Exploring Silence in Psychoanalytic Theory and Clinical Work [Volume 2]

Psychotherapy process research is important in developing technique and enhancing clinical skills. Silence, as an aspect of child and adolescent psychoanalytic psychotherapy, has been a neglected area of research, despite it being acknowledged as an often challenging yet therapeutically useful aspect of the work. This study aims to explore silence in adolescent psychoanalytic psychotherapy, by studying the emergence of silence in therapy sessions and the adolescents’ views. Three Short Term Psychoanalytic Psychotherapies of adolescents with depression were sampled, and silences occurring in six sessions of each therapy were coded using the Pausing Inventory Categorization System (PICS). The study identified that in the three therapies sampled, on average almost one-third of session time was spent in silence, and that most of this silence was coded as ‘obstructive’. The study also found that the change in silence amount through each stage of therapy was different in each patient-therapist dyad. Follow-up interviews conducted with the adolescents were analysed using thematic analysis and found that the adolescents expressed negative feelings about silence in their therapy. Findings from the follow-up interviews were related to silence and outcome data to suggest processes that may have been taking place in each of the therapies. A key hypothesis was that the majority of the silence in the therapies sampled appeared to relate to conflict, which could be viewed as both an aspect of the developmental stage of adolescence, and a symptom of depression. Clinical implications of the findings indicated that long silence do not appear to be useful in adolescent therapy in the way they are considered to be in adult therapy, and so adaptation of therapeutic technique is required

The weight-inclusive vs. weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community

The movement advantage in famous and unfamiliar faces: a comparison of point-light displays and shape-normalised avatar stimuli.

Facial movement may provide cues to identity, by supporting the extraction of face shape information via structure-from-motion, or via characteristic patterns of movement. Currently, it is unclear whether familiar and unfamiliar faces derive the same benefit from these mechanisms. This study examined the movement advantage by asking participants to match moving and static images of famous and unfamiliar faces to facial point-light displays (PLDs) or shape-normalised avatars in a same/different task (experiment 1). In experiment 2 we also used a same/different task, but participants matched from PLD to PLD or from avatar to avatar. In both experiments, unfamiliar face matching was more accurate for PLDs than for avatars, but there was no effect of stimulus type on famous faces. In experiment 1, there was no movement advantage, but in experiment 2, there was a significant movement advantage for famous and unfamiliar faces. There was no evidence that familiarity increased the movement advantage. For unfamiliar faces, results suggest that participants were relying on characteristic movement patterns to match the faces, and did not derive any extra benefit from the structure-from-motion cues in the PLDs. The results indicate that participants may use static and movement-based cues in a flexible manner when matching famous and unfamiliar faces

Energy metabolism in mobile, wild-sampled sharks inferred by plasma lipids

Evaluating how predators metabolize energy is increasingly useful for conservation physiology, as it can provide information on their current nutritional condition. However, obtaining metabolic information from mobile marine predators is inherently challenging owing to their relative rarity, cryptic nature and often wide-ranging underwater movements. Here, we investigate aspects of energy metabolism in four free-ranging shark species (n = 281; blacktip, bull, nurse, and tiger) by measuring three metabolic parameters [plasma triglycerides (TAG), free fatty acids (FFA) and cholesterol (CHOL)] via non-lethal biopsy sampling. Plasma TAG, FFA and total CHOL concentrations (in millimoles per litre) varied inter-specifically and with season, year, and shark length varied within a species. The TAG were highest in the plasma of less active

St Georg Sled medial unicompartmental arthroplasty: survivorship analysis and function at 20years follow up

Purpose: The peri-operative and short-term benefits of unicompartmental knee arthroplasty (UKA) are well supported in the literature. However, there remains concern regarding the higher revision rate when compared with total knee replacement. This manuscript reports the functional outcome and survivorship of a large series of fixed bearing, medial unicompartmental replacements (St Georg Sled), with a minimum of 20years follow-up. Methods: Between 1974 and 1994, 399 patients (496 knees) underwent a medial fixed-bearing UKA. Prospective data were collected pre-operatively and at regular intervals post-operatively using the Bristol Knee Score (BKS), Oxford Knee (OKS) and Western Ontario MacMaster (WOMAC) scores. Kaplan–Meier survival analysis was used to determine survivorship, with revision or need for revision as end point, and differences assessed using Mantel–Cox log rank test. Results: Functional knee scores improved post-operatively, but demonstrated a slight decline from 10years of follow-up onwards. Survivorship is estimated as 86% at 10years, 80% at 15years, and 78% at 20years. Sixty knees were revised, with progression of disease in another compartment the commonest reason. Eighty eight percent were revised using a primary prosthesis. For patients over the age of 65years at the time of index procedure, 93% died with a functioning prosthesis in situ. Conclusion: Medial UKA demonstrates good long-term function and survivorship, and represents an excellent surgical option for patients aged over 65years of age, where few patients will require a revision procedure. Level of evidence: IV

How generic is cosmic string formation in SUSY GUTs

We study cosmic string formation within supersymmetric grand unified theories. We consider gauge groups having a rank between 4 and 8. We examine all possible spontaneous symmetry breaking patterns from the GUT down to the standard model gauge group. Assuming standard hybrid inflation, we select all the models which can solve the GUT monopole problem, lead to baryogenesis after inflation and are consistent with proton lifetime measurements. We conclude that in all acceptable spontaneous symmetry breaking schemes, cosmic string formation is unavoidable. The strings which form at the end of inflation have a mass which is proportional to the inflationary scale. Sometimes, a second network of strings form at a lower scale. Models based on gauge groups which have rank greater than 6 can lead to more than one inflationary era; they all end by cosmic string formation.Comment: 31 pages, Latex, submitted to PR

Microstructural and Chemical Rejuvenation of a Ni-Based Superalloy

This is an open access article published by Springer and distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), http://creativecommons.org/licenses/by/4.0/The microstructural evolution of the Ni-based superalloy CMSX-4 including the change in gamma prime morphology, size and distribution after high temperature degradation and subsequent rejuvenation heat treatments has been examined using field emission gun scanning electron microscopy (FEGSEM) and transmission electron microscopy (TEM). In this paper it is shown that there are significant differences in the size of the ‘channels’ between gamma prime particles, the degree of rafting and the size of tertiary gamma prime particles in each of the different microstructural conditions studied. Chemical analysis has been carried out to compare rejuvenated and pre-service samples after the same subsequent degradation procedure. The results indicate that although the microstructure of pre-service and rejuvenated samples are similar, chemical differences are more pronounced in the rejuvenated samples, suggesting that chemical segregation from partitioning of the elements was not completely eliminated through the applied rejuvenation heat treatment. A number of modified rejuvenation heat treatment trials were carried out to reduce the chemical segregation prior to creep testing. The creep test results suggest that chemical segregation has an immeasurable influence on the short-term mechanical properties under the test conditions used here, indicating that further work is required to fully understand the suitability of specific rejuvenation heat treatments and their role in the extension of component life in power plant applications

Unraveling genetic predisposition to familial or early onset gastric cancer using germline whole-exome sequencing

Recognition of individuals with a genetic predisposition to gastric cancer (GC) enables preventive measures. However, the underlying cause of genetic susceptibility to gastric cancer remains largely unexplained. We performed germline whole-exome sequencing on leukocyte DNA of 54 patients from 53 families with genetically unexplained diffuse-type and intestinal-type GC to identify novel GC-predisposing candidate genes. As young age at diagnosis and familial clustering are hallmarks of genetic tumor susceptibility, we selected patients that were diagnosed below the age of 35, patients from families with two cases of GC at or below age 60 and patients from families with three GC cases at or below age 70. All included individuals were tested negative for germline CDH1 mutations before or during the study. Variants that were possibly deleterious according to in silico predictions were filtered using several independent approaches that were based on gene function and gene mutation burden in controls. Despite a rigorous search, no obvious candidate GC predisposition genes were identified. This negative result stresses the importance of future research studies in large, homogeneous cohorts