Anthony Lewis: What He Learned at Harvard Law School

Anthony Lewis was a columnist for The New York Times for the unusually long tenure of thirty-two years. When he retired in 2001 at the age of seventy-four, Bill Clinton awarded him the Presidential Citizens Medal for setting “the highest standard of journalistic ethics and excellence” and for being “a clear and courageous voice for democracy and justice.” Lewis ended his last column by paraphrasing one of his heroes: “The most important office in a democracy, Justice Louis Brandeis said, is the office of citizen.” Lewis’ point was that the American commitment to the rule of law and the belief in reason on which it rests both depend on citizens standing up to rulers who abuse power by exercising it unreasonably – arbitrarily and unjustly

Speech and language therapy for aphasia following stroke

Background  Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.  Objectives  To assess the effects of speech and language therapy (SLT) for aphasia following stroke.  Search methods  We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched theInternational Journal of Language and Communication Disorders(1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions.  Selection criteria  Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach).  Data collection and analysis  We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators.  Main results  We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes.  Authors' conclusions  Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all

An Analysis of Public Attitudes Toward the Insanity Defense

Results from a public opinion survey of knowledge, attitudes, and support for the insanity defense indicate that people dislike the insanity defense for both retributive and utilitarian reasons: they want insane law-breakers punished, and they believe that insanity defense procedures fail to protect the public. However, people vastly overestimate the use and success of the insanity plea. Several attitudinal and demographic variables that other researchers have found to be associated with people\u27s support for the death penalty and perceptions of criminal sentencing are also related to support for the insanity defense. Implications for public policy are discussed

Non-pharmacological interventions for post-stroke emotionalism (PSE) within inpatient stroke settings: a theory of planned behavior survey

Background: Post-stroke emotionalism (PSE) is common. Trials of antidepressants for PSE suggest only modest clinical benefit and risk of side effects. There have been no trials of non-pharmacological treatments for PSE; in fact, little is known about the non-pharmacological treatments actually provided to PSE sufferers in clinical practice. Objectives: To determine the non-pharmacological interventions provided by stroke professionals, their perceived effectiveness, and the factors associated with the intention to provide them. Methods: Focus groups and published sources of information were used to construct a comprehensive list of non-pharmacological approaches for PSE. This was followed by a national (online) survey of 220 UK stroke clinicians from nursing, medicine, and the allied health professions to investigate the approaches used in clinical practice, using Theory of Planned Behavior components to determine the factors associated with intention to provide them. Results: Most respondents reported high intention to provide non-pharmacological interventions from the list that was constructed. Offering reassurance and talking to patients about goals were the commonest interventions, and distraction and tensing facial muscles least common. Respondents who perceived others to hold them professionally responsible for carrying out non-pharmacological approaches were more likely to use them, as were respondents who held more positive attitudes. Conclusions: Our survey data reveal that stroke clinicians report regular use of non-pharmacological interventions for PSE. There is a pressing need for well-conducted clinical trials to evaluate the effectiveness of these approaches

Fitting as a temporal sensemaking process: shifting trajectories and stable themes

This study identifies several mechanisms and the overall process by which individuals understand their evolving fit with their work environment. Prior person-environment research has emphasized one-time quantitative assessments of fit, primarily as new entrants enter their work environment. In this study, we employed a qualitative approach to investigate the following question: how do long-tenured professionals make sense of fit over time? Three key findings emerged from the fit-related histories we collected. First, we discovered four prototypical fit trajectories, which were constructed from temporal comparisons with past, present, and future fit, and employed to make momentary sense of events occurring in the work environment. Second, we identified two fit processes that played out over time: a slow accumulation journey and a sudden identity-threat journey. Third, we found that individuals’ set of fit experiences was explained by one of four enduring fit themes, explaining their pattern of fit experiences over time and their reaction to misfit. Most surprising was the significant turnover among our long-tenured participants in the year or so following our interviews. Our findings break from traditional thinking about fit as predicting outcomes in the moment, to fitting as both a journey and a retrospective and prospective process of sensemaking. Keywords: person-environment fit, misfit, temporal, time, process, sensemaking, qualitative, identit

Anthony Lewis: What He Learned at Harvard Law School

Anthony Lewis was a columnist for The New York Times for the unusually long tenure of thirty-two years. When he retired in 2001 at the age of seventy-four, Bill Clinton awarded him the Presidential Citizens Medal for setting “the highest standard of journalistic ethics and excellence” and for being “a clear and courageous voice for democracy and justice.” Lewis ended his last column by paraphrasing one of his heroes: “The most important office in a democracy, Justice Louis Brandeis said, is the office of citizen.” Lewis’ point was that the American commitment to the rule of law and the belief in reason on which it rests both depend on citizens standing up to rulers who abuse power by exercising it unreasonably – arbitrarily and unjustly