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Dermatillomania is characterised by repetitive skin picking, resulting in tissue damage and significant distress and/or functional impairment. Cognitive behavioural therapy (CBT) is the recommended psychological intervention for dermatillomania in clinical guidelines, with the evidence base also supporting habit reversal training (HRT) as part of CBT. However, research evaluating CBT and HRT for dermatillomania remains scarce. This case study describes a young woman with dermatillomania, in the context of co-morbid anxiety and low mood, treated with 20 sessions of CBT including HRT in a community setting. Guided by her formulation, additional techniques such as those fostering self-compassion were also integrated, and sociocultural factors were adapted for. Improvements were reported in client-centred goals and outcomes of global psychological distress, functioning, anxiety and symptoms and psychosocial impacts of skin picking. The intervention was well received by the client. Limitations as well as clinical practice implications and research recommendations for dermatillomania are discussed.
Key learning aims
(1) To understand using CBT, including HRT, to treat a case of dermatillomania in the context of anxiety and depression.
(2) To use a formulation-driven approach to guide the intervention.
(3) To consider adapting interventions for sociocultural factors.
In 1524, two anonymous pamphlets were published, both professing to be letters written by a married woman to her sister, a nun. Both draw on a range of New Testament texts to express criticism of ‘the hypocrites’, a term the anonymous author uses to refer particularly to clergy and religious. This article examines how the author of these pamphlets constructed and characterized the category of the hypocrite. Drawing on the work of Hans-Christoph Rublack, the article shows that her critique is coherent with anti-clerical rhetoric found in a wide range of early Reformation pamphlets. It then compares her strictures on hypocrisy with references to hypocrisy and hypocrites in the early German writings of Martin Luther and Andreas Bodenstein von Karlstadt to explore the extent to which accusations of hypocrisy were entwined with anti-clerical and anti-monastic rhetoric in the early Lutheran Reformation. It concludes that while accusations against clergy and religious were often couched in terms of their hypocrisy, Luther's use of the term hypocrite was much broader, extending to all those whom he viewed as presenting themselves as ‘holier than thou’, while Karlstadt made less use of the term.
Electrohydrodynamic (EHD)-induced droplet emission is an efficient method for the production of micron- and submicron-sized droplets in technological applications. Existing studies propose several scaling laws to determine the size of the emitted droplet. However, they have usually focused on the tip streaming phenomena of a droplet when subjected to a uniform electric field. In most applications, a non-uniform distribution of the electric field is created owing to the nozzle-to-plate configuration. Here, we employ an arbitrary Lagrangian–Eulerian method to demonstrate the mechanism of the first droplet emission from an electrified liquid meniscus with a fixed volume hanging at the nozzle tip. The critical condition when tip streaming occurs is determined using our numerical results. A phase diagram in terms of the electric field and initial liquid volume is presented to obtain the commonly used jetting mode. The effects of the liquid volume, electric field strength and electrical conductivity of the liquid on the processes of jet formation and breakup are further investigated. We find a particularly non-monotonic dependence of the size of the emitted droplet on the electrical conductivity. These findings could be useful for generating microdroplets and improving injection frequency in EHD printing technology.
The innate and adaptive immune systems are critical in defense against pathogens and ensuring homeostasis. The central nervous system (CNS) was initially considered to be impermeable to immune cells due to the blood–brain barrier. However, this has now been debunked, with modern research delineating immune cell trafficking within the CNS, ensuring constant immune surveillance. However, these defenses may be breached in infections, which trigger an inflammatory cascade causing tissue damage. In addition, autoimmune conditions and genetic mutations may also lead to sustained proinflammatory molecule release causing significant CNS damage. Ensuing brain injury from most immune triggers is varied but may be associated with common patterns by virtue of a shared immune driver. MRI plays an important role in identifying these conditions and further enables understanding of their pathophysiology as well as their spatial predilection in the brain. In this review, we discuss basic immunology, the major CNS barriers to infections as well as the current understanding of selected pediatric infections and inflammatory processes.
This article examines the use of the concepts of hypocrisy and the hypocrite in the writings of Pope Gregory the Great (590–604) and Archbishop Wulfstan of York (1002–23). Although separated by many centuries, these two treatments are connected through Wulfstan's debt to Gregory's ideas on the evil of hypocrisy, and particularly in his depiction of Antichrist as the chief of all hypocrites. Both use the idea of hypocrisy to critique their contemporary situation: for Gregory, the pride of the Patriarch John IV of Constantinople in adopting the title ‘Ecumenical Patriarch’; and for Wulfstan, the court politics in the turbulent final years of the reign of Æthelred the Unready.
