Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence

Objectives: This study examined: (i) the prevalence of trauma in a bipolar disorder (BD) sample, and (ii) how trauma histories mediated by interpersonal difficulties and alcohol dependence impact on the severity of BD. The prevalence of posttraumatic stress disorder (PTSD) and its relationship to outcomes in BD were also examined.

Methods: Sixty participants were recruited from a geographically well-defined mental health service in Northern Ireland. Self-reported trauma histories, PTSD, interpersonal difficulties and alcohol dependence and were examined in relation to illness severity.

Results: A high prevalence of trauma was found. Trauma predicted the frequency of hospital admissions (R-2 = 0.08), quality of life (R-2 = 0.23) and inter-episode depressive symptoms (R-2 = 0.13). Interpersonal difficulties, but not alcohol dependence, appeared to play an important role in mediating these adverse effects. While only 8% of the sample met criteria for active PTSD, this comorbid disorder was associated with BD severity.

Conclusions: This study indicates that awareness of trauma is important in understanding individual differences in bipolar presentations. The theoretical and clinical implications of evidence that trauma is related to more adverse outcomes in BD are discussed. The finding that interpersonal difficulties mediate the relationship between trauma and BD severity is novel. The need for adjunctive evidence-based treatments targeting interpersonal difficulties is considered.

From Quality Management to Socially Responsible Organisations: the Case for CSR

Purpose – The purpose of this paper is to focus on the growing interest of the role of business in society, commonly referred to as CSR. Historically CSR can be traced back to the 1950s, although in very recent times there has been a virtual explosion of interest in its use and applicability in organisations. However, there are many unresolved issues, most notably in terms of how CSR should or can be implemented and embedded in an organisation. This paper therefore seeks to explore the relationship and potential synergies between quality management and CSR. Design/methodology/approach – The qualitative exploratory study in this paper represents the first stage of an ongoing research programme, and is based on an in-depth analysis of quality award submission documentation from six case organisations that have recently been recognised as winners in relation to their quest for business improvement. Findings – The paper finds that substantial evidence from each of the case organisations demonstrates the breadth and depth of activities in which they are engaging under the broad headings of workplace, environment, social impact, and economic impact. However, whilst there is no doubting the sincerity of the actions, the approaches and activities, a strategic focus on CSR is still very much in its infancy. Research limitations/implications – In this paper there is a paucity of empirical research examining how existing management tools, techniques and methodologies can be used to further the CSR debate. This paper represents an important first step in redressing this imbalance. Practical implications – The paper suggests that the quality management and business excellence frameworks can offer a strong foundation from which to develop CSR strategies, behaviours and activities in an organisation. Originality/value – This paper represents an important first step in understanding how and where CSR “fits” into an organisation and potentially how existing quality methodologies, tools and frameworks can be used to aid the implementation of CSR.

Defensio Prima and the Latin Poets

This chapter, in a prize-winning volume, examines ways in which Milton’s recourse to Latin poetry in Defensio Prima serves a much deeper purpose than that of merely illustrating or lending authority to his argument. Rather, it is argued, the defence engages with a variety of Latin intertexts (Plautus, Terence, Horace, Petronius), which in turn give birth to a range of dramatis personae, with whom Salmasius is ironically and somewhat kaleidoscopically equated. This methodology lends particular force to Milton’s rhetoric of invective whilst hopefully laying to rest the fallacy that his Latin prose writings were writing during a period of ‘poetic inactivity.’ For this is a prose work that is poetically as well as politically aware.

'The Adorning of My Native Tongue: Linguistic Metamorphosis in Milton'

This chapter, in a prize-winnng volume, examines Milton's bilingual practices in relation to his translation of Horace, Odes 1, 5 and the 1645 volume as a whole. Drawing upon seventeenth-century pedagogical practice and methodology it examines the potential importance of his schooling and university exercises to the methodology of Paradise Lost.

Reflecting the Public Value of Sport: A game of two halves

This article draws on qualitative research that explores the concept of public value in the delivery of sport services by the organization Sport England. The research took place against a backdrop of shifting priorities following the award of the 2012 Olympic Games to London. It highlights the difficulties that exist in measuring the qualitative nature of the public value of sport and suggests there is a need to understand better the idea. Research with organizations involved alongside Sport England in the delivery of sport is described. This explores the potential to create a public value vision, how to measure it and how to focus public value on delivery beyond the aim of ‘sport for sports sake’ and more towards ‘sport for the greater good’. The article argues that this represents a game of ‘two halves’ in which the first half focuses on 2012 with the second half concerned with its legacy.

