Schizophrenia as a temporal mode of being: an existential "ante-festum" impatience.

We suggest in a phenomenological perspective to consider schizophrenia as a special form of human temporality. From this perspective, we view the symptoms of schizophrenia as actions undertaken by subjects to stabilize themselves in existence. From this vantage, we describe the clinical expression of the disorder as a type of "existential impatience", characterized by a painful and elusive "now". This present time posits the prime moment of the constitution of the person. Existential impatience reflects from our patients the persistence of excessive efforts towards individuation. Schizophrenia. In human life in general, individuation consists in an unceasing dynamic process of building up of the self. This process starts with the non-self and particularly with the other. Therefore, the emergence of any relation within the self is grounded in the relation with the other and is based on the relation the other establishes with himself. Schizophrenia distinctly displays the two constitutive moments of "being oneself." These moments are generally linked for all of us: an "unending coming to oneself" (difference of identity), and a "continuous maintenance of being a self" (identity of difference). Existential impatience is not only an irritability of a formal order. Existence itself is impatient in the schizophrenic experience as it hastens to reach human goals while trampling on an "ante-festum" temporal mode. This "before-the-feast" temporal structure is dominated by the shiver before an unknown future, a sign of a basic quest for a task. Schizophrenic "ante-festum" is both a constant fear of being unable to come to oneself and a desperate effort to reach this unknown future. If psychopathology claims to settle [establish] that "order" and "measure" would constitute the two fundamental anthropological bases of human being, impatience of existence draws the emblematic figure of the disorder of measure as a referential motion of the birth of any temporalisation. Such considerations suggest the value, in treatment and rehabilitation, of praising patience and focusing on building, or re-building, the past. The main objective is to reach a maieutics of the self based on relationships in the community and with care-givers, all within an accompanying structured, daily framework.     

A population-based study of patterns of care for ovarian cancer: who is seen by a gynecologic oncologist and who is not?

OBJECTIVES: To determine the fraction of patients diagnosed with ovarian cancer and seen by a gynecologic oncologist and to compare outcomes with those patients and others who are not seen by a gynecologic oncologist. METHODS: The statewide, population-based Utah Cancer Registry was used to identify 848 patients diagnosed with epithelial ovarian cancer between 1992 and 1998. Differences between selected characteristics of cases seen/not seen by gynecologic oncologists were assessed with chi2 tests, and survival data were analyzed using Kaplan-Meier curves and log-rank testing. RESULTS: Of 848 incident epithelial ovarian cancer cases diagnosed in Utah residents during the period 1992-1998, 333 (39.3%) were seen by a gynecologic oncologist at some time during their cancer diagnosis and/or treatment. The percentage of ovarian cancer cases seen by a gynecologic oncologist varied with age: 35.6% of cases under 40 years of age at diagnosis were seen by a gynecologic oncologist, as were 54.5% of cases 40-59 years of age, 42.6% of cases 60-69 years, and 23.7% of women 70+ years of age (chi2 test, P < 0.01). The percentage of ovarian cancer cases seen by a gynecologic oncologists increased during the study period, from 33.0% in 1992-1993 to 47.5% in 1997-1998 (chi2 test for trend, P < 0.01). The vast majority of the state's population resides within a contiguous, four-county area near the only major city where gynecologic oncology care is available. Ovarian cancer cases that resided within that geographic area were generally more likely to have been seen by a gynecologic oncologist than those who lived in more rural regions of the state (42.7 and 27.1%, respectively; chi2 test, P < 0.01). For ovarian cancer cases diagnosed with local or regional stages of disease, there were no significant differences in survivorship between those treated or not treated by gynecologic oncologists. Among cases diagnosed with advanced disease, those cases seen by gynecologic oncologists had a significant survival advantage when compared to those that were not (median survival 26 and 15 months, respectively, P < 0.01). CONCLUSIONS: Gynecologic oncologists see less than half of ovarian cancer patients. Patients under 40 years of age, over 70 years of age, and in rural areas were significantly less likely to be seen by a gynecologic oncologist in their course of treatment. Patients with advanced disease experienced a significant survival advantage when a gynecologic oncologist was involved in their care.     

