippology competitions is taken from multiple sources. These include: "The Horse" by Evans et al "Illustrated Dictionary of Equine Terms" by New Horizons Equine Education Center Inc. "Horse Industry Handbook" by American Youth Horse Council "Youth Leaders' Manual" by American Youth Horse Council "Horse Anatomy: A Coloring Atlas" by Kainer and McCracken "Feeding and Care of the Horse" by Lewis "Equine Science" by Griffiths Mammalogy Horses

Ownership (psychology)

In psychology, ownership is the feeling that something is yours. Psychological ownership is distinct from legal ownership: for example, one may feel that one's cubicle at work is theirs and no one else's, even though legal ownership of the cubicle is actually conferred on the organization. Overview People can feel ownership about a variety of things: products, workspaces, ideas, and roles. An example of ownership is the feeling that a product that you developed is yours and no one else's. For instance, the IKEA effect reveals that those who create a particular item value that item more than identical alternatives that they did not develop. At its core, ownership is about possession, stewardship, and the need to have control over something. Since psychological ownership can be experienced for diverse targets such as concrete objects and abstract concepts (e.g., jobs, investments, brands, ideas), the construct of ownership as a psychological phenomenon has been researched within various fields. These fields include organizational behavior, consumer behavior, environmentalism, sustainability, and public health. Causes and Mechanisms Why does psychological ownership prevail? The causes of psychological ownership are the following fundamental human motivations: Efficacy – Humans’ motivation to control their surroundings lead to efficacy, i.e., the ability to generate a preferred or intended outcome. They can control their environment by owning various possessions, which induces psychological ownership. Self-identity – The target of ownership tied to self-identity can be emblematic representations of the self. Their possessions aid people to establish their self-identity, both to themselves and to others. Belonging – People have a motivation to possess a “home”. In order to fulfill this desire, people spend significant resources for potential targets of ownership. These targets eventually get to be a part of ourselves. How does psychological ownership emerge? Psychological ownership emerges in three ways: Control – Having control over a target can result in psychological ownership due to enhanced feelings of self-determination and responsibility. Intimate knowledge – The more we know something, the more likely we are to feel it belongs to us. A sense of fusion with the target of ownership occurs after intimately knowing that target. Self-investment – By expending physical and mental energies, time, ideas, and skills in something, we begin to feel greater ownership. Consequences Positive outcomes Ownership can lead to several positive outcomes: Citizenship behavior, discretionary effort, and personal sacrifice Experienced responsibility and stewardship Negative outcomes Ownership can also lead to negative outcomes, especially when that sense of ownership is challenged (either legitimately, by a higher authority asserting their ownership of an entity, or illegitimately, by a subordinate or co-equal entity usurping one's own ownership): Feelings of personal loss Interpersonal conflict Unwillingness to accept advice Resistance to change Measuring Psychological Ownership Since psychological ownership has been studied by multiple disciplines such as organizational behavior and consumer behavior, there are multiple scales in which the target of ownership is different (e.g., company, product). In organizational behavior, the following scale is used to measure psychological ownership: This is MY organization. I sense that this organization is OUR company. I feel a very high degree of personal ownership for this organization. I sense that this is MY company. In consumer research, the following scale or scales adapted from it are used to measure psychological ownership of products that are the target of ownership: I feel like this is MY (target). I feel a very high degree of personal ownership for this (target). I feel like I own this (target). Ownership in Organizational Settings Ownership is distinctly related to psychological concepts such as organizational identification and organizational commitment. Organizational identification is the sense of belongingness to an organization and using the organization to define oneself. An example of organizational identification could be proudly stating for which organization you work in a casual conversation with a new acquaintance. Organizational commitment is defined as accepting the organization's goals, exerting effort, and a desire to maintain membership. An example of organizational commitment could be deciding to stay at an organization despite receiving an attractive job offer from another organization. Psychological ownership answers the question, ‘What is mine?’ Organizational identification answers the question, ‘Who am I?’ Organizational commitment answers the question, ‘Should I stay?’ Employee ownership is an effective managerial practice to strengthen commitment and emotional connection to the organization's vision and employee motivation at an individual level. Employee ownership can be generated through the following four factors: Independence – Offering instances in which the workers can have leadership and control over an aspect in the organization, e.g., self-managed projects, can produce psychological ownership. Shared information – Sharing information about the project, position, team, or organization that the employee is partaking in can increase psychological ownership. Therefore, workers gathering and knowing more information about certain aspects of the organization is essential. Investing self and contributing to the organization – Employees often invest their time, abilities, and ideas into their jobs. Increasing the sense of personal investment can be also possible through self-managed tasks. Accountability – Giving employees certain responsibilities that will evoke a sense of shared burden and authority can enhance psychological ownership. Ownership of Physical Objects Ownership consists of the relationship between an individual and an object. This relationship can be very strong such that the individual considers their possessions as extensions of themselves. One may claim to own an object by (1) paying attention to it, (2) being in physical contact with it, (3) linking it with an experience or a memory, (4) labeling or marking it, hence, constructing a unique relationship, (5) legally owning.  Furthermore, one might extend themselves to objects by creating both physical and digital collections such as books and music records. Ownership in Personal Finances Ownership can exist in decisions that involve financial programs and services, such as the Social Security program and investments. The American Social Security Administration program was set up by President Franklin D. Roosevelt in 1935. The way it was structured was such that the workers’ contributions, exclusively, would fund it. It was a revolutionary idea at the time, since most social programs in other countries were funded by a composite of government and worker contributions. Even though the US social security system finances current retirees mainly through the contributions of the current employees, instead of what they individually contributed when they were working. These worker-only contributions were intended to install psychological ownership of benefits in workers, since each employee would be actively engaging in the program and have a sense of duty. The research has shown that their goals were met: people feel like the benefits they receive are coming from their own contributions. Similarly, endowment effect supports that investment decisions such as home purchases and stock ownership instantly increase the appraisal of that particular item. This increase in valuation is, at least partially, caused by increased psychological ownership. This effect can be seen when investors prefer to stay with the status quo, i.e., their current particular investment assets more than other assets and when individuals do not want to swap their current inferior bank for a superior bank. See also Conversazione Endowment effect Prospect theory Ikea effect Consumer behavior Organizational behavior Organizational identification Organizational commitment References Organizational behavior

World ORT

ORT, also known as the Organisation for Rehabilitation through Training, is a global education network driven by Jewish values. It promotes education and training in communities worldwide. Its activities throughout its history have spanned more than 100 countries and five continents. It was founded in 1880 in Saint Petersburg to provide professional and vocational training for young Jews. Overview World ORT is a federation of autonomous ORT national organisations. In 2005 ORT's global budget exceeded US$250 million annually. As of 2016, its annual budget was US$62.7 million. ORT's current operations are in Israel, the former Soviet Union (including the Baltic States), Europe, Latin America, and South Africa. ORT also runs International Cooperation programs and supports non-sectarian economic and social development in underdeveloped parts of the world, with vocational training and the provision of technical assistance. In 2003 Israel was the area of ORT's largest operation, with 90,000 students educated or trained at ORT's 159 schools, colleges and institutions, educating 25% of Israel’s hi-tech workforce. However, in 2006 ORT Israel withdrew from World ORT. World ORT continues to work in Israel under the name of Kadima Mada-Educating for Life, working with the Israeli Ministry of Education, other Israeli ministries, regional councils and hospitals providing increased resources and improved facilities and schools equipment. World ORT raises funds through its membership organisations in different countries and through the Jewish Federations of North America'' (JFNA). World ORT is legally constituted in Switzerland, but operates from offices in London, England. It has consultative status for information and education purposes with UNESCO, and observer status at the International Labour Organization ORT is a founding member of ICVA (International Council of Voluntary Agencies). History The second partition of Poland in 1793 had resulted in a sharp increase in the number of Jews in Russia, so that in 1794 Empress Catherine the Great decreed that the majority of them would henceforth be restricted to living and working in the Pale of Settlement. The Jews were not allowed to leave the Pale or own land outside it. They were removed from their homes and villages and once resettled, barred from all but a handful of professions. The crowded conditions and legal barriers to self-sufficiency led to deepening poverty for the Pale's four million inhabitants. After the reforms of Tsar Alexander II in the 1860s, the situation improved for