The Design Process- Making It Relevant For Students

Within the ever-changing arenas of architectural design and education, the core element of architectural education remains: that of the design process. The consideration of how to design in addition to what to design presents architectural educators with that most constant and demanding challenge of how do we best teach the design process?

This challenge is arguably most acute at a student's early stages of their architectural education. In their first years in architecture, students will commonly concentrate on the end product rather than the process. This is, in many ways, understandable. A great deal of time, money and effort go into their final presentations. They believe that it is what is on the wall that is going to be assessed. Armed with new computer skills, they want to produce eye-catching graphics that are often no more than a celebration of a CAD package. In an era of increasing speed, immediacy of information and powerful advertising it is unsurprising that students want to race quickly to presenting an end-product.

Recognising that trend, new teaching methods and models were introduced into the second year undergraduate studio over the past two years at Queen's University Belfast, aimed at promoting student self-reflection and making the design process more relevant to the students. This paper will first generate a critical discussion on the difficulties associated with the design process before outlining some of the methods employed to help promote the following; an understanding of concept, personalisation of the design process for the individual student; adding realism and value to the design process and finally, getting he students to play to their strengths in illustrating their design process like an element of product. Frameworks, examples, outcomes and student feedback will all be presented to help illustrate the effectiveness of the new strategies employed in making the design process firstly, more relevant and therefore secondly, of greater value, to the architecture student.

Advances in microbicide vaginal rings

Vaginal ring devices capable of providing sustained/controlled release of incorporated actives are already marketed for steroidal contraception and estrogen replacement therapy. In recent years, there has been considerable interest in developing similar ring devices for the administration of microbicidal compounds to prevent vaginal HIV transmission. Intended to be worn continuously, such coitally independent micro- bicide rings are being developed to maintain effective vaginal microbicide concentrations over many weeks or months, thereby overcoming issues around timing of product application, user compliance and acceptability associated with more conventional semi-solid formulations. In this article, an overview of vaginal ring technologies is presented, followed by a review of recent advances and issues pertaining to their application for the delivery of HIV microbicides. This article forms part of a special supplement on presentations covering intravaginal rings, based on the symposium “Trends in Microbicide Formulations”, held on 25 and 26 January 2010, Arlington, VA.

Optimum joint detail for a general cold-formed steel portal frame

In the design of cold-formed steel portal frames it is essential that joint flexibility is taken into account in frame analysis. This paper describes optimisation of the joint detail of a cold-formed steel portal frame, conducted concurrently with frame analysis. It is one of the outputs of an Industrial CASE award on the design of cold-formed steel portal frames, which is being used to support a KTP application.

Attitudes of qualified versus student mental health nurses towards an individual diagnosed with schizophrenia

Aims: This paper is the report of a study which sought to compare the attitudes held by student and qualified mental health nurses towards individuals with schizophrenia in the Republic of Ireland. Background: Media portrayals of individuals with schizophrenia often include images of aggression and violence. With global initiatives aimed at reducing the stigma and exclusion associated with mental illness, the attitudes of those who care for people with schizophrenia are of particular interest. Methods: A survey was administered to 66 student mental health nurses, and 121 qualified mental health nurses. Participants completed the community attitudes to mental illness scale (CAMI) and the social interaction scale (SIS) in 2009. Multivariate analysis of variance was used to test for the effects of qualification, work setting, years of experience and education on the measures. Results: A statistically significant difference was found between community mental health nurses and those employed in an inpatient setting on the social restrictiveness and community mental health ideology subscales of the CAMI and on the SIS. Findings also showed a statistically significant difference between nurses in the 10-14 years of experience group and the 5-9 years of experience group on the SIS. Conclusions: Mental health nurses employed in an inpatient setting are often confronted with patients who have challenging behavioural presentations which may explain their socially restrictive attitudes. However, nurses must be alerted to the fact that such negative attitudes may adversely affect the therapeutic relationship and ultimately lead to stigmatisation and its negative consequences.

