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Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
This article presents early findings from the implementation and ongoing evaluation of a new model of care that employs a comprehensive approach to rehabilitation case management for clients with traumatic brain injury, with the aim of improving transition from inpatient rehabilitation to community settings. The evaluation explores the design, implementation, utility and acceptability of the new model using clinicians’ perceptions and experiences. Method: The evaluation framework employs a participatory evaluation approach, drawing on semistructured interview data. Interviews were conducted with brain injury unit clinicians, rehabilitation case managers and external stakeholders at the model's implementation and four months later, as part of a 12-month evaluation period. The data were descriptively organised, then coded and subjected to interpretative analysis to identify key issues. Results: Early findings suggest that the new model provides increased consistency for staff, clients and carers; promotes efficiency in discharge planning and facilitates a more streamlined and seamless transition between inpatient rehabilitation and community services. Data gathered across the remainder of the implementation trial will extend understanding of this comprehensive rehabilitation case management model and its potential utility in other services and settings.
In the context of action research in community forests, stakeholders' values for biodiversity can be elicited, communicated and understood with the help of a multidimensional conceptual framework. This incorporates levels of diversity (genes, species, habitats and processes), types of values (direct use, indirect use, option and existence) and stakeholders. This paper explores the effect of using this framework on forest monitoring, learning and communication, and wider implications for conservation, in Baglung District (Nepal). Monitoring was initially an unfamiliar concept to villagers, but the process clarified its purpose, whilst helping to elicit and exchange values and knowledge amongst stakeholders. This precipitated proposals for silvicultural experimentation and social inquiry into the diversity of users' needs. The framework allowed the translation of local value statements into categories recognized by other actors. It aided external stakeholders in understanding the factors contributing to values held by community forest users. Villagers' appreciation of ‘quality’ forest did not necessarily equate to the most ‘biodiverse’ forest, but rather the greenest and densest and that stocked with useful species. Elite domination, tenure and access to markets affected values assigned and behaviour in forest management. Elicitation of these values provoked questioning of forest management decisions and benefit sharing among community forest users. This, in turn, stimulated more democratic forest management and more inclusive, wide-ranging biodiversity values. Participatory monitoring is more conceptually challenging than is usually recognized, and the links between equity and conservation merit further attention in different cultural contexts.
The Modes of Scepticism is one of the most important and influential of all ancient philosophical texts. The texts made an enormous impact on Western thought when they were rediscovered in the 16th century and they have shaped the whole future course of Western philosophy. Despite their importance, the Modes have been little discussed in recent times. This book translates the texts and supplies them with a discursive commentary, concentrating on philosophical issues but also including historical material. The book will be of interest to professional scholars and philosophers but its clear and non-technical style makes it intelligible to beginners and the interested layman.
This book, like most jointly written works, has arisen from a shared interest which we have developed together with mutual benefit and pleasure. We are especially grateful for the invention of the word-processor, which has stimulated continuous exchanges and criticisms by making correction pleasing rather than tedious, and which has, we think, resulted in a book which is a product of joint labour throughout, even in parts where one or other of us was originally responsible for more of the ingredients.
We have discussed the modes in several seminars and lectures, and we are grateful to our audiences for their patience and their helpful comments. We hope that the book will encourage further discussion, and that others may succeed in elucidating opaque argumentation where we have failed – and may even discover what Pericles' slave really was doing on the roof-top.
What can we know about the world? How can we think and talk about it? Those two large questions determine two main areas of philosophy. Epistemology discusses questions of cognition: What is knowledge? How much can we know? Of what can we be certain? In what circumstances are our beliefs justified? Logic or philosophy of language is devoted to questions of meaning: What is it for us or our utterances to mean something? How can we refer to things in the external world? By what inferential processes can we legitimately move from one statement to another?
Among Anglo-Saxon philosophers, logic is now often taken to be the fundamental part of philosophy, and questions of meaning are accorded a certain priority: until we understand how we can talk and think about things we can make no progress. Such an attitude to philosophy is young. It traces its origins to the work of the German mathematician and logician, Gottlob Frege, whose active life spanned the period from 1880 to 1925.
Before the age of logic came the age of epistemology. For such thinkers as Descartes and Locke, Hume and Kant, the basic questions of philosophy concerned not language and thought but rather the nature and scope of human understanding. The first task of the philosopher was to determine in what ways and to what extent we can gain knowledge of the world. The triumph of logic has given a distinctive colouring to modern Anglo-Saxon philosophy: in style and approach, in method and argument, it differs noticeably from the philosophy of earlier epochs.