Ship in a Bottle

Art in a Bottle- How Did They Get That Ship in There

The Schooner Virginia Races the Pride of Baltimore II past Thimble Shoals Lighthouse.
Created by marine artist Heather Gabrielle Rogers.

The first known ship inside a bottle was created during the early years of the 19th century. Like other sailor-made art forms, these were created aboard old sailing ships in an era when sea voyages lasted months and sometimes years. Whalemen, during their idle hours, produced scrimshaw for family members, sweethearts, and friends. Decorative and utilitarian objects were carved from bone, ivory teeth, and baleen, and designs were engraved on the same materials. But other materials such as wood, rope and yarn were also used, and many interesting and decorative objects were created from these.

Two tall ships pass each other in this early 20th century ship in a bottle diorama.

It is not surprising then that an empty spirit or a medicine bottle lying around aboard ship might have spurred the imagination of a 19th century seaman into devising a way to display a model ship in it. Whatever the origin, the technique for placing ships into bottles was passed along and over time became a favored art form for sailors. Some sailors produced a facsimile of the ship that they sailed aboard; others may have created multiple ships passing by under full sail on rough painted clay seas or a diorama of a ship in harbor with the seaport in a background, a lighthouse at the harbor’s edge, possibly with tugboats in tow. These works can now be found in maritime museums around the world for there are few sailor-made decorations as nautical as a bottled ship.

Tom Applegate prepares the US Coast Guard tall ship "Eagle" for launching in the bottle.

Today, ship-in-bottle artists have taken the old sailor art form and produce exceptional works of art with microscopic detailing that will rival anyone’s imagination of “how did they get that in the bottle.” A selection of new works by Heather Gabrielle Rogers and Tom Applegate will also be a focus of this nautical show.

The US Coast Guard tall ship "Eagle" under sail on blue clay seas.

Skipjack Nautical Wares & Marine Gallery is hosting “Art in a Bottle,” a collection of exceptional ship-in-bottles and dioramas from the 19th century through the present and featuring recent creations by maritime
artists Heather Gabrielle Rogers and Tom Applegate.

Heather Gabrielle Rogers- As a passionate crafter of ships in bottles, Heather has developed a huge appreciation for the challenge of constructing these tiny ships with my main focus directed towards detail. Her overall goal is to always produce what appears to be a miniature version of a ship or vessel captured in a moment in time.

Thomas Applegate- From as far back as he could remember he has had a love for the sea. In the early 1970's he made his first ship in a bottle, a brigantine. Being self taught, he found it very challenging and rewarding. Over the years, he has researched each vessel he has created in order to make them a work of art while being true to life.

LOCATION

Skipjack nautical Wares & Marine Gallery is located on the riverfront, 1 High Street next to the High Street Landing in Olde Towne Portsmouth, Virginia. Parking is available in the municiple parking lot next to the gallery and the Water Street garage located across the street of the building and along High Street.

Link: http://skipjacksnauticalliving.blogspot.ca/

Achieving Manageable, Meaningful Change

Intentional Change Theory

Achieving Manageable, Meaningful Change

Intentional Change Theory gives you the tools you need to transform yourself.

How many times have you tried to change something about yourself, only to find yourself slipping back into old habits?

Change is never easy, whether you're trying to change a behavior, an attitude, or your current circumstances.

The process is likely to be more "stop, start, stop, start" than the smooth transition you'd like it to be, as willpower flags and as other priorities vie for your attention.

Change is especially tough if you haven't wholly bought into it – for example, if you're trying to make a change that, deep down, you don't want to make, or if you're making a change that was designed for someone else and that doesn't fully align with your aspirations.

This is why it's helpful to create a personalized change plan. In this article, we'll look at Intentional Change Theory, a framework that you can use to create a change plan that is tailored to you – with your own unique strengths, weaknesses, learning styles, dreams, and support networks.

Note:

This article focuses on career-related change. However, you can apply Intentional Change Theory to personal goals, too: for example, you can use it for a diet or fitness plan, for home interests or study, or for changing a habit or belief that's holding you back.


About the Tool

Richard Boyatzis, a professor at Case Western Reserve University, developed Intentional Change Theory (ICT) as part of his work on individual and organizational change.

He published it in 2006 in the Journal of Management Development.

The theory outlines five common-sense steps that you need to follow if you want to make a lasting change within yourself. These five steps are:

Discover your ideal self.

Discover your real self.

Create your learning agenda.

Experiment with and practice new habits.

Get support.

From Boyatzis, R.E. (2006) 'An Overview of Intentional Change From a Complexity Perspective,' Journal of Management Development, Vol. 25, No. 7. Reproduced with permission of Emerald Group Publishing Limited.

These steps guide you through the process of mapping out your plans, putting them into practice, and making them part of your life.

Applying Intentional Change Theory

Let's look at each step in detail, and explore how to follow each one through.

1. Discover Your Ideal Self

There is often a gap between who we are and who we ultimately want to be. So, the first step in making an intentional change is to define your ideal self.

Start by forming a clear sense of what you'd like to achieve. Think about your hopes and aspirations, and clarify them into short- and long-term goals .

Pay attention to what excites you during this process. Discard goals that you don't feel enthusiastic about, and keep exploring until you find ones that you'd truly like to achieve. Remember that they might be drastically different from what you're doing now.

Write down all of your dreams, however far-fetched they seem. At this stage of the process, it's helpful to see all of your hopes and aspirations, even if you later decide that some of them are not immediately achievable.

Next, think about what kind of person you'd like to be. Be specific: would you like to have more empathy? Arrive at work with more energy? Have more patience? Visualize the person that you'd like to become in detail, and write this down.

Tip 1:

One way to motivate yourself during your period of change is to create a Treasure Map of your goals. Alternatively, you may find that a personal mission and vision statement inspires you.

Tip 2:

Our Life Plan Workbook ($) gives you a comprehensive framework for exploring and clarifying your life goals.


2. Discover Your Real Self

Your next step is to define your real self – the person you are right now. This can be a challenging step, because many of us have trouble seeing our strengths and weaknesses clearly. However, it's essential to uncover both the good and the bad: you'll struggle to reach your goal if you are not clear about your starting point.

Start by defining your own strengths and weaknesses. Use tools such as the StrengthsFinder , Personal SWOT Analysis , and Myers-Briggs to uncover more about your real self.

Alternatively, start with a simple list. What do you like most about yourself? What needs to change? Explore your current attitudes, assumptions, behaviors, and habits.

Also, ask for feedback  from family, friends, colleagues, and your boss, explaining that you'd like their opinion on your strengths and weaknesses, so that you can work on these. Then use the Feedback Matrix  to explore this feedback in more detail.
3. Create Your Learning Agenda

Now that you've defined who you are and who you'd like to be, you can create a "learning agenda" to align reality with the vision. Your learning agenda (also known as a personal development plan ) will also help you stay on track.

First, define what you need to do to move from your current self to your ideal self. Who can help you along this path? What resources do you need? Brainstorm the ways that you can access the information or training you need.

Then, identify your learning style . When you know this, you can learn more effectively – both on your own and in a group. For example, if you know that you prefer to learn by reflecting on information, schedule time to do this after a class or at the end of a study session.

Find a mentor or coach who can help you become your ideal self. This person might be a work colleague, friend, business associate, or professional coach.

Tip 1:

It's essential to do a reality check at this stage. There may be some changes that just aren't possible right now. Note these down on a "bigger picture" list of plans. You can work on these when your circumstances or resources change.

Tip 2:

You may be held back by a lack of time, or by conflicting demands. You can deal with this by focusing on a few changes at a time. Also, and where appropriate, embed your learning in your working life to help avoid frustration: our article on finding time for professional development outlines ways that you can fit learning into your schedule.


4. Experiment and Practice New Habits

Once you're heading in the right direction, it's time to practice. This will help you turn the changes you've made into new habits. Whether you're adopting a new skill, starting a micro-business, or changing an attitude or belief, do something – however small – every day that reinforces the changes you've made.

This step is also about experimenting – that is, finding stimulating ways to learn – and then testing your new knowledge, skills, or attitudes.

Tip:

Quick wins are an important source of motivation and self-confidence. For example, imagine that you're trying to be more patient with others. Find a small way to build your patience with your team every day.