A turbulent two-vortex system (T-2VS) is obtained by inserting analytical model wake vortices into very weak homogeneous isotropic turbulence (HIT) and by evolving them in time using large-eddy simulation until a turbulent state at statistical equilibrium is reached. The T-2VS is characterised as follows: circulation distribution of the vortices; energy of the mean and fluctuating fields; energy dissipation rate. It is also verified that essentially the same T-2VS is obtained when varying the initial model or initial HIT perturbation. A wall-resolved simulation of the T-2VS further interacting with a smooth ground is then performed at $Re_\varGamma = 2 \times 10^5$; this is $10 \times$ higher than in previous works, which allows us to better capture the high Reynolds number behaviour. The high release height of the T-2VS also ensures a physically correct approach to the ground. The results are compared with the literature and also to what is obtained for the case of non-turbulent vortices interacting with the same ground at the same Reynolds number. The flow topologies are discussed, and significant differences are highlighted regarding the separation of the boundary layer generated at the ground, and the way this secondary vorticity interacts with the primary vortices and makes them decay. The vortex trajectories are also measured, together with their circulation distribution and global circulation evolution, and the differences are discussed.
The white ecclesia in the United States either opposed or equivocated on the matter of the humanity of African Americans. The 1939 unification of majority white Methodist bodies, for example, structurally segregated black members into a separate Central Jurisdiction. This action mimicked practices in the broader body politic that crystallized in American society both de jure and de facto systems of second-class citizenship for African Americans. This hypocrisy mobilized adherents of Gandhian non-violence and elicited from them tenets and tactics which energized moral methodologies that defeated a church and civic collusion that perpetrated black subordination. Interracial alliances derived from the ecclesia and parachurch organizations articulated non-violence as a moral precept that sacralized a grassroots civil rights movement. This initiative morally discredited the racial hypocrisy aimed at America's formerly enslaved and segregated population.
The paper presents the control architecture of a crawler mobile robot designed and developed to sample potentially contaminated lands. The robot, developed in the framework of an Italian national project named ROBILAUT, carries a driller with a customized sampling mechanism to implement on-site the required quartering, and it is controlled to move the drilling device on specific points acquired in real time before the mission starts. The paper describes the software architecture for the navigation and control, focusing on the control framework of the robotic platform. Specifically, the robot exhibits a differential drive kinematics with actuators’ constraints, and two different control strategies have been experimentally tested for comparison both in a structured environment and in the real site in May 2023.
Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew (‘HINTS’) assessment is a clinical bedside test used to aid diagnosis.
Methods
Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored.
Results
Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave.
Conclusion
There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.
This article examines the connections in late antique Christian thought between the ideas that heretics were inspired by the devil, and that the devil was a liar. It begins by showing that the association of the devil with lies was founded on scriptural exegesis, and that Scripture was regularly deployed in heresiologies to cement the links between the devil as ‘father of lies’, and heretics and schismatics as liars in Satan's image. It then offers a detailed case study of when, where and how accusations of direct and indirect diabolical dissimulation were made by the opposing parties of the ‘Donatist controversy’ in polemical texts produced primarily for their own side. The final part considers how these accusations were modulated in invented textual dialogues and in oral debates between the two sides, showing how direct accusations of diabolical activity made against opponents were often eschewed for more subtle insinuations of diabolical association.
In 1976 Raymond Williams commented, ‘Culture is one of the two or three most complicated words in the English language.’ Such implied difficulty has not prevented Bloomsbury Academic, since the 2000s, from publishing around forty series of their well-produced and generously illustrated Cultural Histories, with, according to their website, a further fifty in progress. Each series contains six volumes, each book covering, in theory, the same chronological period (antiquity, the Middle Ages, the Renaissance, the Enlightenment, the age of empire and the modern age), though there is some variation depending on precise topic. The idea is that one can use these books not only to read ‘horizontally’ about a subject across time, but also ‘vertically’ through different subjects in the same period – a idea made easier by the e-texts of the series on Bloomsbury's website.
This article explores the various manifestations of religious hypocrisy to be found in new plays written in England between 1660 and 1720. It shows how the dramatists used hypocrisy both as a polemical weapon at times of religious conflict, and as an engaging form of theatricality. Exploring hypocrisy through drama is apposite as many of the key characteristics of hypocrisy – masks, role-playing, disguise and dissimulation – have been features of the theatre since ancient Greek times. The post-Restoration dramatists created worlds of masquerade for their hypocritical characters to inhabit, while the plays themselves offer examples of unselfconscious casuists, disreputable clerics, predatory monsters, and those who dissimulate religious beliefs, or have none at all.
This article discusses the iconography of Luca Signorelli's Sermon and Deeds of the Antichrist (c.1502–3) in the Cappella Nuova at the cathedral of Orvieto. A combined investigation of the Antichrist's subject matter, Signorelli's literary and visual sources, as well as his discarded drawings for the entire fresco decoration of the Cappella Nuova, brings fresh insights to the thematic intentions of the artist and his advisers. Signorelli's entire view of eschatology marked a renewed interest of Italian artists in the apocalyptic sublime. It also signified a revival of the medieval tradition of the Antichrist as the arch-hypocrite, and his reign as an apocalyptic age of hypocrisy. At the same time, the artist's treatment of the subject matter indicates an ambiguous stance toward religious hypocrisy characterized by a suppression of the anti-clerical and millenarian aspects of the Antichrist myth.
First dispatched to Jamaica in 1818 by The Conversion Society, the Rev. John Stainsby became a prominent figure on the island. This article examines his intense involvement in Anglican missionary affairs to reveal how dishonesties and concealment of belief were used to expand Anglican missions in the Caribbean. Firstly, this article examines two key sites of contention between missionaries and the plantocracy – Sunday markets and baptism – where Stainsby used deception to reconcile his religious duties and colonial law. Secondly, it considers the motivations and actions of The Conversion Society and the Church Missionary Society more generally, including the heavily censored material used for religious instruction. Finally, it examines Stainsby as an enslaver, and considers the religious justifications used to support enslavement by many resident Anglican clergymen in the early nineteenth century.
In 1838, Robert and Samuel Wilberforce published, in five volumes, The Life of William Wilberforce. Although the subject of some contemporary controversy, this work, containing extensive quotations from his diaries, rapidly established itself as the principal source for subsequent biographical writings about Wilberforce and strongly influenced later interpretations. The production of a complete initial transcription of the diaries by the Wilberforce Diaries Project for the first time enables a systematic comparison between the Life and its principal source. This reveals a systematic attempt by his sons to minimize references to Wilberforce's participation in some aspects of Hanoverian sociability, his use of medication to deal with his worsening health, his close associations with and respect for Nonconformists and his own evangelical commitment and spirituality. As a consequence, the Wilberforce we know from the biography is as much a product of early Victorian myth-making as the Wilberforce of 1759–1833.
Driving capacity is affected by vestibular disorders and the medications used to treat them. Driving is not considered during medical consultations, with 92 per cent of patients attending a centre for dizziness not discussing it with the doctor.
Objective
To investigate if medical record prompts facilitate dizziness and driving conversations in ENT balance clinics.
Methods
A questionnaire was designed to reflect the current standards of practice and advice given regarding driving and dizziness during balance clinic consultations.
Results
Medical record prompts facilitated the improved frequency and recording of shared decision-making conversations about driving and dizziness in 98 per cent of consultations.
Conclusion
This study highlights the benefits of medical record prompts for documented and accurate shared decision-making conversations surrounding dizziness, vertigo, vestibular conditions and driving. This potentially improves safety for all road users, and protects the patient and clinician in the event of road traffic accidents and medico-legal investigations.
Epilepsy ranks fourth among neurological diseases, featuring spontaneous seizures and behavioural and cognitive impairments. Although anti-epileptic drugs are currently available clinically, 30 % of epilepsy patients are still ineffective in treatment and 52 % of patients experience serious adverse reactions. In this work, the neuroprotective effect of α-linolenic acid (ALA, a nutrient) in mice and its potential molecular mechanisms exposed to pentylenetetrazol (PTZ) was assessed. The mice were injected with pentetrazol 37 mg/kg, and ALA was intra-gastrically administered for 40 d. The treatment with ALA significantly reduced the overall frequency of epileptic seizures and improved the behaviour impairment and cognitive disorder caused by pentetrazol toxicity. In addition, ALA can not only reduce the apoptosis rate of brain neurons in epileptic mice but also significantly reduce the content of brain inflammatory factors (IL-6, IL-1 and TNF-α). Furthermore, we predicted that the possible targets of ALA in the treatment of epilepsy were JAK2 and STAT3 through molecular docking. Finally, through molecular docking and western blot studies, we revealed that the potential mechanism of ALA ameliorates PTZ-induced neuron apoptosis and neurological impairment in mice with seizures by down-regulating the JAK2/STAT3 pathway. This study aimed to investigate the anti-epileptic and neuroprotective effects of ALA, as well as explore its potential mechanisms, through the construction of a chronic ignition mouse model via intraperitoneal PTZ injection. The findings of this research provide crucial scientific support for subsequent clinical application studies in this field.