Reverse Noir

pages 107-10

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers

Smokers in Greece and the UK are habitually exposed to different levels of social disapproval. This qualitative study explored the accounts of smoking and disapproval offered by 32 UK and Greek smokers. Accounts were framed with reference to a highly moralized construction of smoking. Participants were sensitive to social disapproval of their smoking. While disapproval from those close to them was accepted, disapproval from the general public was not. Two discursive repertories 'smoking works for me now' and 'the struggle to quit' were identified as resources that participants drew upon to enable continued smoking while acknowledging the health issues. While there were many similarities in the accounts provided, there were important differences that seem to reflect the different 'smoking worlds' inhabited. Copyright 2006 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Neurovisceral phenotypes in the expression of psychiatric symptoms

This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brainbody mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in 'emotional' brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognised factors causing vasodilatation (as noted post prandially, post exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety

The initial measurement structure of the Home Drinking Assessment Scale (HDAS)

Aims: To evaluate the initial psychometric properties of a novel Home Drinking Assessment Scale (HDAS). Participants: Five-hundred and twenty-five (58% female) participants recruited from the internet address book of an English University. This also included a sub-sample (6%) recruited from Twitter and Facebook contacts. Design and methods: Internet-based survey analysed using a two-stage factor analysis protocol and internal consistency(IC) assessment. Findings: A power calculation was made on the basis of pilot data and this established that 317 interviewees were required to test the reliability of the HDAS. The items comprising the HDAS were found to offer the best fit to data when they comprised two-subscales: (1) emotional reasons for home drinking (5-items) and (2) practical reasons for home drinking (3-items). Subscale 1 was also found to have acceptable IC whereas subscale 2 exhibited sub-optimal IC characteristics. Conclusions: This initial study indicates that the HDAS has promise as a measure of the individuals' rationale for home drinking. Subscale 1, may usefully be used in future research whereas the IC characteristics of subscale 2 suggests that further development is required, including the evaluation of additional items

Which antidepressants have demonstrated superior efficacy? A review of the evidence

A review of published evidence of superior efficacy of a particular antidepressant in major depressive disorder may assist clinicians in making considered treatment choices. To identify such candidates, an international group of experts met to assess published evidence (identified through searches in Medline and Embase databases and discussions with experts in the field) from randomized, controlled trials and meta-analyses comparing two antidepressants under conditions of fair comparison. Criteria were defined to judge the strength of evidence. Two pivotal studies in moderate-to-severe major depressive disorder that demonstrate superiority on the primary efficacy measure, or alternatively one pivotal study supported by consistent results from meta-analyses, was considered to constitute evidence for definite superiority. Three antidepressants met these criteria: clomipramine, venlafaxine, and escitalopram. Three antidepressants were found to have probable superiority: milnacipran, duloxetine, and mirtazapine. Only escitalopram was found to have definite superiority in the treatment of severe depression; probable superiority was identified for venlafaxine and possible superiority for milnacipran and clomipramine. This review of published data found evidence that only a very few antidepressants are shown to be more effective than other

Stories of Hell and Healing: Internet Users’ Construction of Benzodiazepine Distress and Withdrawal

Abstract Benzodiazepines are a group of drugs used mainly as sedatives, hypnotics, antiepileptics, and muscle relaxants. Consumption is recommended for 2 to 4 weeks only, due to fast onset of dependency and potentially distressing withdrawal symptoms. Few peer-review studies have drawn on the user experiences and language to appreciate firsthand experiences of benzodiazepine withdrawal or discontinuation syndrome. We looked extensively at patient stories of benzodiazepine withdrawal and recovery on Internet support sites and YouTube. Our analysis indicated that users employ rich metaphors to portray the psychologically disturbing and protracted nature of their suffering. We identified seven major themes: hell and isolation, anxiety and depression, alienation, physical distress, anger and remorse, waves and windows, and healing and renewal. By posting success stories, ex-users make known that “healing” can be a long, unpredictable process, but distress does lessen, and recovery can happen

Emergent impacts of rapidly changing climate extremes in Alaska

Thesis (Ph.D.) University of Alaska Fairbanks, 2018The frequency and intensity of certain extreme weather events in Alaska are increasing, largely due to climate warming from greenhouse gas emissions. Future projections indicate that these trends will continue, potentially leading to billions of dollars in climate-related damages this century. Expected damages arise from increases in extreme precipitation, severe wildfire, altered ocean chemistry, land subsidence from permafrost thaw, and coastal erosion. This dissertation applies new downscaled reanalysis and climate model simulations from the fifth phase of the Coupled Model Intercomparison Project to enhance current understanding of climate extremes in Alaska. Model output is analyzed for a historical period (1981-2010) and three projected periods (2011-2040, 2041-2070, 2071-2100) using representative concentration pathway 8.5. Unprecedented heat and precipitation are expected to occur when compared to the historical period. Maximum 1-day and consecutive 5-day precipitation amounts are expected to increase by 53% and 50%, respectively, and the number of summer days per year (Tmax > 25°C) increases from a statewide average of 1.5 from 1981-2010 to 29.7 for 2071-2100. Major alterations to the landscape of Alaska are anticipated due to a decreasing frequency of freezing temperatures. Growing season length extends by 48-87 days by 2071-2100 with the largest changes in northern Alaska. In contrast, projections indicate a reduced snow season length statewide and many locations in southwest Alaska no longer have continuous winter snow cover. Changes to these metrics indicate that a climate-warming signal emerges from the historical inter-annual variability, meaning that future distributions are entirely outside of those previously observed. The largest changes to extremes may be avoided by following a lower emissions trajectory, which would reduce the impacts and associated costs to maintain infrastructure and human health.Alaska Center for Climate Assessment and Policy1. Introduction -- 2. Projections of twenty-first-century climate extremes for Alaska via dynamical downscaling and quantile mapping -- 3. agro-climate projections for a warming Alaska -- 4. Anticipated changes to the snow season in Alaska: elevation dependency, timing and extremes -- 5. Conclusion