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Ludovico’s Technique: The Literary Depiction of Aversion Therapy in ‘A Clockwork Orange’
- J. Wellington, A. Wellington, M. Abbasy, M. Bhagia, D. Myles, V. Bhure
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S879-S880
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Introduction
Anthony Burgess’ novel ‘Clockwork Orange’ identifies the topical debates surrounding the use of aversion therapy (or aversive conditioning) as an effective treatment for addictive behaviours. Widely popularised in literature as ‘Ludovico’s Technique’, Burgess attempts to credit the misunderstanding and dramatization of its effects when the main protagonist is released from a prison sentence after undergoing this treatment.
ObjectivesWe aimed to highlight the depictions of aversion therapy in modern popular literature.
MethodsA narrative review of the current literature concerning aversion therapy and Anthony Burgess’s novel ‘A Clockwork Orange’ was conducted. Emphasis on the misinterpretation of aversive therapies was noted.
ResultsSince the introduction of pharmacological alternatives and additional forms of psychological therapies, there has been a decline in the use of aversion therapy in recent decades. However, it is still effective when conceding the conditioning process. Likewise, its predecessor’ visual imagery’ is believed to be a more acceptable and effective form.
ConclusionsThe depiction of aversion therapy in literature and media has played a role in shaping societal views on aversive conditioning techniques and the degree to which they are deemed acceptable forms of treatment. The “Ludovico Technique” featured in the novel ‘A Clockwork Orange’ and its film adaptation is arguably the most salient depiction of aversion therapy in popular culture.
DisclosureNo significant relationships.
Pilot cohort study of obstructive sleep apnoea in community-dwelling people with schizophrenia
- H. Myles, N. Myles, A. D. Vincent, G. Wittert, R. Adams, M. Chandratilleke, D. Liu, J. Mercer, A. Vakulin, C. L. Chai-Coetzer, C. Galletly
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- Journal:
- Irish Journal of Psychological Medicine / Volume 38 / Issue 1 / March 2021
- Published online by Cambridge University Press:
- 24 April 2020, pp. 23-29
- Print publication:
- March 2021
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Objectives:
We aimed to assess the incidence of obstructive sleep apnoea (OSA) in people with schizophrenia, to explore clinical associates with OSA and how well OSA screening tools perform in this population.
Methods:All patients registered in a community outpatient Clozapine clinic, between January 2014 and March 2016, were consecutively approached to participate. Participants were screened for OSA using at home multichannel polysomnography (PSG) and were diagnosed with OSA if the apnoea-hypopnoea index (AHI) was >10 events/hr. Univariate comparison of participants to determine whether AHI > 10 events/hr was associated with demographic factors, anthropometric measures and psychiatric symptoms and cognition was performed. The sensitivity, specificity, positive predictive value and negative predictive value of the commonly used sleep symptoms scales and OSA screening tools were also determined.
Results:Thirty participants were recruited, 24 men and 6 women. Mean age was 38.8 (range: 25–60), and mean body mass index (BMI) was 35.7 (range 19.9–62.1). The proportion of participants with OSA (AHI > 10 events/hr) was 40%, 18 (60%) had no OSA, 4 (13%) had mild OSA (AHI 10.1–20), zero participants had moderate OSA (AHI 20.1–30) and 8 (27%) had severe OSA (AHI > 30). Diagnosis of OSA was significantly associated with increased weight, BMI, neck circumference and systolic blood pressure. Diagnosis of OSA was not significantly associated with Positive and Negative Symptoms Scale, Montgomery Asperger’s Depression Rating Scale, Personal and Social Performance scale or Brief Assessment of Cognition for Schizophrenia scores. All OSA screening tools demonstrated poor sensitivity and specificity for a diagnosis of OSA.
Conclusion:OSA was highly prevalent in this cohort of people with schizophrenia and was associated with traditional anthropometric OSA risk factors.
Judging clinical competence using structured observation tools: A cautionary tale
- Anthony D. Roth, Pamela Myles-Hooton, Amanda Branson
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 47 / Issue 6 / November 2019
- Published online by Cambridge University Press:
- 15 April 2019, pp. 736-744
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- November 2019
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Background:
One method for appraising the competence with which psychological therapy is delivered is to use a structured assessment tool that rates audio or video recordings of therapist performance against a standard set of criteria.
