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The Art of Child and Adolescent Psychiatry is an engaging and authoritative account of the essential skills required to practice child and adolescent psychiatry for all those working in children's mental health, from trainees to experienced professionals in paediatrics, psychiatry, psychology, and psychotherapy. The practical tasks of meeting the child and family, planning treatments, and working with colleagues are all covered, building on existing texts that mainly focus on diagnostic criteria, protocols, and laws. This book respects the evidence base, while also pointing out its limitations, and suggests ways in which to deal with these. Psychiatry is placed within broader frameworks including strategy, learning, management, philosophy, ethics, and interpersonal relations. With over 200 educational vignettes of the authors' vast experience in the field, the book is also highly illustrated. The Art of Child and Adolescent Psychiatry is an indispensable guide to thoughtful practice in children's mental health.
Communication deviance (CD) reflects features of the content or manner of a person's speech that may confuse the listener and inhibit the establishment of a shared focus of attention. The construct was developed in the context of the study of familial risks for psychosis based on hypotheses regarding its effects during childhood. It is not known whether parental CD is associated with nonverbal parental behaviors that may be important in early development. This study explored the association between CD in a cohort of mothers (n = 287) at 32 weeks gestation and maternal sensitivity with infants at 29 weeks in a standard play procedure. Maternal CD predicted lower overall maternal sensitivity (B = –.385; p < .001), and the effect was somewhat greater for sensitivity to infant distress (B = –.514; p < .001) than for sensitivity to nondistress (B = –.311; p < .01). After controlling for maternal age, IQ and depression, and for socioeconomic deprivation, the associations with overall sensitivity and sensitivity to distress remained significant. The findings provide new pointers to intergenerational transmission of vulnerability involving processes implicated in both verbal and nonverbal parental behaviors.
It is not known whether associations between child problem behaviours and maternal depression can be accounted for by comorbid borderline personality disorder (BPD) dysfunction.
To examine the contributions of maternal depression and BPD symptoms to child problem behaviours.
Depression trajectories over the fist-year postpartum were generated using repeated measurement from a general population sample of 997 mothers recruited in pregnancy. In a stratified subsample of 251, maternal depression and BPD symptoms were examined as predictors of child problem behaviours at 2.5 years.
Child problem behaviours were predicted by a high maternal depression trajectory prior to the inclusion of BPD symptoms. This association was no longer significant after the introduction of BPD symptoms.
Risks for child problem behaviours currently attributed to maternal depression may arise from more persistent and pervasive difficulties found in borderline personality dysfunction.
Early-life institutional deprivation produces disinhibited social engagement (DSE). Portrayed as a childhood condition, little is known about the persistence of DSE-type behaviours into, presentation during, and their impact on, functioning in adulthood.
We examine these issues in the young adult follow-up of the English and Romanian Adoptees study.
A total of 122 of the original 165 Romanian adoptees who had spent up to 43 months as children in Ceauşescu's Romanian orphanages and 42 UK adoptees were assessed for DSE behaviours, neurodevelopmental and mental health problems, and impairment between ages 2 and 25 years.
Young adult DSE behaviour was strongly associated with early childhood deprivation, with a sixfold increase for those who spent more than 6 months in institutions. However, although DSE overlapped with autism spectrum disorder and attention-deficit hyperactivity disorder symptoms it was not, in itself, related to broader patterns of mental health problems or impairments in daily functioning in young adulthood.
DSE behaviour remained a prominent, but largely clinically benign, young adult feature of some adoptees who experienced early deprivation.
The Participatory Model of Atonement (PMA) offers an alternative view of Christian salvation, drawing on Pauline theology. It conceives of sin as a contagion which can usually be escaped only by dying. By ‘participating’ in Christ's death, the believer can escape its effects without having to die. This notion of ‘participation’ is obscure. I consider a possible way of clarifying it using metaphysical ideas taken from Jonathan Edwards. ‘Participation’ might involve becoming similar to Christ through the action of the Holy Spirit, to such a degree that a person might be called identical (in some sense) with Christ.
We consider the relative performance of two common approaches to multiple imputation (MI): joint multivariate normal (MVN) MI, in which the data are modeled as a sample from a joint MVN distribution; and conditional MI, in which each variable is modeled conditionally on all the others. In order to use the multivariate normal distribution, implementations of joint MVN MI typically assume that categories of discrete variables are probabilistically constructed from continuous values. We use simulations to examine the implications of these assumptions. For each approach, we assess (1) the accuracy of the imputed values; and (2) the accuracy of coefficients and fitted values from a model fit to completed data sets. These simulations consider continuous, binary, ordinal, and unordered-categorical variables. One set of simulations uses multivariate normal data, and one set uses data from the 2008 American National Election Studies. We implement a less restrictive approach than is typical when evaluating methods using simulations in the missing data literature: in each case, missing values are generated by carefully following the conditions necessary for missingness to be “missing at random” (MAR). We find that in these situations conditional MI is more accurate than joint MVN MI whenever the data include categorical variables.
