Narrative Rhetoric in Expert Reports: A Case Study

Rhetoric within narratives has been the focus of attention for several well-known scholars in the field of literary criticism. While other forms of writing, such as professional reports, have been analysed through the lens of narrative, the rhetoric therein has received little attention. Although the official position is that UK child protection proceedings are inquisitorial and evidence-based, it is possible to identify rhetorical practices in both narratives of professional reports and the court proceedings. Drawing on Aristotle’s Rhetoric, I will analyse rhetorically the expert pediatric reports presented in a case of alleged Munchausen syndrome by proxy, focusing in particular on ethos and pathos. In so doing, I will seek to illustrate how rhetoric permeates child protection proceedings and indicate how rhetorical analysis might aid the evaluation of evidence and testimony

Narrative and Argumentation in a Case of Alleged Child Abuse

The relationship between argument and narrative has been the subject of much debate, particularly in the area of law, where a number of theorists have argued for the priority of one over the other in the decision-making process, the premise being that argumentation and narrative are two distinct text forms. Through the rhetorical analysis of a series of expert reports in a case of alleged child abuse, we seek to explore the dynamics between argumentation and narrative. In so doing, we argue that while certain actions may undermine the robustness of an argument, it is these very actions that make possible the telling of a persuasive story. We conclude with a plea for the development of rhetorical skills among social workers so as to be better able to discern future directions for the benefit of service user

Narrative and the Reconfiguration of Social Work Ethics

Commencing with a critique of codes of ethics based on the Statement of Principles of the International Federation of Social Work, we explore how a narrative approach to ethics might better serve the practice of social work. We argue that narrative both addresses some of the problems within current codes—such as their Western assumptions, lack of attention to the political role of the social worker, and the privileging of professional expertise—and aligns well with the values social work, being committed to social justice and diversity. Furthermore, we suggest that narrative, because it can operate at the individual, family, community, social, and discoursal levels can help us think ethically about how we construct narratives about, with, and for individual service users while remaining attentive to wider concerns of social justice. In so doing we are not seeking to construct a new code of ethics but to generate debate as to how social work ethics might be reconfigured

Aging, Spirituality, and Narrative: Loss and Repair

In this paper, we explore how narrative loss may impact upon one’s sense of self and the spiritual process of meaning-making and purpose. We argue that we are narrative beings that make sense of our selves and our social, physical, and ideational worlds in and through narrative and that this process, which involves matters of purpose, truth, and values, is at one and the same time a spiritual activity, as both spirituality and narrative involve a sense of openness and indeterminacy, and the generation of meaning and purpose. As we age, however, physical, mental and social changes may disrupt how we narrativize our lives, and social and ideological (or meta-) narratives might frame what stories we can tell, and how we can tell them, in ways different from the past. We explore some of the narrative losses associated with aging and then, drawing on practices in spiritual direction, discuss some possible ways of countering such losses, in particular the development of narrative literacy, the re-ignition of narrative desire, the making of narrative connections, and the deepening of autobiographical reasoning. In this way, we hope to illustrate how narrative works in the spiritual lives of older adults

Exploring the Rhizomal Self

Theories of the Self abound both across and within disciplines. Following a discussion of two frameworks for understanding the Self—the essentialist and the dialogic—we explore the nature of what we call the rhizomal Self. Through autobiographical material we present a rhizomal narrative as a means of understanding the Self as narrative performance. We conclude with a brief discussion of some of the advantages of this way of conceptualizing and representing the Self

Exploring Other-Than-Human Identity: A Narrative Approach to Otherkin, Therianthropes, and Vampires

Drawing on in-depth, narrative interviews with 24 self-identified Otherkin, Therianthropes, and Vampires, we explore how members of these communities navigate Bamberg’s three “dilemmatic spaces” or tensions of continuity/change, similarity/difference, and person-to-world/world-to-person fit. With regard to the first, we identify four aetiological narratives (walk-ins, reincarnation, trapped soul, and evolutionary soul), and discuss stories of shifts and awakening. For the second, we discuss how participants manage the similarity/difference tension with regard to themselves and humans, and explore categorical and renunciatory othering within the communities. Finally, we explore the ways in which members of the communities experience a barren narrative environment, and ways they seek to construct storyworlds and narrative resources as frames for establishing their identities

Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

BACKGROUND Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes. AIMS To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia. METHOD A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods. RESULTS There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively. CONCLUSIONS In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers

Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial).

OBJECTIVE: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. METHODS: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. RESULTS: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil-memantine combined is not more cost-effective than donepezil alone. CONCLUSIONS: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd

Coronal-Line Forest AGN: the best view of the inner edge of the AGN torus?

We introduce Coronal-Line Forest Active Galactic Nuclei (CLiF AGN), AGN which have a rich spectrum of forbidden high-ionization lines (FHILs, e.g. [FeVII], [FeX] and [NeV]), as well as relatively strong narrow ($\sim$300 km s$^{-1}$) H$\alpha$ emission when compared to the other Balmer transition lines. We find that the kinematics of the CLiF emitting region are similar to those of the forbidden low-ionization emission-line (FLIL) region. We compare emission line strengths of both FHILs and FLILs to CLOUDY photoionization results and find that the CLiF emitting region has higher densities (10$^{4.5}$ $<$ n$_H$ $<$ 10$^{7.5}$ cm$^{-3}$) when compared to the FLIL emitting region (10$^{3.0}$ $<$ n$_H$ $<$ 10$^{4.5}$ cm$^{-3}$). We use the photoionization results to calculate the CLiF regions radial distances (0.04 $<$ R$_{CLiF}$ $<$ 32.5 pc) and find that they are comparable to the dust grain sublimation distances (0.10 $<$ R$_{SUB}$ $<$ 4.3 pc). As a result we suggest that the inner torus wall is the most likely location of the CLiF region, and the unusual strength of the FHILs is due to a specific viewing angle giving a maximal view of the far wall of the torus without the continuum being revealed.Comment: 22 pages, 14 Figures and 12 Tables. Resubmitted to MNRAS after minor correction

Spread of psoriasiform inflammation to remote tissues is restricted by the atypical chemokine receptor ACKR2

Elucidating the poorly defined mechanisms by which inflammatory lesions are spatially restricted in vivo, is of critical importance in understanding skin disease. Chemokines are the principal regulators of leukocyte migration and are essential in the initiation and maintenance of inflammation. The membrane-bound psoriasis associated atypical chemokine receptor ACKR2 binds, internalises and degrades most pro-inflammatory CC-chemokines. Here we investigate the role of ACKR2 in limiting the spread of cutaneous psoriasiform inflammation to sites that are remote from the primary lesion.  Circulating factors capable of regulating ACKR2 function at remote sites were identified and examined using a combination of clinical samples, relevant primary human cell cultures, in vitro migration assays and the imiquimod-induced model of psoriasiform skin inflammation. Localised inflammation and IFN together upregulate ACKR2 in remote tissues, protecting them from the spread of inflammation. ACKR2 controls inflammatory T-cell chemotaxis and positioning within the skin, preventing an epidermal influx that is associated with lesion development. Our results have important implications for our understanding of how spatial restriction is imposed on the spread of inflammatory lesions, and highlight systemic ACKR2 induction as a therapeutic strategy in the treatment and prevention of psoriasis and potentially a broad range of other immune-mediated diseases