Aims:The present study examines the inter-rater reliability of a well-established instrument (the Cognitive Therapy Scale – Revised) and a newly developed scale for assessing competence in CBT.
Method:Six experienced raters working independently and blind to each other’s ratings rated 25 video recordings of therapy being undertaken by CBT therapists in training.
Results:Inter-rater reliability was found to be low on both instruments.
Conclusions:It is argued that the results represent a realistic appraisal of the accuracy of rating scales, and that the figures often cited for inter-rater reliability are unlikely to be generalizable outside the specific context in which they were achieved. The findings raise concerns about the use of these scales for making summative judgements of clinical competence in both educational and research contexts.
Radar and Spacecraft Ranging to Mercury between 1966 and 1988
- John D. Anderson, Martin A. Slade, Raymond F. Jurgens, Eunice L. Lau, X. X. Newhall, E. Myles Standish, Jr.
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- Publications of the Astronomical Society of Australia / Volume 9 / Issue 2 / 1991
- Published online by Cambridge University Press:
- 25 April 2016, p. 324
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Improved solutions have been obtained for the orbit and equatorial cross-section of Mercury using radar ranging data spanning 22 years. These data have yielded new results on the precession of Mercury’s perihelion and better limits on a possible time variation in the gravitational constant G.
Intrauterine Hydrocephalus and Ventriculomegaly: Associated Abnomalies and Fetal Outcome
- D. D. Cochrane, S. T. Myles, C. Nimrod, D. K. Still, R. G. Sugarman, B. K. Wittmann
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- Canadian Journal of Neurological Sciences / Volume 12 / Issue 1 / February 1985
- Published online by Cambridge University Press:
- 18 September 2015, pp. 51-59
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Advances in fetal diagnostic techniques have opened many areas to prenatal anatomical scrutiny. Intrauterine hydrocephalus and ventriculomegaly are conditions which are readily diagnosed. Fetal intervention has been undertaken in humans in order to minimize the craniofacial disfigurement and to maximize the growth potential of the brain. To justify such an approach, the significance of all anomalies should be recognized prior to treatment. The authors have reviewed 41 cases of hydrocephalus diagnosed in utero in order to define associated anomalies and patient outcome.
75% of our personal series and 72% of the reviewed literature cases had other anomalies of the central nervous system. Other system malformations, some of which proved fatal, were seen commonly. Prenatal diagnostic techniques did not always reveal these additional problems.
The outcome of these pregnancies is not good. Approximately one third of these fetuses have survived to be treated postnatally and to be followed up clinically. Only 7.5% of this series were felt to have attained normal developmental milestones. The remainder of the survivors have various focal and/or global cerebral deficits.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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The clinical use of buprenorphine in opiate addiction: evidence and practice
- Fergus D. Law, Judy S. Myles, Mark R. C. Daglish, David J. Nutt
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- Acta Neuropsychiatrica / Volume 16 / Issue 5 / October 2004
- Published online by Cambridge University Press:
- 24 June 2014, pp. 246-274
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Buprenorphine is a partial μ-opioid receptor agonist that is being increasingly used in clinical practice in the treatment of opioid dependence in the UK, USA, and, elsewhere. Its unique pharmacological properties mean it is a relatively safe drug, it can be given by alternate day dispensing, and it is associated with relatively mild symptoms on withdrawal. The interpretation of the research literature on buprenorphine is however, complex, and often appears to be in conflict with how buprenorphine is used in clinical practice. This article describes these apparent contradictions, their likely explanations, and how these may further inform our clinical practice. The article also describes the clinically relevant pharmacological properties of buprenorphine, compares it to methadone, relates the evidence to clinical experience, and provides practical advice on how to manage the most common clinical techniques. The best quality evidence suggests that very rapid buprenorphine induction is not associated with a higher drop-out rate than methadone, that buprenorphine is probably as good as methadone for maintenance treatment, and is superior to methadone and α-2 adrenergic agonists for detoxification. However, buprenorphine cannot yet be considered the ‘gold standard’ treatment for opiate dependence because of the higher drop-out rates that may occur on induction using current techniques, its high-cost relative to methadone, and because the place of buprenorphine in treatment is still continuing to evolve.