some Jews but those in the Pale remained trapped by economic hardship and dismal conditions. In 1880, Samuel Polyakov, Horace de Gunzburg and Nikolai Bakst petitioned Tsar Alexander II for permission to start an assistance fund which would improve the lives of the millions of Russian Jews then living in poverty. The fund would provide education and training in practical occupations like handicrafts and agricultural skills and would help people to help themselves. Permission was granted and the appeal was sent out, signed by Poliakov and de Gunzburg as well as Abram Zak, Leon Rosenthal and Meer Fridland, leading to the establishment of the Society for Trades and Agricultural Labor among the Jews in Russia. In its first 25 years, ORT raised educational standards and provided training to 25,000 Jews across the Russian Empire. People trained as artisans in glass-blowing, learned sewing and gardening, trained as mechanics, cabinetmakers, and furniture designers The first programs created by ORT were dictated by the demands of the market. In 1909, the industrialization in Russia created a need for artisans, so ORT developed courses for electricians in Vilna where electric streetcars were being introduced. They offered automotive courses in St. Petersburg when the automobile began taking root there in 1910. ORT's training programs varied to meet the needs of Jews depending on where they lived and what the gaps in the workforce were. That flexibility and diversity meant that ORT became an established educational leader in many fields within only its first few decades of existence. After World War I, ORT opened agricultural schools to provide tools and training for agricultural enterprises. ORT headquarters moved to Berlin in 1921, after the Bolshevik Revolution. Initially, the Berlin office dealt mainly with fundraising and support for Jewish education in other countries where the Jews were less well-off. When the Nazis rose to power in 1933, Jewish children were expelled from German schools. ORT sought to open a school in Berlin but encountered difficulties due to the ban on selling property to Jews. Using its international ties, the British branch of ORT purchased a school building and dormitory in the Moabit quarter of Berlin. It received authorization to open in April 1937 after promising that all graduates would leave the country upon graduation. Later ORT headquarters moved to France and finally to Geneva. Local groups such as American ORT and Women's American ORT, ORT Canada and British ORT were formed to support the growing network of programs. In 1938, Stalinist purges forced the closure of ORT programs in the Soviet Union. During World War II, ORT continued to serve Jewish communities, including those under Nazi occupation. In the Warsaw Ghetto, the German authorities gave ORT permission to open vocational training courses. Those courses continued throughout the war and until the liquidation of the ghetto. They served as a template for similar ORT programs in other Jewish centers like Łódź and Kaunas. After the end of World War II, ORT established rehabilitation programs for the survivors. The first one in Germany was started in August 1945 in the Landsberg DP camp. Vocational training centers were set up in 78 DP (Displaced Persons) Camps in Germany, and nearly 85,000 people acquired professions and the tools they would need to rebuild their lives. Jacob Olejski, a Dachau survivor who had previously organized ORT in Lithuania, was the driving force behind ORT's revival in Germany. After 1948 he organized ORT in the newly founded state of Israel. ORT operations in Israel started in Jaffa and Jerusalem, and although the Iron Curtain forced the closure of ORT's activities in Eastern Europe, in the 1950s ORT activity increased in Western Europe, Algeria, Morocco, Tunisia, Iran and India. During the second half of the 20th century, ORT continued to provide education and relief services to Jewish communities in Israel, Africa and Asia while opening new programs to serve the Latin American Jewish communities in Argentina (ORT Argentina), Brazil and Uruguay (ORT Uruguay). In the early 1990s ORT returned to the former Soviet Union and the Baltic States, where it now serves 27,000 students in 58 schools and educational institutions every year. In 2000, World ORT celebrated its 120th anniversary. The educational services provided through their network continues and has now been supplemented by programs intended to deliver basic nutrition, clothing, books and school supplies, counseling and other services designed to meet the growing emotional needs of students as well Current and ongoing programs In addition to technical and financial support for its network of schools and programs in more than 30 countries around the world, ORT has in the past run campaigns including: The Latin America Campaign: In 2006–7, ORT began a major program of new projects intended to create a sense of unity and connection throughout the region, meeting the highly individual and specific needs of each community. This campaign was active in small Jewish communities as well as larger ones. For example, the two ORT Argentina high schools in Buenos Aires are overcrowded and a new high school is planned to accommodate the students there. At the same time, the Jewish community in Montevideo (where ORT operates a university), is getting much needed scholarship funds. World ORT Kadima Mada in Israel: Kadima Mada is World ORT's arm in Israel and has run since 2007, delivering electronic, science and computer labs as well as technology education to students in schools throughout