5. Get Support

None of us gets far alone. Friends, family, colleagues, and our community can encourage us and give support that propels us through challenging times.

As you're going through the intentional change process, draw on the support of the people around you. Tell people you trust about what you want to do, and why you want to do it. Share your learning agenda, and ask for their support as you move forward.

Tip:

Remember, you're not the only person who's trying to change him- or herself positively. Build good work relationships by helping your colleagues with their own development: this way, you can give one-another support.

Key Points

Richard Boyatzis, a professor at Case Western Reserve University, created the Intentional Change Theory (ICT) and published it in the Journal of Management Development in 2006.

The model recommends that you use the following five steps to make a lasting change:

Discover your ideal self.
Discover your real self.
Create your learning agenda.
Experiment with and practice new habits.
Get support.

You can use the framework to customize your change process to suit your own life, learning style, and environment. However, change will only happen if you build small changes into your life, practice them to build new habits, and ask for support when you need it.


This site teaches you the skills you need for a happy and successful career; and this is just one of many tools and resources that you'll find here at Mind Tools.

 Subscribe to our free newsletter, or join the Mind Tools Club and really supercharge your career!

By Caroline Smith and the Mind Tools Team

Source: http://www.mindtools.com/pages/article/intentional-change-theory.htm

O VAGABUNDO - Charles Chaplin

Link: https://youtu.be/ye1If4cjwY4

Robbie Burns: To A Mouse

 

 

TO A MOUSE

ON TURNING HER UP IN HER NEST WITH THE PLOUGH, NOVEMBER, 1785

by: Robert Burns (1759-1796)

I

 

EE, sleekit, cowrin, tim'rous beastie,

Oh, what a panic's in thy breastie!

Thou need na start awa sae hasty,

Wi' bickering brattle!

I was be laith to rin an' chase thee,

Wi' murd'ring pattle!

 

II

 

I'm truly sorry man's dominion

Has broken Nature's social union,

An' justifies that ill opinion

Which makes thee startle

At me, thy poor, earth-born companion

An' fellow-mortal!

 

III

 

I doubt na, whyles, but thou may thieve;

What then? poor beastie, thou maun live!

A daimen-icker in a thrave

'S a sma' request;

I'll get a blessin wi' the lave,

And never miss't!

 

IV

 

Thy wee-bit housie, too, in ruin!

Its silly wa's the win's are strewin!

An' naething, now, to big a new ane,

O' foggage green!

An' bleak December's winds ensuin,

Baith snell an' keen!

 

V

 

Thou saw the fields laid bare an' waste,

An' weary winter comin fast,

An' cozie here, beneath the blast,

Thou thought to dwell,

Till crash! the cruel coulter past

Out thro' thy cell.

 

VI

 

That wee bit heap o' leaves an stibble,

Has cost thee mony a weary nibble!

Now thou's turn'd out, for a' thy trouble,

But house or hald,

To thole the winter's sleety dribble,

An' cranreuch cauld!

 

VII

 

But, Mousie, thou art no thy lane,

In proving foresight may be vain:

The best-laid schemes o' mice an' men

Gang aft a-gley,

An' lea'e us nought but grief an' pain,

For promis'd joy!

 

VIII

 

Still thou art blest, compared wi' me!

The present only toucheth thee:

But och! I backward cast my e'e,

On prospects drear!

An' forward, tho' I cannot see,

I guess an' fear!

"To a Mouse" is reprinted from English Poems. Ed. Edward Chauncey Baldwin & Harry G. Paul. New York: American Book Company, 1908.

 Source:
 http://www.poetry-archive.com/b/to_a_mouse.html

  

 Robert Burns by Alexander Nasmyth
(By permission of the National Galleries of Scotland) 

Embrace Change

The world hates change, yet it is the only thing that has brought progress
– Charles F. Kettering



The secret of change is to focus all of your energy, not on fighting the old, but on building the new.
- Socrates


What saves a man is to take a step. Then another step.
- C. S. Lewis



An investment in life is an investment in change... When you are changing all the time, you've got to continue to keep adjusting to change, which means that you are going to be constantly facing new obstacles. That's the joy of living. And once you're involved in the process of becoming, there is no stopping.
- Leo F. Buscaglia



All changes, even the most longed for, have their melancholy, for what we leave behind us is a part of ourselves; we must die to one life before we can enter into another.
- Anatole France




Become a student of change. It is the only thing that will remain constant.
- Anthony D'Angelo'

Addiction and Recovery

 
Home » Substance-Related Disorders

Psychiatric Times. Vol. 28 No. 6

SUBSTANCE ABUSE: ADDICTION and RECOVERY

Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse
Brief Screening, Referral, and Cognitive Rehabilitation

*By Antonio Verdejo-García, PhD | June 8, 2011


The prevalence and durability of cognitive deficits in patients with substance use disorders raises the need to develop specific assessment and rehabilitation strategies. This is pertinent because general deficits in cognitive function and specific deficits in executive functions are robustly associated with worse drug treatment outcomes, including poorer adherence, shorter retention, and greater risk of relapse.14-16

In this article, I propose the use of a brief screening instrument for frontal-executive deficits in patients with substance use disorders and provide examples of novel treatment interventions aimed at addressing these deficits.

Instruments to assess substance use–related cognitive deficits

Key manifestations of cognitive/executive dysfunction among patients with substance use disorders are:

• Difficulties in understanding complex instructions

• Distractibility

• Premature or disinhibited responses

• Thought and behavioral inflexibility

• Some other symptoms may be neglected by the patient but stressed by significant collaterals, including:

- problems with initiating and planning novel activities, 

- disorganized behavior, 

- lack of insight into his or her mistakes, and 

- lack of concern about the consequences.
Insight is often lacking in the patient, which underscores the need for the clinician to effectively screen for cognitive dysfunction.

If cognitive impairment is suspected in light of clinical observations and interviews, I recommend the use of a brief screening instrument to detect frontostriatal systems–derived cognitive, behavioral, and emotional deficits. For example, the Frontal Systems Behavior Scale (FrSBe) is a sensitive instrument used to detect frontostriatal-related deficits in patients with substance use disorders.17-19

The FrSBe is composed of 46 items (rated on a 1 to 5 Likert scale) that yield 3 scores for:

-symptoms of apathy, 

- disinhibition, and executive dysfunction (working memory, planning, or awareness deficits), as well as

- an overall score of frontostriatal-systems dysfunction.

The scale includes a self-report and a collateral report. Both reports have shown adequate reliability indices, but the use of the latter is especially recommended when the patient’s insight deficits are overtly manifest.17

The scale also possesses norms extracted from the healthy population of the United States, which provides easy classification of patients as impaired or nonimpaired in comparison with demographically adjusted norms.

If the information from the clinical interviews and the scale’s scores converges to suggest at least mild cognitive impairment (below 1.5 standard deviations [SDs] in some of the FrSBe scales), the clinician can complement the assessment by administering a brief battery of neuropsychological tests focused on those cognitive abilities with well-known implications for addiction treatment prognosis (Table). Response inhibition is measured with the Stroop test, the Wisconsin Card Sorting Test (WCST) is used to measure flexibility/perseveration, decision-making capacity is measured using the Iowa Gambling Task (IGT).14-16

The Stroop test measures response inhibition, and it is based on the interference effect driven by the demand of naming the color of a word that is printed in a color incongruent with the name (eg, the word blue printed in red).20

The test consists of 3 conditions.

1. The first condition (W) presents the words red, blue, and green printed in black ink, and patients are requested to read aloud these words.

2. The second condition (C) presents strings of XXX printed in the same 3 colors, and patients have to name the colors as quickly and accurately as possible.

3. The third condition (WC) introduces the interference effect: the words red, blue, and green are printed in incongruent colors and patients have to name the color and ignore the word.

The interference score (IS) is calculated by subtracting a weighted mean of the first 2 conditions from the third condition [IS = WC 2 (C 3 W)/(C + W)]; then results are compared with normative values to evaluate the degree of impairment.

The WCST21 is a measure of flexibility to change. It measures response patterns in the face of changing schedules of reinforcement. The clinician presents 4 stimulus cards; the shapes on the cards differ in color, quantity, and design. 

The patient is given a stack of 64 cards that he has to sort according to initially unknown criteria. However, the examiner knows the criteria (the first sorting criterion is the color of the shapes, the second is the design of the shapes, and the third is the number of shapes) and provides trial-by-trial feedback of the correctness or incorrectness of each card sorted.

Patients try to sort the cards correctly by adjusting their performance to the ongoing feedback. Critically, the sorting criteria change across the test (without any overt warning from the examiner): after 10 consecutive hits in sorting by color, the criterion changes to shape, and then to number.





*Dr Verdejo-García is Researcher and Lecturer at the Department of Clinical Psychology and Institute of Neuroscience, Universidad de Granada, Spain. He reports no conflicts of interest concerning the subject matter of this article.



Read More:
Source:  http://www.psychiatrictimes.com/substance-use-disorder

ANIMAL FRIENDS IN PICTURES

 

 

 

 

 

 

 

 

A Simple Philosophy

“To ensure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.”

-William Londen

Cannabis

 Although medical cannabis is now legal, it is hazy as to how it will be dispensed in Canada --- probably by your GP.  

Surveys like this one show how reactionary this profession is SO you must wonder how easy it will be to obtain from your local doctor.

The Dope on Medical Cannabis: Results of a Survey of Psychiatrists : 

- See more at: http://www.psychiatrictimes.com/psychopharmacology/dope-medical-cannabis-results-survey-psychiatrists/page/0/8#sthash.Ab7kzUZP.dpuf

Psychiatrists

News | July 11, 2013 | Substance Use Disorder, PTSD, Psychopharmacology

By Susan Kweskin

If our survey on medical cannabis is any indication, psychiatrists are widely—and deeply—divided on whether and how marijuana should be used in clinical practice. You can read the results here.

Treating the “Mind” Versus the “Brain” in Substance Dependence

- See more at: http://www.psychiatrictimes.com/substance-use-disorder#sthash.BWIzXKUh.dpuf

The Dope on Medical Cannabis: Results of a Survey of Psychiatrists

News | July 11, 2013 | Substance Use Disorder, PTSD, Psychopharmacology

By Susan Kweskin

Linked Articles

The Dope on Medical Cannabis: Results of a Survey of Psychiatrists

The Haze Surrounding Medical Cannabis—Take the Survey

If our survey on medical cannabis is any indication, psychiatrists are widely—and deeply—divided on whether and how marijuana should be used in clinical practice. Feelings are running, well . . . high, about whether, when, or in what circumstances this drug might be prescribed for patients with psychiatric disorders.

- See more at: http://www.psychiatrictimes.com/psychopharmacology/dope-medical-cannabis-results-survey-psychiatrists#sthash.iZ1uVy71.dpuf

We invited psychiatrists to complete a survey about medicinal marijuana and didn’t expect nearly 2200 people to complete that survey in a just a few days. We heard from 1138 psychiatrists, 930 of whom practice in the US. We also heard from 109 psychologists, 163 nurse practitioners, and 22 physician assistants. About 30% of the respondents were 51 - 60 years old; 20% were 41 - 50; and 22% were 61 - 71. The minority (40%) live in a state where medical cannabis is legal.

The graphs you see on the following pages summarize survey results.

What is your opinion of medical marijuana?

We got 922 answers and 112 comments: 37% would never prescribe; 40% would consider prescribing in some circumstances; and 11% would consider, but only in pill form. Here’s a sampling of the widely divergent opinions.

“Marijuana should be legal for all and should not require a prescription."

“There is no medical necessity to legalize or prescribe something as addictive or toxic as smoked marijuana.”

“I am offended at the use of the term 'medical.' I am a physician and it is up to physicians to decide what is medical, not politicians. It is recreational or political, not medical until we as a profession say otherwise."

“Marijuana is NOT medicine. It happens to be effective for chemotherapy-related side effects, but not all the time, and not for everyone. Let’s get real. People want ‘medical marijuana’ because they feel less discomfort WHEN THEY ARE HIGH. When people are facing terminal illness, I give them whatever they want. Welldocumented, intractable pain—almost anything they want, with careful monitoring. Short of this, they want the buzz. There is nothing inherently wrong with wanting this. I, however, do not need to support it in my practice.”

“I would not prescribe marijuana because it has no psychiatric indication.”

“I work in a state facility where it is not an option to prescribe marijuana. However, some of my elder patients may benefit from prescribed pills of its synthetic derivatives like Marinol.”

“When I see good double blind studies that demonstrate effective long-term uses in psychiatric conditions, I would consider prescribing regulated medical marijuana.”

“I have a 49 year old patient with rapid deterioration of multiple sclerosis. Marijuana helps her with mood swings and discomfort. If legal, I would prescribe it without hesitation . . . ”

“I would prescribe for terminally ill cancer patients. I consider it to be a toxic, dangerous drug under most circumstances.”

“I would legalize all drugs of abuse as the war on drugs is a failure, wastes money, is a threat to civil liberties, and funds narco-terrorism.”

“Because I am an addiction psychiatrist, I do not prescribe medical marijuana. Like all drugs, it has its place in the medical armamentarium, and I approve of its medical use when appropriate. There should be more funded research and less ‘religious opinion’ so we can know what the proper use of marijuana is. Currently it has become a political football and the medical- correctional industry has a financial stake in not acknowledging the abject failure of the War on Drugs.”

Cannabis—Take the Survey

For what psychiatric conditions would you prescribe medical cannabis?

531 respondents left comments. Aside from “none,” these were among the responses:

“Anorexia”

“Agitated dementia”

“Severe anxiety disorders”

“Chronic pain”

“None, well, perhaps chemotherapy nausea”

“Weight loss in dementia”

“PTSD”

“Pain management, glaucoma, migraine, cancer, AIDS, and a number of other conditions”

“Anxiety, insomnia, appetite stimulation”

“Geriatric depression, geriatric anxiety”

“Bipolar I & PTSD & disability level inability to have social encounters or even to venture out when a neighbor can view them. If it significantly eases paranoid delusional obsessions. Those I feel comfortable in trying out.”

“Terminal patients who qualify for Hospice”

“Comorbid oncology and severe pain”

If your patient was receiving medical marijuana from another prescriber for PTSD, would you continue to treat his/ her psychiatric illness?

The majority (48%) answered “yes” to the question. Among the 182 comments were these: “

What hasn’t been addressed is the liability of mixing psych meds with cannabis when there is no way to determine the cannabis dose. If we Rx cannabis and the patient has a MVA are we liable?”

“My patients have a ‘one prescriber’ contract with me.”

“Would attempt to replace the MJ ultimately via the treatment; would not accede to patient continuing to take as part of a lifeplan.”

“Most likely, but only if I felt it was being used appropriately and not hindering treatment progress or adherence to evidence-based treatments.”

“I would not treat with psychopharmacology. I would assume that person is the prescriber. I might treat with psychotherapy if it was a collaborative approach and therapeutic.”

We would like to extend a special thank-you to our Editorial Board Member, Dr Helen Lavretsky, who wrote our cover story about medical cannabis and who helped us develop this survey. And thank you to all who took the time to complete this survey. We would also call your attention to a survey recently conducted by The New England Journal of Medicine in which physicians across various specialties were asked their views about medicinal use of marijuana.1

The Dope on Medical Cannabis: Results of a Survey of Psychiatrists

The Haze Surrounding Medical Cannabis—Take the Survey

Link:  http://www.psychiatrictimes.com/psychopharmacology/dope-medical-cannabis-results-survey-psychiatrists

addiction

PsychiatricTimes SearchMedica Medline Drugs


Psychiatric Times. Vol. 28 No. 6


SUBSTANCE ABUSE: ADDICTION & RECOVERY
Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse
Brief Screening, Referral, and Cognitive Rehabilitation



By Antonio Verdejo-García, PhD | June 8, 2011



Dr Verdejo-García is Researcher and Lecturer at the Department of Clinical Psychology and Institute of Neuroscience, Universidad de Granada, Spain. He reports no conflicts of interest concerning the subject matter of this article.


The prevalence and durability of cognitive deficits in patients with substance use disorders raises the need to develop specific assessment and rehabilitation strategies. This is pertinent because general deficits in cognitive function and specific deficits in executive functions are robustly associated with worse drug treatment outcomes, including poorer adherence, shorter retention, and greater risk of relapse.14-16

In this article, I propose the use of a brief screening instrument for frontal-executive deficits in patients with substance use disorders and provide examples of novel treatment interventions aimed at addressing these deficits.

Instruments to assess substance use–related cognitive deficits

Key manifestations of cognitive/executive dysfunction among patients with substance use disorders are:


• Difficulties in understanding complex instructions


• Distractibility


• Premature or disinhibited responses


• Thought and behavioral inflexibility

Some other symptoms may be neglected by the patient but stressed by significant collaterals, including problems with initiating and planning novel activities, disorganized behavior, lack of insight into his or her mistakes, and lack of concern about the consequences.

Insight is often lacking in the patient, which underscores the need for the clinician to effectively screen for cognitive dysfunction. If cognitive impairment is suspected in light of clinical observations and interviews, I recommend the use of a brief screening instrument to detect frontostriatal systems–derived cognitive, behavioral, and emotional deficits. For example, the Frontal Systems Behavior Scale (FrSBe) is a sensitive instrument used to detect frontostriatal-related deficits in patients with substance use disorders.17-19

The FrSBe is composed of 46 items (rated on a 1 to 5 Likert scale) that yield 3 scores for symptoms of apathy, disinhibition, and executive dysfunction (working memory, planning, or awareness deficits), as well as an overall score of frontostriatal-systems dysfunction. The scale includes a self-report and a collateral report. Both reports have shown adequate reliability indices, but the use of the latter is especially recommended when the patient’s insight deficits are overtly manifest.17 The scale also possesses norms extracted from the healthy population of the United States, which provides easy classification of patients as impaired or nonimpaired in comparison with demographically adjusted norms.

If the information from the clinical interviews and the scale’s scores converges to suggest at least mild cognitive impairment (below 1.5 standard deviations [SDs] in some of the FrSBe scales), the clinician can complement the assessment by administering a brief battery of neuropsychological tests focused on those cognitive abilities with well-known implications for addiction treatment prognosis (Table). Response inhibition is measured with the Stroop test, the Wisconsin Card Sorting Test (WCST) is used to measure flexibility/perseveration, decision-making capacity is measured using the Iowa Gambling Task (IGT).14-16



The Stroop test measures response inhibition, and it is based on the interference effect driven by the demand of naming the color of a word that is printed in a color incongruent with the name (eg, the word blue printed in red).20 The test consists of 3 conditions. The first condition (W) presents the words red, blue, and green printed in black ink, and patients are requested to read aloud these words. The second condition (C) presents strings of XXX printed in the same 3 colors, and patients have to name the colors as quickly and accurately as possible. The third condition (WC) introduces the interference effect: the words red, blue, and green are printed in incongruent colors and patients have to name the color and ignore the word. The interference score (IS) is calculated by subtracting a weighted mean of the first 2 conditions from the third condition [IS = WC 2 (C 3 W)/(C + W)]; then results are compared with normative values to evaluate the degree of impairment.

The WCST21 is a measure of flexibility to change. It measures response patterns in the face of changing schedules of reinforcement. The clinician presents 4 stimulus cards; the sh apes on the cards differ in color, quantity, and design. The patient is given a stack of 64 cards that he has to sort according to initially unknown criteria. However, the examiner knows the criteria (the fi

Breaking the Cycle of Substance Abuse and Addiction: Focus on Management Strategies

Approaching Crossroads in Psychiatry: Eating Disorders, Suicide and Substance Abuse

More Addiction CME






 

Frank Lloyd Wright’s famous house: A River Runs Through It

A River Runs Through It

One of the most famous and beloved houses in the country has not survived without a struggle.

BY: Renee Valois 

June 09, 2009

From the very beginning, Fallingwater made a huge splash in the world of architecture. In 2000 the American Institute of Architects voted it the Building of the Century. But Frank Lloyd Wright’s famous house did not always look like it would last through the century.

The house remains as unique today as when it was designed in 1935. But the very originality that made Fallingwater so beloved has also endangered it.

When department store magnate Edgar J. Kaufmann commissioned Wright to design a country house for him on the Bear Run stream on forested mountain property in western Pennsylvania, he expected Wright to build a retreat with a view of the waterfall his family loved. He did not anticipate a house built right on top of the river—incorporating the very boulders upon which the family enjoyed basking.

Legend has it that the design for Fallingwater spewed out of Wright in one frantic session. It started one morning in September 1935, when Kaufmann called Wright to inform him that he was in Milwaukee, about to drive up to Taliesin (Wright’s home and studio in his childhood town of Spring Green, Wis.) to see Wright’s designs. Kaufmann had been waiting impatiently for months. Wright replied “Come along, E.J. We’re ready for you,” implying that the plans were finished. In reality, Wright had not even begun to work on the designs—at least on paper.

As his apprentices Edgar Tafel and Bob Mosher later recalled, Wright talked to himself as he laid out plans for the house. “Liliane and E.J. will have tea on the balcony . . . The rock on which E.J. sits will be the hearth, coming right out of the floor, the fire burning just behind it . . .” He kept his two assistants sharpening the colored pencils he rapidly used up. The plans, elevations, and sections were finished just in time for Kaufmann’s arrival.

Fallingwater comprises a series of concrete levels anchored in rock. It is so integrated into the landscape that the huge boulder Wright envisioned actually protrudes through the floor of the living room. Multilevel platforms and balconies mimic the natural ledges of the falls, and stone quarried from the area enhances the organic look. The cantilevered house projects over the river, and steps from the living room lead right down to the water.

The spectacle of breathtaking architecture enfolded in a beautiful forest stream has drawn visitors from around the world. In 1963 Edgar Kaufmann Jr., who was instrumental in his father’s original decision to hire Wright, gave Fallingwater and its acreage to the public in care of the Western Pennsylvania Conservancy as a memorial to his parents. Today, 135,000 people visit annually.

But peaceful surroundings belie the danger Fallingwater has endured through the decades. In 1956 a tornado hit, and Edgar Jr. wrote, “The house was being racked . . . The main stairs . . . carried a cascade from the hillside behind the house. Ankle deep in water, we looked over an alien lake obliterating the glen and shoving restlessly against glass doors, while the wind howled and the rain poured down in wild sheets . . . The next morning we awoke to a house thick with sludge. The banks of Bear Run were ravaged . . . smaller boulders were swept away, trees were down . . . Two bronze statues, set outdoors near the house, had disappeared.”

Fallingwater came through the terrible storm structurally intact, and the mud and drowned snakes were cleaned out, but nagging problems have resurfaced through the years.

When the house was built, many engineers feared the cantilevers that supported the floors would eventually collapse—or the river would cause the house to disintegrate. Indeed, the cantilevers sagged so much over time, and moisture damage was so pervasive, that in 1999 a plan was formulated to resolve both issues. In 2002 the cantilevers were stabilized with post-tensioning, using high-strength steel cables buried inside the floors.

Lynda Waggoner, director of Fallingwater, says water damage had warped doors, peeled paint, and caused stains and cracks in walls, creating problems that rivaled the sagging cantilevers in importance. Fortunately, advances in modern technology have made it possible to completely waterproof the building.

However, Waggoner says that, just as with any home, one might put a new roof on, but then something else needs to be replaced—there are always new issues. She says that although the original glass was replaced with UV-filtering laminate glass in 1987, it’s beginning to fail. Also, it has always been difficult to get paint to adhere to the building because Fallingwater has a lot of horizontal surfaces.

Waggoner says it’s difficult to ask fans of preservation for more money after the big capital campaign that recently funded the extensive structural and waterproofing work.

But the physical poetry of Fallingwater will surely ensure its preservation. As Waggoner says, “It’s one of our national treasures. It’s the most famous modern house museum on the planet. Few houses speak to a whole host of people. But you don’t have to be an architectural aficionado to love Fallingwater.”

Renee Valois wrote about Civil War battle relics in the September/October 2006 issue of the magazine.

Source:
A River Runs Through It The History Channel Club

http://www.thehistorychannelclub.com/articles/articletype/articleview/articleid/204/a-river-runs-through-it