The diagnosis of multiple personality disorder in adults

Professional interest in multiple personality disorder (MPD) was heightened by the 1973 report of the treatment of Sybil (Lindsley, 1992), who had sixteen alternate personalities (Kluft, 1984; Rathus & Nevid, 1991). It was not until 1980, however, that the American Psychiatric Association recognized MPD as a legitimate mental illness (Smolowe, 1990). MPD, long considered a rarity, is being diagnosed, treated, and researched with increasing frequency (Kluft, 1984). Knowledge and recognition of the disorder are essential to its proper treatment (Lindsley, 1992). This paper will present a literature review of the development and diagnosis of this disorder

Adopting, implementing, and assimilating coproduced health and social care innovations involving structurally vulnerable populations: Findings from a longitudinal, multiple case study design in Canada, Scotland, and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation, and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.Methods: We conducted a four-year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding, and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model, and Lozeau’s Compatibility Gaps to understand assimilation.Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organisations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures, and an emphasis on driving transformational change in organisational cultures

Understanding the Astrophysics of Galaxy Evolution: the role of spectroscopic surveys in the next decade

Over the last decade optical spectroscopic surveys have characterized the low redshift galaxy population and uncovered populations of star-forming galaxies back to z ~ 7. This work has shown that the primary epoch of galaxy building and black hole growth occurs at redshifts of 2 to 3. The establishment of the concordance LCDM cosmology shifted the focus of galaxy population studies from constraining cosmological parameters to characterizing the processes which regulate the formation and evolution of galaxies.In the next decade, high redshift observers will attempt to formulate a coherent evolutionary picture connecting galaxies in the high redshift Universe to galaxies today. In order to link galaxy populations at different redshifts, we must not only characterize their evolution in a systematic way, we must establish which physical processes are responsible for it. Considerable progress has already been made in understanding how galaxies evolved from z ~ 1 to the present day. Large spectroscopic surveys in the near infrared are required to push these studies back towards the main epoch of galaxy building. Only then will we understand the full story of the formation of L* galaxies like our own Milky Way. A large near-IR spectroscopic survey will also provide the calibration needed to avoid systematics in the large photometric programs proposed to study the nature of dark matter and dark energy. We provide an outline design for a multi-object 0.4 to 1.8 micron spectrograph, which could be placed on an existing telescope, and which would allow a full characterization of the galaxy population out to z ~ 2. We strongly recommend a serious further study to design a real instrument, which will be required for galaxy formation studies to advance to the next frontier.Comment: White paper, primary author J.E. Gunn, submitted to Astro2010 Decadal Survey, see http://www7.nationalacademies.org/bpa/Astro2010_SWP_byTitle.htm

The RoxyScan is a novel measurement of red blood cell deformability under oxidative and shear stress

Exposure to both oxidative and shear stress, a condition that the red blood cell (RBC) continuously experiences in the circulation in vivo can be mimicked in a Couette type viscometer and monitored by ektacytometry. RBCs maintain their deformation and orientation under shear stress and oxidative stress until a threshold is reached at which these conditions appear to overwhelm the elaborate and complex pathways that maintain a proper redox environment in the cell. Oxidative stress under shear alters the ability of the cell to deform, changes cell morphology, its orientation in the shear stress field, and appears to alter intracellular and membrane characteristics. The application of the RoxyScan technology allows the comparison of oxidant effects and the role of antioxidant systems. This provides the opportunity to study the ability of RBC to deal with oxidative stress in various conditions, including RBC disorders such as sickle cell disease (SCD)

Proton Pump Inhibitor Use and Efficacy of Nivolumab and Ipilimumab in Advanced Melanoma

The impact of proton pump inhibitors (PPIs) on clinical outcomes with first-line immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma was previously analyzed in the phase II study, CheckMate 069. This retrospective analysis utilized data from three phase II/III studies of first-line ICI therapy in untreated advanced melanoma: CheckMate 066, 067, and 069. All randomized patients with PPI use ≤ 30 days before initiating study treatment were included in the PPI-use subgroup. Possible associations between baseline PPI use and efficacy were evaluated within each treatment arm of each study using multivariable modeling. Approximately 20% of 1505 randomized patients across the studies reported baseline PPI use. The median follow-up was 52.6–58.5 months. Objective response rate (ORR), progression-free survival (PFS), and overall survival analyses provided insufficient evidence of a meaningful association between PPI use and efficacy outcomes with nivolumab-plus-ipilimumab, nivolumab, or ipilimumab therapy. In five of the six ICI treatment arms, 95% confidence intervals for odds ratios or hazard ratios traversed 1. Significant associations were observed in the CheckMate 069 combination arm between PPI use and poorer ORR and PFS. This multivariable analysis found insufficient evidence to support meaningful associations between PPI use and ICI efficacy in patients with advanced melanoma

The Grizzly, January 29, 1982

Two Alumni Join Administration • So Much, POD, in College Bowl Finals • Hermann Eilts on The Middle East • College Receives $500,000 • Teachers Audition For EC/BA Positions • Honor Societies Meet to Discuss Future Plans • Union Undergoes Attractive Renovations • Evening School Expands • Spiritwood Returns for Coffeehouse • German Students Sample American College Life • Mozart Concert to Conclude Winterfest! • Myrin Exhibits Storybook Etchings • Collegeville Claustrophobia? • Schaff Plagued With Repeated Break-ins • Forums, Forums, Forums • Mens Basketball Has Good Vacation • Gymnasts\u27 Work Pays Off • Badminton Opens Season With Temple • Grapplers Impressive in Latest Victories • Hoopsters Lose to Widener • Karas Resigns; New Coach Expected Soon • Widener Drownshttps://digitalcommons.ursinus.edu/grizzlynews/1070/thumbnail.jp

Experiences of a digital health intervention for young people exposed to technology assisted sexual abuse:A qualitative study

BACKGROUND: There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools such as smartphones have the potential to increase access to mental health support and may provide an opportunity for YP to both manage their distress and reduce the possibility of further victimization. The current study explores the acceptability of a digital health intervention (DHI; the i-Minds app) which is a theory-driven, co-produced, mentalization-based DHI designed for YP aged 12-18 who have experienced TASA.METHODS: Semi-structured interviews were conducted with 15 YP recruited through Child and Adolescent Mental Health Services, a Sexual Assault Referral Centre and an e-therapy provider who had access to the i-Minds app as part of a feasibility clinical trial. Interviews focused on the acceptability and usability of i-Minds and were coded to themes based on the Acceptability of Healthcare Interventions framework.RESULTS: All participants found the i-Minds app acceptable. Many aspects of the app were seen as enjoyable and useful in helping YP understand their abuse, manage feelings, and change behavior. The app was seen as usable and easy to navigate, but for some participants the level of text was problematic and aspects of the content was, at times, emotionally distressing at times.CONCLUSIONS: The i-Minds app is useful in the management of TASA and helping change some risk-related vulnerabilities. The app was designed, developed and evaluated with YP who had experienced TASA and this may account for the high levels of acceptability seen.TRIAL REGISTRATION: The trial was registered on the ISRCTN registry on the 12/04/2022 as i-Minds: a digital intervention for young people exposed to online sexual abuse (ISRCTN43130832).</p

Future policy and research for advance care planning in dementia:consensus recommendations from an international Delphi panel of the European Association for Palliative Care

Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.</p

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups. Methods: We conducted a 4 year longitudinal multiple case study (2019–2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau’s Compatibility Gaps to understand assimilation. Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change. Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures