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Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.
Key learning aims
(1) How can training of CBT techniques such as exposure occur prior to graduate education?
(2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals?
(3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?
ABSTRACT IMPACT: This research is intended to provide researchers and clinicians information on factors that impact psychiatric health outcomes in a specialty perinatal mood disorders clinic. OBJECTIVES/GOALS: The present study seeks to examine factors that impact psychiatric outcomes at the University of Florida Department of Obstetrics and Gynecology Perinatal Mood Disorders Clinic (PMDC). METHODS/STUDY POPULATION: A hierarchical multinomial logistic regression will be conducted to evaluate predictors that may influence patients receiving a referral to specialty care, a return to primary care or being lost to follow up. Included predictors are changes in insurance status, baseline depression scores, and baseline obsessive-compulsive symptoms (OCS). A multinomial logistic regression will be conducted to determine if OCS and depressive symptoms predict referral to/establishment of psychotherapeutic care. A secondary binary logistic regression will be conducted to evaluate predictors that may predict reduction in depressive symptoms among women seen for more than one session. Included predictors of outcome include time (weeks in psychiatric treatment), OCS at baseline, and referral to psychological therapy. RESULTS/ANTICIPATED RESULTS: Data collection is multiphasic and ongoing via a retrospective chart review of patients seen in the PMDC. Hypotheses include that experiencing a change in insurance will significantly increase the risk of being lost to follow up, as compared to referral to specialty clinic or returning to primary care. It is also predicted that individuals with higher depressive symptoms or OCS will be more likely likely to be assigned to specialty care than to be lost to follow up or primary care. It is believed that greater time in psychiatric care, and lower OCS will increase the likelihood of reductions in depressive symptoms. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study seeks to provide information on predictors that influence outcome this specialty clinic, while extending the limited literature that has examined the influence of OCS on depressive symptoms. It is the hope of the authors to provide information on intervenable factors that influence psychiatric outcomes in a perinatal specialty clinic.
Retrospectively apply criteria from Center to Advance Palliative Care to a cohort of children treated in a cardiac ICU and compare children who received a palliative care consultation to those who were eligible for but did not receive one.
Medical records of children admitted to a cardiac ICU between January 2014 and June 2017 were reviewed. Selected criteria include cardiac ICU length of stay >14 days and/or ≥ 3 hospitalisations within a 6-month period.
Measurements and Results:
A consultation occurred in 17% (n = 48) of 288 eligible children. Children who received a consult had longer cardiac ICU (27 days versus 17 days; p < 0.001) and hospital (91 days versus 35 days; p < 0.001) lengths of stay, more complex chronic conditions at the end of first hospitalisation (3 versus1; p < 0.001) and the end of the study (4 vs.2; p < 0.001), and higher mortality (42% versus 7%; p < 0.001) when compared with the non-consulted group. Of the 142 pre-natally diagnosed children, only one received a pre-natal consult and 23 received it post-natally. Children who received a consultation (n = 48) were almost 2 months of age at the time of the consult.
Less than a quarter of eligible children received a consultation. The consultation usually occurred in the context of medical complexity, high risk of mortality, and at an older age, suggesting potential opportunities for more and earlier paediatric palliative care involvement in the cardiac ICU. Screening criteria to identify patients for a consultation may increase the use of palliative care services in the cardiac ICU.
Denham praises Cowley for writing original verse under the appropriate influence of prominent models old and new. In Swift’s poem, more than half a century later, the venerable art of imitation (imitatio veterum) had been displaced by the dubious threat of theft (stealing hints). What does it mean to steal a hint? ‘To steal another’s idea is wrong’, as James McLaverty says; but ‘to take it and adapt it (as Swift does with the La Rochefoucauld maxim that stimulates the Verses or with Denham’s couplet in these lines) is a vital aspect of invention’.2 A hint can be gifted and regifted among likeminded writers. Swift gave John Gay the idea for The Beggar’s Opera, though the latter preferred ‘to have my own Scheme and to treat it in my own way’.3 Sometimes ‘a friend’, Swift retorted, ‘may give you a lucky [hint] just suited to your own imagination’.4 But hints can be hijacked by hacks, as Pope affirms in the first book of the 1728 Dunciad: ‘How hints, like spawn, scarce quick in embryo lie; / How new-born nonsense first is taught to cry’.5
In the late 1710s and early 1720s, Swift produced three fairly neglected but potent short poems that break open the typical depiction of romance in verse. ‘Phillis, or, The Progress of Love’ tells the tale of an artful prude who elopes with an unpromising hero. ‘The Progress of Beauty’ presents Celia as a syphilitic nymph rotting to pieces before the narrator can finish her story. ‘The Progress of Marriage’ revels in the misfortunes of a foolish old cleric and his vain wife. If anyone could lay claim to the dubious honour of being Swift’s own muse it was Esther Johnson (“Stella”). Swift wrote her an annual poem for nearly a decade until she died. What sort of love poetry could Swift write? Pretty panegyrics for a younger woman he admired? Profound verse essays on life and love and ageing? Metapoems for a trainee poet? Some important friendships made for difficult poetry. The most noteworthy case in point is doubtless Esther Vanhomrigh, another former tutee, whom Swift immortalized in his longest ever poem. 'Cadenus and Vanessa', like the Stella series, is a remarkable non-love poem that conveys a deeper attachment to the subject than a straightforward parody would imply.
In the 1730s Swift produced his most controversial poems (‘The Lady’s Dressing Room’, ‘A Beautiful Young Nymph Going to Bed’, ‘Strephon and Chloe’, and ‘Cassinus and Peter’). Often read as discomfiting scatological poems, these works have been grouped together as 'the unprintables', proof (some critics argue) of an increasingly depraved mind. My new interpretation treats the works in the context of Swift’s career-long fascination with the materiality of poetry. In the unprintables Swift messily mingles the conventions of ancient and Renaissance love poetry in an exposé of what he perceives to be the limitations of form itself. This chapter also places Swift’s most famous poem, 'Verses on the Death of Dr Swift', alongside his other self-portraits written between 1731 and 1733, including political satires and metapoems alike, from verse libels on Delany to 'On Poetry: A Rapsody' and ‘The Legion Club’. Odes, epistles, fables, ballads, verse libels, political satires, descriptive and narrative verses, imitations, auto-eulogies, elegies, rhapsodies, anti-erotica, peeping-tom poems, metapoems, and more: to the end, Swift kept reinventing himself and the poetry and poets around him.
By the time we reach the first half of the 1710s, Swift had become – briefly – a key propagandist for the government. Taking gentle Horace as his model, Swift freely adopted a disparate range of prose and verse, including that of his rival, Richard Steele. In this period Swift deftly experimented with a number of classical sources, often in startling but wholly effective ways. ‘A Description of a City Shower’ and ‘A Description of the Morning’ revisit Virgil by way of Dryden and Donne, among other improbable bedfellows. Like many poets before him, Swift explicitly turned to Ovid (and his chief English imitator, Dryden) when writing ‘Baucis and Philemon’, a raucously mundane British variation on the story made famous in Metamorphoses. Description poetry, irreverent odes and epistles, fantastical fables, repurposed songs, fake prophecies and even a premature elegy: in his mid-career verse Swift covered a wide range of mixed-up genres, many of which had (to his mind) become corrupted by modern poets and commentators, as well as writers in all sorts of other lines of work, from shamming astrologers to political pamphleteers.
Chiefly focusing on Swift’s Cowleyan odes and epistles of the 1690s, this chapter demonstrates the author’s early rejection of conventional imitation in favour of a spontaneous form of appropriative writing. Railing against the accumulated habits of his seventeenth-century forebears, Swift repeatedly reveals in the early poems his own thwarted attempts to reinvent poetry for an unheroic age. Temporarily discarding the panegyric mode at the end of the decade, Swift found a new metafictional style that challenged the very medium of poetry. How can we adequately describe whispering or smells? If a table-book could talk would it have anything valuable to say? What would the petition of a barely literate waiting woman sound like? What happens if an overconfident member of your circle finishes one of your unfinishable ballads?
This chapter examines some of the Market Hill poems, which Swift wrote during bouts of intense creativity while in semi-retirement in the north of Ireland in the late 1720s. A subseries of poems written to, and in the guise of, the author’s hosts explicitly turn away from such famous works as Jonson’s ‘To Penshurst’ or Marvell’s ‘Upon Appleton House’ by moving inward: whereas the ideal poem in this mode celebrates a grand home as the material manifestation of the owner’s impeccable qualities, Swift instead voices the hostess as a trainee vexer, the host as a cruel dullard, the staff as aggravated upstarts, and even himself, in the character of an unwelcome if noteworthy houseguest. The gentrified British pastoral gives away to Irish realism. The satirical panegyrical ode has become a vehicle of self-critique. In markedly different ways, whether risibly or aggressively, the Market Hill poems deal with the Dean’s uncertain legacy as a Hibernian Patriot, a hard-worn but easily dashed image. This chapter ends with an examination of a shortlived but excessive verse war conducted with a rival cleric poet from Dublin who sought to tarnish Swift’s reputation.
Published posthumously, ‘On the Day of Judgement’ was written, according to current critical consensus, sometime between Verses on the Death of Dr Swift, D.S.P.D. in 1731 and On Poetry: A Rapsody in 1733.1 Shorter and blunter than practically all of Swift’s other poems in the period, ‘Day’ showcases a new flair for dramatic satire. Swift’s adoption of the voice of Jove is framed on the page with quotation marks and prefaced with dramatic signage (‘Jove, nodding, shook the Heav’ns, and said …’). The ensuing speech takes up twelve of the twenty-two lines, and closes the poem. This theatricality distracts us from the poem’s primary voice, one not unlike the egoistic Stroller later used in ‘The Legion Club’ or the millennialist visionaries heard in the eschatological poems that appeared with some regularity in the first three decades of the century: ‘With a Whirl of Thought oppress’d, / I sink from Reverie to Rest’. ‘An horrid Vision seiz’d my Head’, he says of himself, reducing everyone else to silent, sorrowful corpses (‘the Graves give up their Dead’, ‘each pale Sinner hangs his Head’). Unlike the narrator, who cannot control his visions, Swift’s Jove revels in his moral judgement. He spares names, but he does not spare the lash: ‘Offending Race of Human Kind, / By Nature, Reason, Learning, blind’.
After his return to Ireland, Swift mixed with brash younger clerics such as Thomas Sheridan and Patrick Delany. Daniel Jackson’s large nose proved to be the unlikely source of profound ekphrastic pieces written by the group. Jovial bagatelles aside, ‘To Mr Delany’ displays a mid-career poet querying his craft. In ‘The Progress of Poetry’ urban hacks and farmer’s geese alike have grown fat and shrill. ‘Advice to the Grub-Street Verse-Writers’ ironically advises how modern hacks might trick a real poet – Pope – into writing original works into the margins of their books. Swift continued to rework British and Irish georgic and pastoral poetry with extraordinary inventiveness in the 1720s, whether in drolly dreary hospitality poems or pseudo-prophecy verses in the voice of St Patrick himself. Swift found new ways to insult his friends, including his hostess Lady Anne Acheson (‘The Journal of a Modern Lady’, ‘Death and Daphne’) and Matthew Pilkington (‘Directions for a Birth-Day Song’), as well as emerging poets for whom he had little taste. Such insults were couched within the unlikely genres with which he engaged, from the Ovidian courtship tale to the royal ode.