Hearing voices, dissociation and the self: a functional-analytic perspective

Item does not contain fulltextIn the current paper, we review existing models of the aetiology of voice hearing. We summarise the argument and evidence that voice hearing is primarily a dissociative process, involving critical aspects of self. We propose a complementary perspective on these phenomena that is based on a modern behavioural account of complex behaviour, known as Relational Frame Theory (RFT). This type of approach to voice hearing concerns itself with: the functions served for the individual by this voice hearing; the necessary history, such as trauma, that establishes these functions; and the relevant dissociative processes involving self and others. In short, we propose a trauma-dissociation developmental trajectory in which trauma impacts negatively on the development of self, through the process of dissociation. Using the RFT concept of relations of perspective-taking, our dissociation model purports that trauma gives rise to more co-ordination than distinction relations between self and others, thus weaking an individual's sense of a distinct self. Voice hearing experiences, therefore, reflect an individual's perceptions of self and others, and may indicate impairments in the natural psychological boundaries between these critical related concepts. One clinical implication suggested by this model is that therapeutic 'intervention' should understand the behaviours associated with a sense of self that is fragile and threatened by others. Relations with self and others should be a key focus of therapy, as well as interventions designed to enhance a coherent distinct sense of self.20 p

Non-tariff barriers, integration and the transatlantic economy

We examine the potential impact of TTIP through trade-cost reductions, applying a mix of econometric and computational methods to develop estimates of the benefits (and costs) for the EU, United States, and third countries. Econometric results point to an approximate 80% growth in bilateral trade with an ambitious trade agreement. However, at the same time, computable general equilibrium (CGE) estimates highlight distributional impacts across countries and factors not evident from econometrics alone. Translated through our CGE framework, while bilateral trade increases roughly 80%, there is a fall of about 2.5% in trade with the rest of the world in our central case. The estimated gains in annual consumption range between 1% and 2.25% for the United States and EU, respectively. A purely discriminatory agreement would harm most countries outside the agreement, while the direction of third-country effects hinges critically on whether NTB reductions end up being discriminatory or not. Within the United States and EU, while labour gains across skill categories, the impact on farmers is mixe

Calcium waves driven by "sensitization” wave-fronts

Objective: Cellular Ca2+ waves are understood as reaction-diffusion systems sustained by Ca2+-induced Ca2+ release (CICR) from Ca2+ stores. Given the recently discovered sensitization of Ca2+ release channels (ryanodine receptors; RyRs) of the sarcoplasmic reticulum (SR) by luminal SR Ca2+, waves could also be driven by RyR sensitization, mediated by SR overloading via Ca2+ pump (SERCA), acting in tandem with CICR. Methods: Confocal imaging of the Ca2+ indicator fluo-3 was combined with UV-flash photolysis of caged compounds and the whole-cell configuration of the patch clamp technique to carry out these experiments in isolated guinea pig ventricular cardiomyocytes. Results: Upon sudden slowing of the SERCA in cardiomyocytes with a photoreleased inhibitor, waves indeed decelerated immediately. No secondary changes of Ca2+ signaling or SR Ca2+ content due to SERCA inhibition were observed in the short time-frame of these experiments. Conclusions: Our findings are consistent with Ca2+ loading resulting in a zone of RyR ‘sensitization' traveling within the SR, but inconsistent with CICR as the predominant mechanism driving the Ca2+ waves. This alternative mode of RyR activation is essential to fully conceptualize cardiac arrhythmias triggered by spontaneous Ca2+ releas

Piecewise Potential Vorticity Inversion without Far-Field Response?