Conceiving a design as both a history and a fiction is not exclusive to the analogy of architecture to landscape. But it is central to this tradition because of the simultaneous and interdependent emergence in the early eighteenth century of new art forms, each of them a creative and questioning response to empiricism's detailed investigation of subjective experience and the natural world: the picturesque landscape, analytical history and English novel, which its early advocates conceived as a fictional autobiography and characterised as a history not a story. The conjunction of new art forms stimulated a lyrical environmentalism that profoundly influenced subsequent centuries, and is increasing relevant today due to anthropogenic climate change, which is now the principal means to consider the relations between nature and culture.
While a prospect of the future is implicit in many histories and novels, it is explicit in a design, which is always imagined before it is built. Creative architects have often looked to the past to imagine the future, studying an earlier architecture not to replicate it but to understand and transform it, revealing its relevance to the present. Twenty-first century architects need to appreciate the shock of the old as well as the shock of the new.
Dual-energy X-ray absorptiometry (DXA) and isotope dilution technique have been used as reference methods to validate the estimates of body composition by simple field techniques; however, very few studies have compared these two methods. We compared the estimates of body composition by DXA and isotope dilution (18O) technique in apparently healthy Indian men and women (aged 19–70 years, n 152, 48 % men) with a wide range of BMI (14–40 kg/m2). Isotopic enrichment was assessed by isotope ratio mass spectroscopy. The agreement between the estimates of body composition measured by the two techniques was assessed by the Bland–Altman method. The mean age and BMI were 37 (sd 15) years and 23·3 (sd 5·1) kg/m2, respectively, for men and 37 (sd 14) years and 24·1 (sd 5·8) kg/m2, respectively, for women. The estimates of fat-free mass were higher by about 7 (95 % CI 6, 9) %, those of fat mass were lower by about 21 (95 % CI − 18, − 23) %, and those of body fat percentage (BF%) were lower by about 7·4 (95 % CI − 8·2, − 6·6) % as obtained by DXA compared with the isotope dilution technique. The Bland–Altman analysis showed wide limits of agreement that indicated poor agreement between the methods. The bias in the estimates of BF% was higher at the lower values of BF%. Thus, the two commonly used reference methods showed substantial differences in the estimates of body composition with wide limits of agreement. As the estimates of body composition are method-dependent, the two methods cannot be used interchangeably.
The seat of arbitration is fundamental to defining the legal framework for international arbitral proceedings. Although parties are able to select the arbitral seat, arbitration clauses are frequently ‘pathological’, failing to designate the seat or failing to do so clearly. If the seat is not clearly identified by the parties’ agreement, the court may be called upon to decide which country is the seat (typically, in order to determine whether or not it has jurisdiction to entertain certain types of arbitration application). The simplest situations are ‘uni-directional’ cases in which, in procedural terms, the parties' agreement points expressly or impliedly towards a single location. More difficult are ‘pluri-directional’ cases in which the agreement refers to more than one possible location. While certain scenarios are relatively straightforward, what constitutes a choice by the parties is more complicated if the parties' agreement contains signposts pointing in different directions. In ‘uni-directional’ cases, the English courts have developed a series of interpretative guidelines which solve most of the problems posed by potentially ambiguous clauses. However, in ‘pluri-directional’ situations, the English case law is less convincing. In such cases, the courts have not approached the identification of the arbitral seat in a consistent way; they have not laid down a clear doctrinal framework; and they may be legitimately criticized for displaying a measure of ‘forum preference’.
Associations between low birth weight and prenatal anxiety and later psychopathology may arise from programming effects likely to be adaptive under some, but not other, environmental exposures and modified by sex differences. If physiological reactivity, which also confers vulnerability or resilience in an environment-dependent manner, is associated with birth weight and prenatal anxiety, it will be a candidate to mediate the links with psychopathology. From a general population sample of 1,233 first-time mothers recruited at 20 weeks gestation, a sample of 316 stratified by adversity was assessed at 32 weeks and when their infants were aged 29 weeks (N = 271). Prenatal anxiety was assessed by self-report, birth weight from medical records, and vagal reactivity from respiratory sinus arrhythmia during four nonstressful and one stressful (still-face) procedure. Lower birth weight for gestational age predicted higher vagal reactivity only in girls (interaction term, p = .016), and prenatal maternal anxiety predicted lower vagal reactivity only in boys (interaction term, p = .014). These findings are consistent with sex differences in fetal programming, whereby prenatal risks are associated with increased stress reactivity in females but decreased reactivity in males, with distinctive advantages and penalties for each sex.
Assessment of risk and uncertainty is crucial for natural hazard risk management, facilitating risk communication and informing strategies to successfully mitigate our society's vulnerability to natural disasters. Written by some of the world's leading experts, this book provides a state-of-the-art overview of risk and uncertainty assessment in natural hazards. It presents the core statistical concepts using clearly defined terminology applicable across all types of natural hazards and addresses the full range of sources of uncertainty, the role of expert judgement and the practice of uncertainty elicitation. The core of the book provides detailed coverage of all the main hazard types and concluding chapters address the wider societal context of risk management. This is an invaluable compendium for academic researchers and professionals working in the fields of natural hazards science, risk assessment and management and environmental science, and will be of interest to anyone involved in natural hazards policy.