Malignant pleural mesothelioma: current treatments and emerging drugs

Background: Malignant pleural mesothelioma (MPM) is an uncommon disease whose incidence is increasing worldwide over the past 30 years. Surgical resection and radiotherapy represent the standard treatment in patient with resectable MPM. Chemotherapy is also necessary to reduce incidence of distant metastases, but the optimal setting of treatment (neoadjuvant, adjuvant and intrapleural) is not clarified. For the patients with unresectable MPM, the combination cisplatin and pemetrexed or ralitrexed is the standard treatment as supported by a Phase III study. Better understanding of molecular pathways involved in MPM has enabled inclusion of new drugs targeted against pathways responsible for proliferation, cell survival and angiogenesis. Objective: This review discusses the current treatment option, the specific signal pathways activated in MPM and the novel agents under evaluation in clinical trials. Methods: We use for this article abstracts, papers, oral presentations from ASCO and the website http://www.clinical-trials.gov. Results/conclusion: This review summarizes the activity of chemotherapy and of new agents under evaluation in clinical trials. The better understanding of molecular pathways activated in MPM will hopefully provide new therapeutic options for these patients in the future.

The effect of priming on perceptions of dog breed traits

This study examined whether priming cues embedded in mediastyle presentations shaped people's perceptions of specific dog breeds, and in particular, the German shepherd dog (GSD). Two hundred and four adult females were exposed to one of two types of media-style presentation (stories or pictures). Half of the participants in each condition were exposed to versions designed to portray the GSD in a positive light; the remainder to stimuli developed to present the same breed in a negative light. Participants subsequently rated six individual breeds of dog, including the target breed, on a number of traits (e.g., “friendliness,“ “aggression“). Analysis revealed a significant effect of priming on people's perceptions of the GSD. Participants exposed to the negative stimuli perceived this breed as significantly less approachable, and more dangerous and aggressive, than those exposed to the positive stimuli. Priming did not influence the participants' perceptions of other breeds, even those often regarded in a negative light, although there was some evidence of breed-related category-based stereotyping. Overall, results suggest that people's perceptions of dog breeds can be influenced by verbal and visual representations. The results have implications for how dogs are portrayed in the media and other publically available sources of information.

The Impact of Shame on the Therapeutic Alliance and Intimate Relationships

Objectives


This study examined the role of shame coping styles and state shame in predicting the therapeutic alliance and intimate relationship functioning in individuals with mental health problems.


Method


A sample of 50 treatment-receiving adults aged 21 to 67 years with a mix of common mental health difficulties was recruited from a clinical psychology service. Participants were given questionnaire measures of shame states, shame coping styles, intimate relationship functioning, and the therapeutic alliance.


Results


Regression analyses indicated that the shame coping strategy of physical and psychological withdrawal was the primary risk factor for development of a less effective therapeutic alliance. Both withdrawal and attack self coping styles were significant predictors of impaired intimate relationship functioning.


Conclusions


These findings have implications for the theoretical role of shame in mental health presentations as well as the potential for internalizing shame coping styles (i.e., withdrawal, attack self) to act as a barrier to successful therapy and interpersonal relationships. The inclusion of shame-focused assessments and interventions in the initial stages of treatment with clients exhibiting these strategies could improve prognosis.

The 'Unified airway': The RCPCH care pathway for asthma/or rhinitis

Abstract Aims The Royal College of Paediatrics and Child Health (RCPCH) Science and Research Department was commissioned by the Department of Health to develop national care pathways for children with allergies: the asthma/rhinitis care pathway is the third such pathway. Asthma and rhinitis have been considered together. These conditions co-exist commonly, have remarkably similar immuno-pathology and an integrated management approach benefits symptom control. Method The asthma/rhinitis pathway was developed by a multidisciplinary working group and was based on a comprehensive review of evidence. The pathway was reviewed by a broad group of stakeholders including the public and was approved by the Allergy Care Pathways Project Board and the RCPCH Clinical Standards Committee. Results The pathway entry points are defined by symptom type and severity at presentation. Acute severe rhinitis and life-threatening asthma are presented as distinct entry routes to the pathway, recognising that initial care of these conditions requires presentation-specific treatments. However, the pathway emphasises that ideal long term care should take account of both conditions in order to achieve maximal improvements in disease control and quality of life. Conclusions The pathway recommends that acute presentations of asthma and/or rhinitis should be treated separately. Where both conditions exist, ongoing management should address the upper and lower airways. The authors recommend that this pathway is implemented locally by a multidisciplinary team (MDT) with a focus on creating networks. The MDT within these networks should work with patients to develop and agree on care plans that are age and culturally appropriate.