List of contributors
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- By Eva Alcón Soler, Joe Barcroft, Martha Bigelow, Ellen Broselow, Jennifer Cabrelli Amaro, Kees de Bot, Laurent Dekydtspotter, Jean-Marc Dewaele, Giovanna Donzellii, Astrid Ensslin, Suzanne Flynn, Claire Foley, Alice Foucart, Cheryl Frenck-Mestre, María del Pilar, García Mayo, Elena Gavruseva, Kit Hansen, Roger Hawkins, Belma Haznedar, Julia Herschensohn, Randal Holme, Tania Ionin, Anna Dina L. Joaquin, Yoonjung Kang, Jan Koster, Cedric Krummes, Ryuko Kubota, Donna Lardiere, Andrea W. Mates, Elizabeth R. Miller, James Milton, Silvina Montrul, Florence Myles, Amy Snyder Ohta, Vera Regan, Jason Rothman, Bonnie D. Schwartz, Michael Sharwood Smith, Roumyana Slabakova, Rex A. Sprouse, Elaine Tarone, Margaret Thomas, Richard Towell, John Truscott, Anne Vainikka, Daniel Véronique, Melinda Whong, Wynne Wong, Clare Wright, Martha Young-Scholten
- Edited by Julia Herschensohn, University of Washington, Martha Young-Scholten, University of Newcastle upon Tyne
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- The Cambridge Handbook of Second Language Acquisition
- Published online:
- 05 July 2013
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- 17 January 2013, pp xii-xiv
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Recovery of Impairments After Severe Traumatic Brain Injury: Findings From a Prospective, Multicentre Study
- Robyn L. Tate, Ross D. Harris, Ian D. Cameron, Bridget M. Myles, Julie B. Winstanley, Adeline E. Hodgkinson, Ian J Baguley, Peter G Harradine, Brain Injury Outcomes Study (BIOS) Group
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- Brain Impairment / Volume 7 / Issue 1 / 01 May 2006
- Published online by Cambridge University Press:
- 21 February 2012, pp. 1-15
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This study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n = 19), 2 to 4 weeks (n = 44) and more than 4 weeks (n = 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.
GROWTH AND PUBLIC INFRASTRUCTURE
- Nigar Hashimzade, Gareth D. Myles
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- Journal:
- Macroeconomic Dynamics / Volume 14 / Issue S2 / November 2010
- Published online by Cambridge University Press:
- 16 November 2010, pp. 258-274
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The paper analyzes a multicountry extension of the Barro model of productive public expenditure. In the presence of positive infrastructural externalities between countries, the provision of infrastructure will be inefficiently low if countries do not coordinate. This provides a role for a supranational body, such as the European Union, to coordinate the policies of the individual governments. It is shown how intervention by a supranational body can raise welfare by internalizing the infrastructural externality. Infrastructural externalities increase the importance of tax policy in the growth process and distribute the benefits of taxation across countries.
Contributors
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- By Ashok Agarwal, Joseph P Alukal, Deborah J Anderson, Linda D Applegarth, Saleh Binsaleh, Elizabeth M Bloom, Karen E Boyle, Nancy L Brackett, Robert E Brannigan, James V Bruckner, Victor M Brugh, Ettore Caroppo, Grace M Centola, Aleksander Chudnovsky, Susan L Crockin, Fnu Deepinder, David M. Fenig, Aaron B Grotas, Matthew P. Hardy, Wayne J. G. Hellstrom, Stanton C Honig, Stuart S Howards, Keith Jarvi, Rajasingam S Jeyendran, William E Kaplan, Edward Karpman, Sanjay S Kasturi, Mohit Khera, Nancy A Klein, Dolores J Lamb, Jane M Lewis, Larry I Lipshultz, Kirk C Lo, Charles M Lynne, R. Dale McClure, Antoine A Makhlouf, Myles Margolis, Clara I. Marín-Briggiler, Randall B Meacham, Jesse N Mills, John P Mulhall, Alexander Müller, Christine Mullin, Harris M Nagler, Craig S Niederberger, Robert D Oates, Dana A Ohl, E. Charles Osterberg, Rodrigo L Pagani, Vassilios Papadopoulos, Joseph A Politch, Gail S Prins, Angela A Reese, Susan A Rothmann, Edmund S Sabanegh, Denny Sakkas, Jay I Sandlow, Richard A Schoor, Paulo C Serafini, Mark Sigman, Suresh C Sikka, Rebecca Z Sokol, Jens Sønksen, Miguel Srougi, James Stelling, Justin Tannir, Anthony J Thomas, Paul J Turek, Terry T Turner, Mónica H. Vazquez-Levin, Moshe Wald, Thomas J Walsh, Thomas M Wheeler, Daniel H Williams, Armand Zini, Barry R Zirkin
- Edited by Larry I. Lipshultz, Stuart S. Howards, University of Virginia, Craig S. Niederberger, University of Illinois, Chicago
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- Book:
- Infertility in the Male
- Published online:
- 19 May 2010
- Print publication:
- 24 September 2009, pp vii-x
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Comparison of intra-articular fentanyl and intra-articular bupivacaine for post-operative pain relief after knee arthroscopy
- J. S. Pooni, K. Hickmott, D. Mercer, P. Myles, Z. Khan
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- Journal:
- European Journal of Anaesthesiology / Volume 16 / Issue 10 / October 1999
- Published online by Cambridge University Press:
- 16 August 2006, pp. 708-711
- Print publication:
- October 1999
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A randomized double-blinded study consisting of 107 patients was conducted to compare the effect on post-operative pain relief of intra-articular fentanyl and intra-articular bupivacaine after knee arthroscopy. The results showed that intra-articular bupivacaine produced superior analgesia in the immediate post-operative period. At 2 h post-operatively, the intra-articular bupivacaine group had a mean pain score of 2.0 (standard deviation 2.1, P <0.05) compared with the intra-articular fentanyl group which had a mean pain score of 3.2 (standard deviation 2.3, P <0.05) After 2 h post-operatively, intra-articular bupivacaine and intra-articular fentanyl had a similar effect on pain scores. The mean pain score 18 h post-operatively was 2.7 for the intra-articular bupivacaine group (standard deviation 2.2, P value 0.6) compared with the intra-articular fentanyl group which had a mean pain score of 2.8 (standard deviation 1.9, P value 0.6).
List of tables
- Gareth D. Myles, University of Exeter
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- Book:
- Public Economics
- Published online:
- 05 June 2012
- Print publication:
- 23 November 1995, pp xiv-xiv
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Contents
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 05 June 2012
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- 23 November 1995, pp ix-x
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Subject index
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 05 June 2012
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- 23 November 1995, pp 542-546
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6 - Policy reform
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 05 June 2012
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- 23 November 1995, pp 167-195
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Summary
INTRODUCTION
The previous two chapters have considered the determination of optimal commodity and income taxes. In practice, if the derived tax rules were to be implemented it would be likely that a major upheaval of the fiscal structure would be required. To be willing to enact such a major change would require the policy maker to have considerable faith in the accuracy of the policy advice. Taking this into account, many countries have opted in favour of gradual policy reforms which involve slowly phasing in some taxes and removing others. The design of such reforms will be the subject of this chapter.
The theoretical literature on policy reform has been concerned with characterising when there exist feasible reforms that satisfy the policy maker's objectives and with determining the optimal direction of reform. For the purpose of formal analysis, reforms are always interpreted as differential changes in the vector of policy instruments. This is the limiting interpretation of the reforms being small.
This chapter will review the standard analysis that has been developed for determining the existence of worthwhile reforms in the vector of consumer prices. The inverse optimum problem, which calculates the welfare weights of households implied by a given set of policy parameters, will be related to this analysis and the concept of marginal social cost will be discussed. Several applications of these methods, including empirical investigations, will be described.
Preface
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 23 November 1995, pp xv-xvi
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Summary
This book provides a systematic treatment of the major themes in public economics. It is primarily theoretical although empirical results and simulation results are described where these illustrate the theoretical arguments. The merit of the theoretical approach is that it provides arguments and methods of reasoning that are not dependent on transitory institutional detail but can be applied in a wide variety of contexts. The unifying feature of the analysis is the employment of general equilibrium theory to provide a consistent foundation on which results are developed. The use of general equilibrium techniques reflects the author's belief that, since the secondary effects of policy can sometimes outweigh the direct effects, this is the only method that can provide defensible conclusions.
The book is written primarily for graduate students and economists from other fields wishing to learn about public economics. Although this means that some sections are advanced, and some of the proofs terse, there is much that can be profitably read by advanced undergraduates. In fact, the first three chapters could constitute a self-contained treatment of general equilibrium and welfare economics for such students. I have also attempted to structure the chapters so that the basic points are made early on in the simplest acceptable framework. For graduate students, the book should show them public economics as it appears in academic journals. If they wish really to understand the material and intend to contribute to its future development, then mastery of the methods of argument and the details of proofs is essential.
12 - Tax evasion
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 23 November 1995, pp 383-412
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INTRODUCTION
An implicit assumption that supported the analysis of taxation in the previous chapters was that firms and consumers honestly report their taxable activities. Although acceptable for providing simplified insights into the underlying issues, this assumption is patently unacceptable when confronted with reality. The purpose of this chapter can therefore be seen as the introduction of practical constraints upon the free choice of tax policy. Tax evasion, the intentional failure to declare taxable economic activity, is pervasive in many economies as the evidence given in the following section makes clear and is therefore a subject of practical as well as theoretical interest.
After reviewing evidence on the extent of tax evasion, the chapter considers the tax evasion decision of consumers. This decision is represented as a choice under uncertainty and naturally employs the techniques of chapter 7. Within this framework, the optimal degree of auditing and of punishment is considered. This is then extended to include decisions over labour supply, since the choice of occupation can determine opportunities for evasion, and the role of public goods and social norms. The analysis predicts the relationship between the level of evasion, tax rates and punishments. The results of experiments that investigate these are discussed. A more developed analysis of the optimal choice of audit is then given. The analysis of tax evasion is then completed by consideration of evasion by firms.
8 - Corporate taxation
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 23 November 1995, pp 231-260
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INTRODUCTION
The corporation is treated as a separate entity for tax purposes in all developed countries. It has been subject to numerous tax instruments with a variety of different motivations. The transfers between the corporation and its stockholders result in the behaviour of the corporation also being influenced by the structure of the personal tax system, most notably through the favourable tax treatment of capital gains. The intention of this chapter is to describe the relevant tax instruments and to determine their effects. This will give an insight into the many issues that arise in the analysis of corporate taxation.
This chapter is distinguished from those that precede it by its focus upon the effects of taxation rather than upon optimisation exercises. There are several reasons for this. Input taxes have often been employed in many countries and the effects of such taxes are important because of this, but it has already been shown that they would not form part of an optimal tax system for a competitive economy. Therefore there is no need for a further study of optimisation. In simple settings where shareholders exercise direct control, the corporation cannot be identified as an entity distinct from its owners. A coherent tax structure would then involve a comprehensive income tax on owners, covering all sources of earnings, with no need for separate taxation of the corporation. Although the effects of corporation taxation are still of interest in such a framework since they suggest issues that may arise in more complex settings, optimisation is again of limited interest.
7 - Risk
- Gareth D. Myles, University of Exeter
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- Public Economics
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- 23 November 1995, pp 196-230
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INTRODUCTION
Risk is a factor that is evident throughout economic activity. Firms must choose between investment plans for which neither the cost nor the return can be known with certainty, households purchase goods whose value in use is determined by the state of nature and the government receives uncertain revenues and allocates funds to projects with unknown outcomes. Although the Arrow–Debreu economy is capable of incorporating risks of these kinds, so that they can be viewed as having already been covered by previous analysis, the special features involved with risk justify a separate chapter devoted to the subject.
The interpretation of the Arrow–Debreu economy in the presence of risk is discussed first and the Pareto optimality of equilibrium is reconsidered with particular focus placed upon the number of markets necessary to sustain optimality. This analysis is at the level of generality of previous chapters. The reasons why there may be too few markets to sustain optimality and whether this may justify government intervention are also considered. Individual attitudes to risk, in terms of measures of risk aversion, are then contrasted to social attitudes. Alternative perspectives on social attitudes, including the Arrow–Lind theorem supporting risk neutrality of government, are contrasted. A more general framework is then presented which shows how social attitudes to risk can be derived from the social insurance effects of projects and the weighting of households in the social welfare function.
A more specific interpretation of risk in terms of assets with random returns is then adopted and household maximisation is analysed in further detail.