Given a flow domain D with subdomains D1 and D2, piecewise potential vorticity inversion (PPVI) inverts a potential vorticity (PV) anomaly in D2 and assumes vanishing PV in D1 where boundary conditions must be taken into account. It is a widely held view that the PV anomaly exerts a far-field influence on D1, which is revealed by PPVI. Tests of this assertion are conducted using a simple quasi geostrophic model where an upper layer D2 contains a PV anomaly and D1 is the layer underneath. This anomaly is inverted. Any downward physical impact of PV in D2 must also be represented in the results of a downward piecewise density inversion (PDI) based on the hydrostatic relation and the density in D2 as following from PPVI. There is no doubt about the impact of the mass in D2 on the flow in the lower layer D1. Thus results of PPVI and PDI have to agree closely

Potential temperature inversion: Complementary approaches

Given the distribution of one atmospheric variable, that of nearly all others can be derived in balanced flow. In particular, potential vorticity inversion (PVI) selects PV to derive pressure, winds and potential temperature θ. Potential temperature inversion (θI) starts from available θ-fields to derive pressure, winds and PV. While PVI has been applied extensively, θI has hardly been used as a research tool although the related technical steps are well known and simpler than those needed in PVI. Two idealized examples of θI and PVI are compared. ERA analyses are used to determine typical anomalies of PV and of θ in the North Atlantic stormtrack region. Statistical forms of PVI and θI are applied to these anomalies. The inversions are equivalent but the results of θI are generally easier to understand than those of PVI. The issues of attribution and piecewise inversion are discussed

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Gains and losses from internal migration: evidence from migrant-sending households in Ghana

Migration is a common strategy adopted to escape poverty and improve living standards, but it is not without risks and there are no guarantees of success. We analyse the impact of migration on the welfare of migrant-sending households in Ghana by exploring what their living standards might have been had their migrant members remained at home. We do this by estimating a counterfactual consumption distribution for households with migrants. We examine the importance of selection bias and compare results obtained with and without selection controls. We illustrate how sensitive conclusions about the welfare gains of migration are to the decision to address selection issues. We present preliminary results which suggest that estimated gains are sensitive to whether and how we address selection bias. While the uncorrected results suggest an average gain from migration for households with migrants, once we control for potential selection bias we find that on average households with migrants are worse off than they might have been had their members stayed at home. Our selection corrected results also suggest that initially better off households are more likely to experience gains from migration and that poorer households lose out. Our results are consistent with qualitative research conducted with a small sample of migrants from our migrant-sending households

The Role of Goods Trade Networks for Services Trade Volume

In this paper, we address the role of countries’ goods-trade networks for their services-trade volume. The paper employs a large cross section of bilateral trade data on aggregate cross-border goods and services sales and illustrates that the depth and overlap of two countries’ services networks induce a positive direct impact on their services-trade volume. The evidence takes into account that goods trade flows and networks are potentially endogenous so that the estimated direct effects support a causal interpretation. We find that the magnitude of the multilateral goods-trade network effect on the bilateral services-trade volume is much larger than that of bilateral goods-trade volume

Effectiveness of 80% vs 30–35% fraction of inspired oxygen in patients undergoing surgery: an updated systematic review and meta-analysis

Background In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based. Methods We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30–35%) FiO2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression. Results Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73–1.07]. There was evidence that high FiO2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64–0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91–1.58); test of interaction; P=0.048]. Conclusions The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO2, overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered

Metagenomic next-generation sequencing of samples from pediatric febrile illness in Tororo, Uganda.

Febrile illness is a major burden in African children, and non-malarial causes of fever are uncertain. In this retrospective exploratory study, we used metagenomic next-generation sequencing (mNGS) to evaluate serum, nasopharyngeal, and stool specimens from 94 children (aged 2-54 months) with febrile illness admitted to Tororo District Hospital, Uganda. The most common microbes identified were Plasmodium falciparum (51.1% of samples) and parvovirus B19 (4.4%) from serum; human rhinoviruses A and C (40%), respiratory syncytial virus (10%), and human herpesvirus 5 (10%) from nasopharyngeal swabs; and rotavirus A (50% of those with diarrhea) from stool. We also report the near complete genome of a highly divergent orthobunyavirus, tentatively named Nyangole virus, identified from the serum of a child diagnosed with malaria and pneumonia, a Bwamba orthobunyavirus in the nasopharynx of a child with rash and sepsis, and the genomes of two novel human rhinovirus C species. In this retrospective exploratory study, mNGS identified multiple potential pathogens, including 3 new viral species, associated with fever in Ugandan children