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"Phelps, James"
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Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity
BackgroundIn the 1970 s, scientific research on psychiatric nosology was summarized in Research Diagnostic Criteria (RDC), based solely on empirical data, an important source for the third revision of the official nomenclature of the American Psychiatric Association in 1980, the Diagnostic and Statistical Manual, Third Edition (DSM-III). The intervening years, especially with the fourth edition in 1994, saw a shift to a more overtly “pragmatic” approach to diagnostic definitions, which were constructed for many purposes, with research evidence being only one consideration. The latest editions have been criticized as failing to be useful for research. Biological and clinical research rests on the validity of diagnostic definitions that are supported by firm empirical foundations, but critics note that DSM criteria have failed to prioritize research data in favor of “pragmatic” considerations.ResultsBased on prior work of the International Society for Bipolar Diagnostic Guidelines Task Force, we propose here Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC–BP) for use in research studies, with the hope that these criteria may lead to further refinement of diagnostic definitions for other major mental illnesses in the future. New proposals are provided for mixed states, mood temperaments, and duration of episodes.ConclusionsA new CRDC could provide guidance toward an empirically-based, scientific psychiatric nosology, and provide an alternative clinical diagnostic approach to the DSM system.
Journal Article
Pediatric fractures secondary to trampoline injury: A prospective analysis of user circumstances and injury severity with respect to American Academy of Pediatrics policy statement
Introduction: The purpose of this study was to prospectively analyze
injury patterns and severity with respect to American Academy of
Pediatrics/Council on Sports Medicine and Fitness (AAP/CSMF) safety
guidelines, and to report parental safety-awareness and behavior.
Methods: Two hundred ninety-nine consecutive patients were enrolled.
Measures of severity included the abbreviated injury scale (AIS), and
need for sedated procedure/surgery. Risk factors were defined by the
AAP/CSMF recommendations.
Results: Of the 299 patients, 99% (296/299) had severe/serious or
moderate AIS scores. 49% (147/299) required a surgical intervention
or sedation-assisted fracture manipulation. An adult was present during
72% (214/299) of injuries, and 55% (164/299) of injuries occurred with
use of protective safety devices. 86% (255/299) of injuries occurred
with multiple children on the trampoline. 42% (126/299) of injuries
occurred in children less than 6 years of age, and a high-risk maneuver
was attempted in 23% (70/299). Children less than 6 years old did
not sustain more severe injuries compared to older children (p=0.81).
Paradoxically, having less children on the trampoline correlated to
sustaining more severe injuries (p=0.03). 83% (248/299) of parents
reported awareness of the dangers of trampolines prior to their child's
injury.
Conclusion: This study reinforces the AAP/CMSF discouragement of
home trampoline use, multiple jumpers, and younger children. Safety
equipment, avoidance of high-risk maneuvers, parental supervision,
and parental awareness of trampoline dangers did not decrease injury
severity There is no such thing as \"safe\" trampolining, and severe
injuries occur despite the best vigilance of parents.
Journal Article
Turnover Intention Among Probation Officers and Direct Care Staff: A Statewide Study
[...] normative commitment represents an employee's feeling obligated to continue employment: employees stay with the organization because they ought to. [...] younger personnel and those with fewer years of service are more likely to feel inclined to leave their probation jobs man older employees and those with more tenure.
Trade Publication Article
Supply Chain Finance: Exploring the State of Adoption With Small Business Suppliers in U.S. Defense Procurement Contracts
Innovative supply chain finance (SCF) practices offer alternative approaches to relief of cash flow distress for suppliers in an extended enterprise by enhancing access to and affordability of working capital. Adopting optional SCF instruments can be especially beneficial for small–medium-sized enterprises (SMEs), which are more acutely affected when credit conditions tighten. This explorative research described the state of buyer-led SCF adoption in defense procurement contracts used to produce highly technical weapons systems. A case study research design with embedded units across four groups of intermediaries was employed to compare the state of SCF adoption between a defense and a commercial business environment in the context of alternative working capital finance instruments. The study identified boundary conditions limiting the awareness and use of the buyer-led reverse factoring instrument for SME suppliers performing as subcontractors in the defense business environment. The study found that enterprise orchestration should be considered as a critical mediator for successful SCF adoption in the defense business environment. Contributions include descriptions of evolving motives, key enablers, and challenges of SCF adoption, emphasizing implications for SME manufacturers and suppliers producing vital components for the U.S. Department of Defense and the military services.
Dissertation
DSM-5 won't solve the overdiagnosis problem --but clinicians can
According to DSM-IV, she might qualify (barring other diagnoses that trump bipolar disorder, such as a mood disorder due to a general medical condition). [...]they can be used to identify patients who should not receive an antidepressant before further assessment by a mental health specialist. Because the Bipolar Spectrum Diagnostic Scale (BSDS) has been found to be more sensitive for bipolar II, it is preferable for use in primary care, where bipolar II is more likely to be missed than bipolar I.11 The BSDS has been appended with a 1-page questionnaire that assesses all of the factors shown in Table 2.12 This version of the BSDS does not require further validation, because the additional questions merely gather data for interpretation by a clinician.
Journal Article
Overdiagnosis: examine the assumptions, anticipate new bipolar criteria
Consider the sheer number of genes and consider the role of environmental variation in modifying gene impact, as seen in the short/long variation of the serotonin transporter gene and depression vulnerability, where an otherwise substantial gene effect is completely overridden by benign upbringing. 7 Imagine the number of combinations of genes and environments possible and imagine the array of phenotypes that would emerge from them? A DSM-5 committee considered all of these factors in their 2006 discussion of whether to introduce a spectrum approach to diagnosis in the upcoming edition. While I deeply respect the importance of this kind of research, the underlying logic is necessarily simplistic. [...]any conclusion of overdiagnosis based on this study is likewise an oversimplification.
Journal Article