Experimental evaluation of a preschool language curriculum: influence on children's expressive language skills

PURPOSE: The primary purpose of this study was to investigate child impacts following implementation of a comprehensive language curriculum, the Language-Focused Curriculum (LFC; Bunce, 1995), within their preschool classrooms. As part of this larger purpose, this study identified child-level predictors of expressive language outcomes for children attending at-risk preschool programs as well as main effects for children's exposure to the language curriculum and its active ingredients-namely, teacher use of language stimulation techniques (LSTs; e.g., open questions, recasts, models). METHOD: Fourteen preschool teachers were randomly assigned to 2 conditions. Treatment teachers implemented the experimental curriculum for an academic year; a total of 100 children were enrolled in their classrooms. Comparison teachers maintained their prevailing curriculum; a total of 96 children were enrolled in these classrooms. Teachers' fidelity of implementation was monitored using structured observations conducted 3 times during the academic year. Children's growth in expressive language was assessed using measures derived from language samples in the fall and spring, specifically percent complex utterances, rate of noun use, number of different words, and upper bound index. RESULTS: Children's language skill in the fall, socioeconomic status (household income), and daily attendance served as significant, positive predictors of their language skill in the spring. The impact of the language curriculum and LST exposure was moderated by children's classroom attendance, in that the language curriculum accelerated language growth for children who attended preschool regularly; a similar effect was seen for LST exposure. CONCLUSIONS: Adoption of a comprehensive language curriculum may provide a value-added benefit only under highly specific circumstances. Findings suggest that at-risk children who receive relatively large doses of a curriculum (as measured in days of attendance during the academic year) that emphasizes quality language instruction may experience accelerated expressive language growth during pre-kindergarten.     

Computer graphics for digitally formatted images

The increasing use of digitally formatted imaging systems requires high-quality interactive gray-scale computer raster graphics systems for the management, display, and analog film recording of digital image and alphanumeric information. These systems are a combination of computer hardware and software and implement a set of graphics protocols. This paper describes a set of interactive graphics protocols that has been developed for clinical use.     

Diagnosis of Huntington disease: A model for the stages of psychological response based on experience of a predictive testing program

Persons diagnosed as affected with Huntington's disease (HD) may have similar stages of psychological response to the clinical presentation of the illness. Here we describe a model of these stages of response based on our experience during a predictive testing program for HD. During the warning Stage, asymptomatic persons are aware of their risk status for HD and develop defenses which favor adaptation to their genetic risk. In response to the initial signs and symptoms of HD (the Incipient Stage) unconscious working through of this realization occurs while it is still kept out of conscious awareness. When symptoms become obvious such that recognition of disease onset is inevitable (Break-through Stage) the possibility of the diagnosis of HD is assimilated. After the delivery of the diagnosis during the Adjustment Stage, short-and long-term adaptive responses to living with HD occur. Recognition of the stage of psychological response of a patient who presents with HD is important prior to delivering a clinical diagnosis. In a significant minority of cases, the psychological readiness lags behind the clinical symptomatology and premature presentation of diagnosis may result in significant untoward adverse events. Understanding of the stages of response may provide a frame-work for evaluating the psychological state of the person with HD and determining their readiness to receiving the diagnosis. This model may have relevance to the psychological responses of patients to the diagnosis of other late onset autosomal dominant disorders. © 1993 Wiley-Liss, Inc.     

Clinical and statistical prediction: Where are we and where do we go from here?

In the years following the publication of P.E. Meehl's monograph, our understanding of clinical and statistical prediction has been enriched by both empirical and conceptual analyses. The highlights of this period are reviewed with an emphasis on prediction models, in order to illustrate the basic features held in common by these two literatures. We appear to be on the threshold of an era of parsimonious prediction models. That being the case we can now return our attention to the problems of developing better assessment devices and more meaningful criterion measures and of developing procedures that will increase the accuracy of clinical judgment and prediction.