Israel, most of which are in northern Israel, and in the south of the country close to the border with Gaza. New computer labs and whiteboard technology provide a new opportunity for students. The program works with local authorities, in cooperation with the Ministry of Education, and marks a new phase in ORT's commitment to bring the best practical education available to the Jewish State. Regeneration CIS: This program aimed to bring quality Judaic and general high school education to Jewish communities throughout the independent sovereign states of the region that was formerly the Soviet Union. In order to complete its mission for the renewed program, ORT ensures that equipment and services in existing centers are maintained and fully operational, to upgrade systems to enable them to deliver enhanced options, to provide school-wide training to ensure that all staff is able to deliver the new materials, and to provide ongoing staffing and resources. In the new centers, ORT carries out necessary refurbishments, plans and installs new systems and services, trains staff, and provides ongoing staffing and support. Locations North America: ORT America and ORT Canada fundraise for World ORT programs around the globe. Latin America: Locations of ORT programs in Latin America include: Argentina, Brazil, Chile, Cuba, Mexico, Panama, Peru, and Uruguay. Asia: ORT ran programs in India and has an affiliate school in Singapore. Africa: A global aid program previously ran in a number of African countries. The center of operations is currently South Africa with occasional courses in countries including Burkina Faso. Europe: Schools, courses and fundraising run and take place in countries including: France, United Kingdom, Italy, Spain, Netherlands, Switzerland, Bulgaria, Czech Republic, Russia, Ukraine, Moldova, Estonia, Lithuania, Latvia and Belarus. Israel: The Kadima Mada school network runs in Israel along with extra-curricular and vocational training. References External links World ORT Anières Elite Academy was founded by World ORT Kadima Mada in Israel Charities based in London International educational organizations International organisations based in London Jewish charities based in the United Kingdom Jewish organizations established in 1880 Non-profit organisations based in Switzerland Organisations based in the London Borough of Barnet Organizations established in 1880 World Jewish Congress

Martindale: The Complete Drug Reference

Martindale: The Complete Drug Reference is a reference book published by Pharmaceutical Press listing some 6,000 drugs and medicines used throughout the world, including details of over 125,000 proprietary preparations. It also includes almost 700 disease treatment reviews. It was first published in 1883 under the title Martindale: The Extra Pharmacopoeia. Martindale contains information on drugs in clinical use worldwide, as well as selected investigational and veterinary drugs, herbal and complementary medicines, pharmaceutical excipients, vitamins and nutritional agents, vaccines, radiopharmaceuticals, contrast media and diagnostic agents, medicinal gases, drugs of abuse and recreational drugs, toxic substances, disinfectants, and pesticides. International usefulness Martindale aims to cover drugs and related substances reported to be of clinical interest anywhere in the world. It provides health professionals with a useful source of information to identify medicines, such as confirming the drug and brand name of a medication being taken by a patient arriving from abroad. Alternatively, if the drug is not available, the class of agent can be determined allowing a pharmacist or doctor to determine which other equivalent drugs might be substituted. Monographs include Chemical Abstracts Service (CAS) numbers, Anatomical Therapeutic Chemical Classification System (ATC) codes and FDA Unique Ingredient Identifier (UNII) codes to help readers refer to other information systems. Arrangement Martindale is arranged into two main parts followed by three extensive indexes: Monographs on drugs and ancillary substances, listing over 6,400 monographs arranged in 49 chapters based on clinical use with the corresponding disease treatment reviews. Monographs summarize the nomenclature, properties, actions, and uses of each substance. A chapter on supplementary drugs and other substances covers monographs on new drugs, those not easily classified, herbals, and drugs no longer clinically used but still of interest. Monographs of some toxic substances are also included. Preparations - including over 125,000 items from 43 countries and regions, including China. Directory of Manufacturers listing some 25,000 entries. Pharmaceutical Terms in Various Languages: this index lists nearly 5,600 pharmaceutical terms and routes of administration in 13 major European languages as an aid to the non-native speaker in interpreting packaging, product information, or prescriptions written in another language. General index: prepared from over 175,000 entries it includes approved names, synonyms and chemical names; a separate Cyrillic section lists non-proprietary and proprietary names in Russian and Ukrainian. Digital versions include an additional 1,000 drug monographs, 100,000 preparation names, and 5,000 manufacturers. List of the editions To date there have been 40 editions of Martindale: The Complete Drug Reference. The 40th edition was published in May 2020. See also British National Formulary British National Formulary for Children References External links Martindale: The Complete Drug Reference, 40th Edition Pharmacology literature Medical manuals