The phenomenology of the events of client inhibition and self-disclosure in the therapeutic dialogue

The aim of this study was to provide an account of the power relations that are implicit in the experience of clients who initially withhold but eventually disclose a sensitive issue in the psychotherapeutic dialogue. Mainstream psychotherapeutic literature has maintained that clients who withhold sensitive material implicitly express a psychological powerlessness. The literature review also turned attention to an alternative view, not arising from within the psychotherapeutic literature. Specific reference was made to the work of Foucault who suggests that although clients may appear to be empowered through self-disclosure, they are in fact constrained, since disclosing themselves constitutes. an appropriation of selfunderstanding which forecloses openness to other forms of self-understanding. The tension between these conflicting accounts about the relation of self-disclosure to empowerment was discussed as an issue requiring further exploration through clinical research. A phenomenologically orientated research method was used to describe the experiences of five clients who withheld and subsequently disclosed sensitive issues in psychotherapy. These descriptions yielded a thematically differentiated process of psychological change. The structure of client inhibition and self-disclosure was seen to correspond to the concepts of powerlessness and empowerment outlined in the psychotherapeutic literature. The apparent empowerment of clients during self-disclosure casts doubt on Foucault's perspective. However, on further reflection and through a review of the research method, it became apparent that the lack of support for Foucault's perspective was a consequence of the particular research method used rather than an indication of the non-existence of constraint. Ricoeur's hermeneutic phenomenology was used to develop the above methodological critique. Using this alternative approach the researcher critically evaluated the findings of the phenomenological study. This facilitated a reinterpretation of the clinical material. It emerged that the experience of empowerment represents a particular form of selfunderstanding, and it was shown, in relation to the clinical material, how this can indeed as Foucault suggests (because of its very specificity) constrain the client from understanding him/herself in alternative ways. It was revealed that the experience of empowerment is a necessary but limited component of successful client disclosure. This does not, however, go far enough. It was suggested that ideally, critical reflection on the constraints of self-understanding, rather than self-disclosure per se, should be regarded as the destination of the urge to self-disclosure

A memory model of presymbolic unconscious mentation

The biological energy concepts used by Freud to account for unconscious mental processes in psychoanalysis are discredited by modem biological findings. As a result, different psychoanalytic schools developed new foundational theories in order to verify unconscious mentation. The present study argues that these theories are unsuccessful for two main reasons. Firstly, replacing Freud's drive energy theory with other equally hypothetical foundational constructs does not solve the problem of finding proof for the existence of unconscious mentation. Secondly, the clinical psychoanalytic definition of unconscious mentation as imaginary, internally generated processes, autonomous from the external world is misguided. External sensory data may play a formative role in producing unconscious mentation. In particular, neurobiological findings on sensory data encoding and storage in human infants may throw light on the nature of unconscious processes. The present study therefore compares ideas derived from Lacanian psychoanalysis with neuropsychological memory and infant research findings to ascertain whether unconscious mentation is linked to the memory encoding of sensory data in infants. This analysis is in tum contrasted with a more contemporary psychoanalytic synthesis of findings on infant memory and unconscious mentation (Lichtenberg, 1989, Lichtenberg, Lachmann, and Fosshage, 1992). The latter theory identifies connections between unconscious mentation and the encoding of sensory memories in infancy, but does not connect the episodic and procedural memory constructs used in this account to specific neurolo·gical mechanisms in the brain. The present study's original contributions therefore involve firstly connecting the development of aversive episodic and procedural memories to neurological mechanisms in the brain during the period between birth and 28 months of age. Secondly, this memory model suggests that the storage of aversive memories in infancy has lasting unconscious motivational significance for subjects. Presymbolic memories may unconsciously manipulate conscious attention and memory retrieval in verbal subjects, inviting comparison with the psychoanalytic concept of dynamic unconscious mentation. Thirdly, the presymbolic memory model contributes towards a novel understanding of false memories of childhood sex abuse, and the dissociation of real traumatic memories that occur in many cases of Post Traumatic Stress Disorder.PsychologyD.Litt. et Phil. (Psychology

Cigarette smoking in an adolescent psychiatric population

Objective. To examine the relationship between cigarette smoking and psychiatric symptomatology in an outpatient psychiatric population of adolescents.Method. A retrospective analysis was done of 934 patient charts at an outpatient psychiatric centre.Results. 48.4% of the psychiatric sample reported regular smoking behaviour, which is substantially more than the 18.1 % prevalence found in a local epidemiological study. Incomparing smokers and non-smokers within the psychiatric sample, it was noted that smokers were significantly younger and scored somewhat higher on depression ratingscales than non-smokers. A logistical regression, using quasi-Newton estimation, was chosen as the most suitable statistical method for building a classificatory model ofsmoking. Two continuous variables, age and the Hamilton depression score, along with 39 discrete variables, were chosen for modelling purposes. Model building was conducted in a hierarchical fashion, starting with demographic variables, the variable selection beingcontrolled by using chi-square tests of model differences. A predictive model of smoking with nine variables was finally selected.Conclusions. As a whole the results support the strong association between smoking and psychiatric problems, but in this adolescent sample smoking is more likely to be partof a general risk-taking behaviour pattern than an attempt to medicate depression. Anti-tobacco campaigns that highlight the risks of smoking are therefore open invitationsfor adolescents to take up the habit

A Bi-objective Optimization Study of an Acid-Base Flow Battery for High Efficiency and Improved Power Density

Electrical energy storage is critical for a broader penetration of renewable energies with intermittent nature, such as solar and wind energy. The Acid/Base Flow Battery (AB-FB) is a unique, sustainable, and environmental-friendly storage technology with high electrolyte solution energy density. The method relies on reversible electrodialytic technologies using bipolar membranes to transform electrical energy into chemical energy related to pH gradients and vice versa. The charge phase is accomplished by using bipolar membrane electrodialysis, whereas the discharge phase is performed via bipolar membrane reverse electrodialysis. In a previous work, we developed an advanced multi-scale process model (Culcasi et al., 2021b), revealing the importance of operating conditions and design features for the AB-FB battery performance. For the first time, the current work attempts to optimize the AB-FB. The net Round Trip Efficiency and average net discharge power density were maximized in a two-objective optimization. The ε-constraint method was used to construct curves of Pareto optimal solutions under various scenarios, thereby systematically assessing the effect of decision variables consisting of operating and design parameters. The gPROMS Model Builder® software package's optimization tool was used. This optimization study demonstrated that in a closed-loop configuration, optimized operating conditions and design features can be chosen to maximize net Round Trip Efficiency up to 64% and average net discharge power density up to 19.5 W m-2 using current commercial membranes

Adverse events associated with nicotine replacement therapy (NRT) for smoking cessation. A systematic review and meta-analysis of one hundred and twenty studies involving 177,390 individuals

Abstract Background Nicotine replacement therapy (NRT) is the most common form of smoking cessation pharmacotherapy and has proven efficacy for the treatment of tobacco dependence. Although expectations of mild adverse effects have been observed to be independent predictors of reduced motivation to use NRT, adverse effects associated with NRT have not been precisely quantified. Objective A systematic review and meta-analysis aimed to identify all randomized clinical trials (RCTs) of NRT versus inert controls and all observational studies to determine the magnitude of reported adverse effects with NRT. Methods Searches of 10 electronic databases from inception to November 2009 were conducted. Study selection and data extraction were carried out independently in duplicate. RCTs were pooled using a random effects method with Odds Ratio [OR] as the effect measure, while proportions were pooled from observational studies. A meta-regression analysis was applied to examine whether the nicotine patch is associated with different adverse effects from those common to orally administered NRT. Results Ninety-two RCTs involving 32,185 participants and 28 observational studies involving 145, 205 participants were identified. Pooled RCT evidence of varying NRT formulations found an increased risk of heart palpitations and chest pains (OR 2.06, 95% Confidence Interval [CI] 1.51-2.82, P < 0.001); nausea and vomiting (OR 1.67, 95% CI 1.37-2.04, P < 0.001); gastrointestinal complaints (OR 1.54, 95% CI, 1.25-1.89, P < 0.001); and insomnia (OR 1.42, 95% CI, 1.21-1.66, P < 0.001). Pooled evidence specific to the NRT patch found an increase in skin irritations (OR 2.80, 95% CO, 2.28-3.24, P < 0.001). Orally administered NRT was associated with mouth and throat soreness (OR 1.87, 95% CI, 1.36-2.57, P < 0.001); mouth ulcers (OR 1.49, 95% CI, 1.05-2.20, P < 0.001); hiccoughs (OR 7.68, 95% CI, 4.59-12.85, P < 0.001) and coughing (OR 2.89, 95% CI, 1.92-4.33, P < 0.001). There was no statistically significant increase in anxiety or depressive symptoms associated with NRT use. Non-comparative observational studies demonstrated the prevalence of these events in a broad population. Conclusion The use of NRT is associated with a variety of side effects. In addition to counseling and medical monitoring, clinicians should inform patients of potential side effects which are associated with the use of NRT for the treatment of tobacco dependence

A New High Contrast Imaging Program at Palomar Observatory

We describe a new instrument that forms the core of a long-term high contrast imaging program at the 200-inch Hale Telescope at Palomar Observatory. The primary scientific thrust is to obtain images and low-resolution spectroscopy of brown dwarfs and young Jovian mass exoplanets in the vicinity of stars within 50 parsecs of the Sun. The instrument is a microlens-based integral field spectrograph integrated with a diffraction limited, apodized-pupil Lyot coronagraph, mounted behind the Palomar adaptive optics system. The spectrograph obtains imaging in 23 channels across the J and H bands (1.06 - 1.78 microns). In addition to obtaining spectra, this wavelength resolution allows suppression of the chromatically dependent speckle noise, which we describe. We have recently installed a novel internal wave front calibration system that will provide continuous updates to the AO system every 0.5 - 1.0 minutes by sensing the wave front within the coronagraph. The Palomar AO system is undergoing an upgrade to a much higher-order AO system ("PALM-3000"): a 3388-actuator tweeter deformable mirror working together with the existing 241-actuator mirror. This system will allow correction with subapertures as small as 8cm at the telescope pupil using natural guide stars. The coronagraph alone has achieved an initial dynamic range in the H-band of 2 X 10^-4 at 1 arcsecond, without speckle noise suppression. We demonstrate that spectral speckle suppression is providing a factor of 10-20 improvement over this bringing our current contrast at an arcsecond to ~2 X 10^-5. This system is the first of a new generation of apodized pupil coronagraphs combined with high-order adaptive optics and integral field spectrographs (e.g. GPI, SPHERE, HiCIAO), and we anticipate this instrument will make a lasting contribution to high contrast imaging in the Northern Hemisphere for years.Comment: Accepted to PASP: 12 pages, 12 figure

Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting

Objectives Xpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture. Methods Xpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance. Results A total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected. Conclusions Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy

Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting

Objectives Xpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture. Methods Xpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance. Results A total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected. Conclusions Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy