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Home Tags Brain
Tag: Brain
The set point: how your brain keeps you from gaining or...
Mauricio Luque - April 26, 2021 0
You may have on many occasions embarked on a diet with the goal of gaining or losing weight, but, after failing to do so...
Four free Android games to train your brain
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A monkey playing Pong is the first demonstration of Neuralink, Elon...
Mauricio Luque - April 9, 2021 0
Neuralink aims to connect brains and computers. It is Elon Musk's latest project and we know less about it. After several years of tests...
How the brain comprehends the meaning of a spoken sentence?
Theresa Taboada/Press releases - April 5, 2021 0
New research involving neuroimaging and AI describes the complex network within the brain that comprehends the meaning of a spoken sentence. "It has been unclear...
People with Alzheimer's forget the way to back home. Yes, but...
Theresa Taboada/Press releases - July 24, 2020 0
Disruption of normal brain network function in hippocampus cells may explain loss of spatial memory in people with Alzheimer's disease, according to a new...
Why do you make worse decisions when you're stressed?
Stress can hinder our ability to develop informed plans by preventing us from being able to make decisions based on memory, researchers report. "We draw...
Sleep deprivation promotes the development of Alzheimer's disease
The first study shows that different forms of a key Alzheimer's protein known as tau arise in a predictable sequence as the disease develops,...
Why you should take out time for solving a jigsaw puzzle...
webmaster - May 24, 2018 0
The kind of world that we are living in today has put the human life on a roller coaster ride. Regardless of age group,...
Your brain is indeed the master of every single organ
Human brain is the most complicated creation which hasn't been completely sorted out yet. It is the most intriguing and mysterious part and can...
Can meditation replace sleep?
webmaster - November 20, 2017 0
Meditation has been much vaunted recently. Big names like Katy Perry, Madonna, and Hugh Jackman all sing its praises, as do the millions of...
Sony to manufacture more PS4s due to PS5 shortage


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1.
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WOULD WE EXPECT THE PERFORMANCE OF A FLEXIBLE STATISTICAL LEARNING METHOD TO BE BETTER
OR WORSE THAN AN INFLEXIBLE METHOD.

-- Flexible models can estimate more possible shapes of f

-- Inflexible models make up front assumptions about the shape of f eg f is linear

(a) If the sample size n is extremely large and the number of predictors p is small
then:

The performance of a flexible statistical learning model will generally be a better choice when a sample size n is large. Flexible statistical learning methods require a large number of observations to perform well. The reason behind this, is flexible statistical learning methods do not make explicit assumptions about the functional form of f. They instead attempt to accurately produce an estimate of f, that is as close the observed data as possible. As the number of observations grow, the more accurate the estimation of f becomes.
The benefit of estimating f, opposed to explicitly making an assumption about the form of f, is that flexible statistical learning methods have the potential to fit question <- 'What is our prediction with k=1? why?'

clses <- as.factor(c('RED', 'GREEN'))

knn(c(0,0,0), c(0,3,0), cl = clses, k=1)

a wider range of possible shapes of f.
Inflexible statistical learning methods explicitly assume the form of f, eg f is linear and so an inflexible statistical learning method, will usually not match the true form of f. The result of this can be the model we chose is to far from the true f and so our
predictions will be poor.

(b) If the number of predictors p is extremely large and the number of observations n
is small then:

The performance of an inflexible statistical learning model will generally be a better
choice when the number of predictors p is large and the number of observations n is
small. Inflexible statistical learning models make an up front assumption about f
ie f is linear. Given we have such a small number of observations, assuming linearality means f will never be to far from the true f. Assuming f is linear means the response variable and the predictors have a linear relationship and the entire fitting problem comes down to estimating p+1 coefficients.

(c) If the relationship between the predictors and the response is highly non-linear then:

In this instance, the performance of a more flexible model would be better than a less flexible models performance. This is because an inflexible model, such as the linear
regression model, can only generate linear functions. Inflexible models, such as thin-plate
splines, can estimate multiple different forms for f. A generalised additive model (GAM) is
an extension of a more restrictive linear model, which allows for certain non-linear
relationships. GAM's lie in the middle ground between flexible and inflexible models.

(d) The variance of the error terms, i.e. σ2 = Var(ε), is extremely high.

Variance relates to how much an estimate of f would change if we estimated it using a
different set of training data. Different training data sets will result in different
estimates for f. Ideally the estimate for f should not vary to much between training sets.
Given this, a less flexible model would be more appropriate as more flexible models have
higher variance. This would mean small changes in the training data could result in large
changes in the estimate of f. Flexible models having a high variance shows that, given their
generally close relationship to the true shape of f, changing any of the predictions would
result in considerable changes to any estimate of f.

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2.
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WHICH IS A CLASSIFICATION PROBLEM AN WHICH IS A REGRESSION PROBLEM EXPLAINING WHETHER WE
ARE MOST INTERESTED IN INFERENCE OR PREDICTION.

REGRESSION - estimating or predicting a response (response variable takes continuous values)

CLASSIFICATION - identifying group membership (response variable takes class labels)

(a) If we collect a set of data on the top 500 firms in the US. If for each firm we recorded
profit, number of employees, industry and the CEO salary. If we are interested in
understanding which factors affect CEO salary then this would classify as a regression problem
as we are interested in how the predictors: profit, number of employees and industry effect
the response variable CEO salary. We are most interested in inference as we are not
wanting to predict the response, but measure how the response changes as a function
of the predictors eg what effect would changes in profit (predictor) have on CEO salary
(response).

(b) If we are considering launching a new product and wish to know whether it will be a
success or a failure. If we collect data on 20 similar products that were previously launched.
If for each product we have recorded whether it was a success or failure, price charged for
the product, marketing budget, competition price, and ten other variables then this would
classify as a classification problem since we are interested in a binary respone eg success or
failure. We are most interested in inference as we are interested in obtaining an
understanding of the relationship between the predictors from similar, previously launched
products and the new products predictors eg how much more successful was the previous product
when price charged increased by 2%.

(c) If we are interested in predicting the % change in the US dollar in relation to the
weekly changes in the world stock markets. Hence we collect weekly data for all of 2012. For
each week we record the % change in the dollar, the % change in the US market, the % change in
the British market, and the % change in the German market then this would clasify as a
regression problem as we are interested in predicting the response variable (% change ins US
dollar). We are most interested in both inference and prediction. Initial questions may be
"how does the % change in the British market effect the % change in the US mrket?" this
inference. Predicting the % change in the US dollar in relation changes in the world markets
is prediction.

5.
What are the advantages and disadvantages of a very flexible (versus a less flexible)
approach for regression or classification?

Advantages of flexible models are:
They avoid an assumption of being of a particular functional form of f, but instead seek an
estimate of f that gets as close to the data points as possible

Can fit many different shapes of f opposed to a non-parametric approach making an up front
assumption of f being linear etc

Disadvantages of flexible models are:
They require a greater number of observations in order do produce an accurate estimate of f
The possibility of overfittig which results in inacurate estimates on new observations

Advantages of less flexible models are:
Since we make an up front assumption about the functional form of f, we do not need to
estimate an entire p dimentional function, we only need to estimate p+1 coefficients

The model we choose will usually not match the true unknown form of f. This can result in
poor predictions if the model we chose is to far from the true form of f

Under what circumstances might a more flexible approach be preferred to a less flexible
approach? A less flexible model is more appropriate when we want to achieve more accurate predictions, although this may not always be the case if overfitting occurs

When might a less flexible approach be preferred? If we are only interested in inference then
a less flexible model is preferred as they are more interpretable eg much easier to
understand the relationship between Y and X1, X2, ... Xp where in an inflexible model the
estimates for f can be very complicated

6.
What are the differences between a parametric and a non-parametric statistical learning
approach? The differences are that parametric approaches involve a two step model based
approach where we firstly make an up front assumpotion about the functional form of f
eg f is linear in X and secondly use the training data to fit or train the model. For
non-parametric approaches do not make up front assumptions about the functional form of f in
X, instead they seek to estimate f, that is produce a fit that is as close to the data points
as possible without being to rough or wiggly.

What are the advantages of a para-metric approach to regression or classification
(as opposed to a non- parametric approach)? The advantages of parametric approaches are
that the model fitting procedure is simplified down to estimating a set of parameters. This
makes such models easier to interperet the relationship between parameters, making
non-parametric models a good choice for doing inference. The advantages of parametric
approaches are that they can fit a wider range of shapes of f due to not making any up front
assumptions. This flexibility can yield much more accurate predictions so long as we do not
over fit the model.

What are their disadvantages? Disadvantages of a parametric approach to model fitting are
that since they make an up front assumption abount the shape of f, it is likely the shape of
f in the parametric model will not match the true unknown form of f. If this is the case, our
estimates will be poor. The disadvantages of a non-parametric approach to model fitting are
that, since we are estimating f, we need a large number of observations in order to obtain an
accurate result. This makes non-parametric models not a good choice for inference since we
would want to know how parameters relate. Non-parametric approaches also have the possiblity
of being over fitted.

7.

(a) Compute the Euclidean distance between each observation and test point X1=X2=X3=0

observation 1 [RED]: distance = 3
observation 2 [RED]: distance = 2
observation 3 [RED]: distance = 3.162
observation 4 [GREEN]: distance = 2.236
observation 5 [GREEN]: distance = 1.414
observation 6 [RED]: distance = 1.732

(b) What is our prediction with k=1? why?

When k=1 this means we find only the closest point to the point we are currently trying to
classify. Given this we can see the closest point is observation 4 at 1.414 which means
if k=1 our prediction is feature vector 1 that is GREEN

(c) What is our prediction when k=3? Why?

When k=3 this means we find the points that are closest to the point xi we are trying to
classify. Which ever set of feature vectors (points) has the most closest points
(in this case closest 2 points) then this is the set in which xi will be composed. The 3
closest feature vectors are 4, 5 and 6. This means we have two [GREEN] and one [RED] meaning
our prediction for xi is [GREEN]

(d) If the Bayes decision boundary in this problem is highly non-linear, then would we expect the best value for k to be large?.. or small? why? The higher K is the closer the decision boundary is to being linear. Lower K gives more complex / irregular decision boundaries.

redpajama_set_name: RedPajamaGithub


Although this project is in its early stages, its successes thus far have been promising. Notably, these two institutions hosted a summer workshop to discuss and debate best teaching practices using digital technologies. Participants benefited from hearing the viewpoints of faculty members at both a research-centered and a teaching-focused institutions and arranged to implement changes into their curriculum based on these discussions.
This presentation, therefore, will trace the effectiveness of the University of Iowa and Grinnell College's collaboration by collecting and analyzing feedback from institute participants. It will also discuss future plans for the partnership, particularly the additional collaborations that occur throughout the beginning of the fall semester. In doing so, it seeks to propose a model for successful future collaborations between research and teaching institutions of higher education.


If you own a business space, it is your responsibility to keep it clean and maintained. A clean office space can bring a number of benefits to you and your business – it can boost the morale of your employees and attract potential customers and clients.
Sometimes, we are so engross on keeping the interiors of our workspace clean that we often forget the exteriors. The outside look of your office is important on building a good impression to your visitors. It will serve as your business ID as well. If the visitors find it unclean and unkempt, you will be having a hard time to convince them on the legitimacy of your business. So pay attention to your façade and get the best facade cleaning services in Dubai to help you will the upkeep.
Upon entering your business premises, visitor will focus their eyes on your walls. Aside from putting elegant decors on the wall, be sure that it is clean and free of dust or embellishments. Have your cleaning service provider clean them on a regular basis to maintain its appearance. If you see some cracks, get a contractor to fix it before the damage is too late to fix.
One of the dirtiest part of any establishment or space is the floors. Usually, shoe impressions and dirt gather on the floors making it look dirty and filthy. And it is not a pretty sight. Have you cleaner do some sweeping on the floors three times a day to get the dust off and schedule a regular floor cleaning (once a month is ideal) to remove the hard-to-clean dirt on the flooring. Depending on the material (tiles, wood, cement, etc.) have the scrubbed and shined to make it pleasant to look at.
Corners and hidden spaces are one of the most forgotten places to clean. When you do a major cleaning on your office space, sweep the whole place including the corners. There might be dust gathering on the corners and it might cause major respiratory ailments and allergies. Remind your cleaners to clean them as well.
Uncleaned air vents can be harmful to you and to your employees. Conduct a regular inspection and have them cleaned at least once a month. If you see any damage on your vent, have them repaired or replaced.
Visit our website for more cleaning tips and hacks.


text:
The Book Adept
Readers' advisory and all things bookish
I haven't read a book by John Grisham for many years, and my reading was mostly restricted to his legal thrillers (not being a fan of baseball, his other main focus), which I enjoyed quite a lot, particularly A Time to Kill and Runaway Jury. Honestly, when it comes to those kinds of books, he is as much of a screenwriter as a novelist, because they are so aptly suited for the visual medium. I have enjoyed both reading and watching them.
In recent years, it seems like he has been trying to expand his repertoire (or soften his image?) to include other kinds of fiction—A Painted House, Playing for Pizza, Skipping Christmas, and this one I just finished, Camino Island. I'm not sure that these efforts have been entirely successful; while these books have all been pleasant, interesting, and well written, they don't seem to me to have the snap of his legal dramas.
This book is billed as a "heist" novel, but although the theft of five original manuscripts written by F. Scott Fitzgerald from Princeton University is detailed in the first part of the book, there isn't much excitement surrounding it. The heist planning was interesting, but because it was all done undercover, so to speak, with distraction rather than direct action enabling the crew to pull it off, it wasn't all that gripping.
Then there are not one but two abrupt shifts in the book—one to a bookstore owner and his history as a bookseller, and the other to a broke, blocked writer trying to figure out how she's going to survive. These are initially confusing, until you realize that both these people are going to have some role in the further history of the heist.
Bruce Cable has a bookstore on Camino Island, in Florida, and the tracing of certain industry connections of his has led the insurance company to conclude that he may know something about the missing manuscripts that the company will be expected to pay out on if they aren't located and returned to Princeton. The company hires an unnamed investigative entity who in turn hires Mercer Mann, a writer who had some success with her first novel, but is now blocked on her second and has just been let go from her teaching job. Mercer has ties to the island (her grandmother lived there and she visited every summer as a child), so the investigators feel it will seem natural for her to "infiltrate" by staying at her grandmother's cottage, ostensibly to write, and inserting herself into the local literary scene at the bookstore. They hope that by doing so, she can discover whether there is any truth to the rumors about the manuscripts being linked to Bruce Cable.
I most enjoyed the evolution of the bookstore, with all the details involved; I hadn't picked up this book specifically because it was about books and reading, but luck took me there, and I always like to hear about the set-up, philosophy, and day-to-day business practices of bookstores and their owners.
I least enjoyed the character Mercer (the young woman writer), who whined a lot about not being able to write but didn't actually seem to be trying that hard amidst all her other distractions.
A little excitement comes back into the book when the FBI and the insurance company catch some of the thieves and it seems that Mercer's rather flat-footed undercover work with Bruce Cable may actually lead to one or more of the stolen manuscripts being located. But the ending itself was rather a sterile wrap-up. I suppose everything was resolved adequately, but again, not particularly excitingly.
It was a pleasant read, but not a gripping one, and definitely not my favorite of Grisham's.
I was somewhat embarrassed to discover that while I've been ignoring his recent adult works, I also apparently missed that he's been writing a series for young teens about a 13-year-old lawyer, Theodore Boone. These sound like books I could promote to reluctant young male readers; I'll have to read one and see!
Category: SuspenseTags: Books about books, Stand-alone
← Discussing appeals
A feast →
Melissa Elliott
thebookadept@gmail.com
Consultant to libraries for readers' advisory services, book-talking training, young adult literature and programming.
Hiatus, nostalgia, TV January 29, 2023
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text:
Are Podcasts Poised to Break Into Advertising Mainstream?
Popular Crime Show 'Serial' Has Piqued Interest, But Measurement Is Hurdle
By Max Willens. Published on November 21, 2014.
This fall, one of the most talked-about shows on Thursday has been a podcast.
The show, called "Serial," tells the story of a reporter named Sarah Koenig trying to make sense of the case of Adnan Syed, a second-generation immigrant serving a life sentence after being convicted of murdering his ex-girlfriend while still in high school.
Since launching just over two months ago, "Serial" has been written up everywhere from The New Yorker to The Guardian. It has spawned a parody podcast, "The Serial Serial" and two separate podcasts devoted solely to analyzing and discussing the action that unfolds on each episode. More importantly, the hubbub surrounding "Serial" has been driving advertiser interest in the medium it was made for.
Once regarded as a fringe add-on to large digital campaigns, podcasts are now regarded a play for brands seeking to reach well-educated, tech-savvy consumers.
"It's five times as effective as buying one website," said Mike McLaughlin, the director-digital at Palisades MediaGroup. "In the past, we'd buy NPR and maybe they'd throw in a podcast. Now we go and say, 'We want five of your best podcasts, and we'll take one of your websites as a throw-in.'"
Though podcast stars have been blips on the mainstream-media radar before–Marc Maron, the host of a popular podcast called "WTF," garnered some media attention when cable channel IFC gave him his own scripted show several years ago – agency players like Mr. McLaughlin say that "Serial" is getting a level of attention no show has since.
"I'd say it's a gamechanger," Mr. McLaughlin said of the show's surging popularity. "I hate using that word, but it really is."
A big hit with direct response
Direct-response marketers have been aware of the power of podcasts for years. Podcast advertising companies like Midroll Media first attracted the interest of direct-response brands like Stamps.com and Warby Parker. Show hosts would read ads that included show-specific promotional codes, and sponsors would measure results in customers acquired or sales generated.
"The return was immediate and measurable," said Adam Sachs, CEO of Midroll.
Finally hitting scale
But mainstream attention and direct-response success are just part of the equation. After many years of steady growth, podcasting is finally able to offer opportunities at scale to advertisers. Just nine episodes into its existence, "Serial" has been downloaded more than five million times from the iTunes Store, the fastest any podcast has hit this mark, according to a statement released by Apple. Established shows, like Leo Laporte's "This Week in Tech," are downloaded more than five million times a month.
Mr. Sachs said his company has been getting more and more RFPs from major media agencies in the past few months. Midroll offers more than 150 podcasts exclusively, including shows like "WTF," Slate.com's Gabfests and Dan Savage's "Savage Lovecast," and the company said users will download more than 900 million episodes of its shows this year.
Over the summer, Edison Research conducted a "Share of Ear" study that concluded nearly 13 million Americans listen to a podcast every day, and more than 39 million listen to at least one per month. Those listeners, Edison Research concluded, spend nearly as much time listening to podcasts as they do terrestrial radio.
"Some of these shows have these rabid audiences," Mr. Sachs said.
A near-native format
Podcast ads differ from the ads typically found in other digital media. Unlike video ads, which can be inserted at various junctures by third parties, podcast ads are embedded in the sound files themselves, which users tend to download onto their phones rather than stream in real time.
"We don't yet have the same data that Pandora has for their listeners," Mr. Sachs said. "The industry as a whole understands that it's a shortcoming."
That lack of laser precision, however, is countered by qualities not found in most ad formats. Companies like Midroll and Archer Avenue sell ads that hosts read in the middle of the shows, often working from scripts that show hosts create themselves. Alex Blumberg, a former reporter on "This American Life" and the host of a podcast called "Startup," interviews representatives from the companies sponsoring his show. Roger Bennett and Michael Davis, the co-hosts of a popular soccer podcast called "Men in Blazers," spent the summer cracking open cans of Guinness before settling in to recap top soccer matches.
"It's not this annoying thing that a lot of advertising has become or has this perception of being," Palisades' Mr. McLaughlin said. "Many times it's actually entertaining. I've read many a tweet about people actually being sure to hear the ad."
One hindrance is the lack of measurement. Midroll's CEO Mr. Sachs says he's in talks with Nielsen and the Interactive Advertising Bureau about the prospect of setting industry standards. That will likely involve working with third parties including Apple, which now offers podcasting software preloaded on the latest version of iOS, and a number of other podcasting apps.
"If the IAB could bless a set of standards, that would go a long way for us," said Mr. Sachs.
But until that next step is taken, advertisers may be listening closely for a new opportunity. "It may be less measurable," Mr. McLaughlin said, "but I'm willing to accept less accountability on some level knowing there's all these other benefits."
CORRECTION: An earlier version of this article referred to the group IAB as the Internet Advertising Bureau. It is the Interactive Advertising Bureau.
Marketing News & Strategy


1.1.1.1 People with OCD or BDD are often ashamed and embarrassed by their condition and may find it very difficult to discuss their symptoms with healthcare professionals, friends, family or carers. Healthcare professionals should help patients, and their families or carers where appropriate, to understand the involuntary nature of the symptoms by providing accurate information in an appropriate format on current understanding of the disorders from psychological and/or biological perspectives.
1.1.1.2 When assessing people with OCD or BDD, healthcare professionals should sensitively explore the hidden distress and disability commonly associated with the disorders, providing explanation and information wherever necessary. In particular, people with OCD who are distressed by their obsessive thoughts should be informed that such thoughts are occasionally experienced by almost everybody, and when frequent and distressing are a typical feature of OCD.
1.1.2.1 OCD and BDD are frequently recurring or chronic conditions that often affect some of the most intimate aspects of a person's life. Healthcare professionals should therefore ensure continuity of care and minimise the need for multiple assessments by different healthcare professionals.
1.1.2.2 Because OCD and BDD may occur across a person's lifespan, particular care should be given to the provision of appropriate care at all ages and a seamless transition between services aimed at specific ages, such as the transition from services for young people to services for adults.
healthcare professionals should liaise with other professionals involved in providing care and support to the patient.
1.1.3.1 Treatment and care should take into account the individual needs and preferences of people with OCD or BDD. Patients should have the opportunity to make informed decisions about their care and treatment. Where patients do not have the capacity to make decisions, or children or young people are not old enough to do so, healthcare professionals should follow the Department of Health guidelines (Reference guide to consent for examination or treatment ).
1.1.3.2 Good communication between healthcare professionals and people with OCD or BDD is essential. Provision of information, treatment and care should be tailored to the needs of the individual, culturally appropriate, and provided in a form that is accessible to people who have additional needs, such as learning difficulties, physical or sensory disabilities, or limited competence in speaking or reading English.
1.1.3.3 Healthcare professionals should consider informing people with OCD or BDD and their family or carers about local self‑help and support groups, and encourage them to participate in such groups where appropriate.
1.1.4.1 Obsessive‑compulsive symptoms may sometimes involve a person's religion, such as religious obsessions and scrupulosity, or cultural practices. When the boundary between religious or cultural practice and obsessive‑compulsive symptoms is unclear, healthcare professionals should, with the patient's consent, consider seeking the advice and support of an appropriate religious or community leader to support the therapeutic process.
1.1.5.1 Because OCD and BDD often have an impact on families and carers, healthcare professionals should promote a collaborative approach with people with OCD or BDD and their family or carers, wherever this is appropriate and possible.
1.1.5.2 In the treatment and care of people with OCD or BDD, family members or carers should be provided with good information (both verbal and written) about the disorder, its likely causes, its course and its treatment.
1.1.5.3 Assessment and treatment plans for people with OCD or BDD should, where appropriate, involve relevant family members or carers. In some cases, particularly with children and young people, when the symptoms of OCD or BDD interfere with academic or workplace performance, it may be appropriate to liaise with professionals from these organisations. Assessment should include the impact of rituals and compulsions on others (in particular on dependent children) and the degree to which carers are involved in supporting or carrying out behaviours related to the disorder.
1.1.5.4 If dependent children are considered to be at risk of emotional, social or mental health problems as a result of the behaviour of a parent with OCD or BDD and/or the child's involvement in related activity, independent assessment of the child should be requested. If this is carried out, the parent should be kept informed at every stage of the assessment.
1.1.5.5 In the treatment of people with OCD or BDD, especially when the disorder is moderate to severe or chronic, an assessment of their carer's social, occupational and mental health needs should be offered.
The stepped‑care model draws attention to the different needs of people with OCD and BDD, depending on the characteristics of their disorder, their personal and social circumstances, their age, and the responses that are required from services. It provides a framework in which to organise the provision of services in order to identify and access the most effective interventions (see Figure 1).
The full guideline contains Figure 1.
Stepped care attempts to provide the most effective but least intrusive treatments appropriate to a person's needs. It assumes that the course of the disorder is monitored and referral to the appropriate level of care is made depending on the person's difficulties. Each step introduces additional interventions; the higher steps normally assume interventions in the previous step have been offered and/or attempted, but there are situations where an individual may be referred to any appropriate level. The guidance follows the steps in the figure.
Although the more common forms of OCD are likely to be recognised when people report symptoms, less common forms of OCD and many cases of BDD may remain unrecognised, sometimes for many years. Relatively few mental health professionals or GPs have expertise in the recognition, assessment, diagnosis and treatment of the less common forms of OCD and BDD.
1.3.1.1 Each PCT, mental healthcare trust and children's trust that provides mental health services should have access to a specialist OCD/BDD multidisciplinary team offering age‑appropriate care. This team would perform the following functions: increase the skills of mental health professionals in the assessment and evidence‑based treatment of people with OCD or BDD, provide high‑quality advice, understand family and developmental needs, and, when appropriate, conduct expert assessment and specialist cognitive‑behavioural and pharmacological treatment.
1.3.1.2 Specialist mental healthcare professionals in OCD or BDD should collaborate with local and national voluntary organisations to increase awareness and understanding of the disorders and improve access to high‑quality information about them. Such information should also be made available to primary and secondary healthcare professionals, and to professionals from other public services who may come into contact with people of any age with OCD or BDD.
1.3.1.3 Specialist OCD/BDD teams should collaborate with people with OCD or BDD and their families or carers to provide training for all mental health professionals, cosmetic surgeons and dermatology professionals.
1.4.1.1 For people known to be at higher risk of OCD (such as individuals with symptoms of depression, anxiety, alcohol or substance misuse, BDD or an eating disorder), or for people attending dermatology clinics, healthcare professionals should routinely consider and explore the possibility of comorbid OCD by asking direct questions about possible symptoms such as the following.
Is there any thought that keeps bothering you that you would like to get rid of but can not?
Are you concerned about putting things in a special order or are you very upset by mess?
1.4.1.2 In people who have been diagnosed with OCD, healthcare professionals should assess the risk of self‑harm and suicide, especially if they have also been diagnosed with depression. Part of the risk assessment should include the impact of their compulsive behaviours on themselves or others. Other comorbid conditions and psychosocial factors that may contribute to risk should also be considered.
1.4.1.3 If healthcare professionals are uncertain about the risks associated with intrusive sexual, aggressive or death‑related thoughts reported by people with OCD, they should consult mental health professionals with specific expertise in the assessment and management of OCD. These themes are common in people with OCD at any age, and are often misinterpreted as indicating risk.
1.4.2.1 For people known to be at higher risk of BDD (such as individuals with symptoms of depression, social phobia, alcohol or substance misuse, OCD or an eating disorder), or for people with mild disfigurements or blemishes who are seeking a cosmetic or dermatological procedure, healthcare professionals should routinely consider and explore the possibility of BDD.
1.4.2.2 In the assessment of people at higher risk of BDD, the following five questions should be asked to help identify individuals with BDD.
Does it make it hard to do your work or be with friends?
1.4.2.3 People with suspected or diagnosed BDD seeking cosmetic surgery or dermatological treatment should be assessed by a mental health professional with specific expertise in the management of BDD.
1.4.2.4 In people who have been diagnosed with BDD, healthcare professionals should assess the risk of self‑harm and suicide, especially if they have also been diagnosed with depression. Other comorbid conditions and psychosocial factors that may contribute to risk should also be considered.
1.4.2.5 All children and young people who have been diagnosed with BDD should be assessed for suicidal ideation and a full risk assessment should be carried out before treatment is undertaken. If risks are identified, all professionals involved in primary and secondary care should be informed and appropriate risk management strategies put into place.
1.4.2.6 Specialist mental health professionals in BDD should work in partnership with cosmetic surgeons and dermatologists to ensure that an agreed screening system is in place to accurately identify people with BDD and that agreed referral criteria have been established. They should help provide training opportunities for cosmetic surgeons and dermatologists to aid in the recognition of BDD.
Effective treatments for OCD and BDD should be offered at all levels of the healthcare system. The difference in the treatments at the higher levels will reflect increasing experience and expertise in the implementation of a limited range of therapeutic options. For many people, initial treatment may be best provided in primary care settings. However, people with more impaired functioning, higher levels of comorbidity, or poor response to initial treatment will require care from teams with greater levels of expertise and experience in the management of OCD/BDD.
Irrespective of the level of care, the following recommendations should be taken into account when selecting initial treatments for people with OCD or BDD. The specific recommendations on how to provide these treatments follow in the subsequent sections.
Regulatory authorities have identified that the use of SSRIs to treat depression in children and young people may be associated with the appearance of suicidal behaviour, self‑harm or hostility, particularly at the beginning of treatment. There is no clear evidence of an increased risk of self‑harm and suicidal thoughts in young adults aged 18 years or older. But individuals mature at different rates and young adults are at a higher background risk of suicidal behaviour than older adults. Hence, young adults treated with SSRIs should be closely monitored as a precautionary measure. The Committee on Safety of Medicine's Expert Working Group on SSRIs, at a meeting in February 2005, advised that it could not be ruled out that the risk of suicidal behaviour, hostility and other adverse reactions seen in the paediatric depression trials applies to use in children or young people in all indications. Consequently, the recommendations about the use of SSRIs for people of any age with OCD or BDD have taken account of the position of regulatory authorities.
The intensity of psychological treatment has been defined as the hours of therapist input per patient. By this definition, most group treatments are defined as low intensity treatment (less than 10 hours of therapist input per patient), although each patient may receive a much greater number of hours of therapy.
group CBT (including ERP) (note, the patient may be receiving more than 10 hours of therapy in this format).
1.5.1.2 Adults with OCD with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low intensity treatment has proved to be inadequate, should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.
1.5.1.3 Adults with OCD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.
1.5.1.4 Adults with OCD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP).
1.5.1.5 Adults with BDD with mild functional impairment should be offered a course of CBT (including ERP) that addresses key features of BDD in individual or group formats. The most appropriate format should be jointly decided by the patient and the healthcare professional.
1.5.1.6 Adults with BDD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive individual CBT (including ERP) that addresses key features of BDD.
1.5.1.7 Adults with BDD with severe functional impairment should be offered combined treatment with an SSRI and CBT (including ERP) that addresses key features of BDD.
1.5.1.8 For children and young people with OCD with mild functional impairment, guided self‑help may be considered in conjunction with support and information for the family or carers.
1.5.1.9 Children and young people with OCD with moderate to severe functional impairment, and those with OCD with mild functional impairment for whom guided self‑help has been ineffective or refused, should be offered CBT (including ERP) that involves the family or carers and is adapted to suit the developmental age of the child as the treatment of choice. Group or individual formats should be offered depending upon the preference of the child or young person and their family or carers.
1.5.1.10 All children and young people with BDD should be offered CBT (including ERP) that involves the family or carers and is adapted to suit the developmental age of the child or young person as first‑line treatment.
1.5.1.11 If psychological treatment is declined by children or young people with OCD or BDD and their families or carers, or they are unable to engage in treatment, an SSRI may be considered with specific arrangements for careful monitoring for adverse events.
1.5.1.12 The co‑existence of comorbid conditions, learning disorders, persisting psychosocial risk factors such as family discord, or the presence of parental mental health problems, may be factors if the child or young person's OCD or BDD is not responding to any treatment. Additional or alternative interventions for these aspects should be considered. The child or young person will still require evidence‑based treatments for his or her OCD or BDD.
1.5.2.1 All healthcare professionals offering psychological treatments to people of all ages with OCD or BDD should receive appropriate training in the interventions they are offering and receive ongoing clinical supervision in line with the recommendations in Organising and Delivering Psychological Therapies (Department of Health, 2004).
1.5.2.2 For adults with obsessive thoughts who do not have overt compulsions, CBT (including exposure to obsessive thoughts and response prevention of mental rituals and neutralising strategies) should be considered.
1.5.2.3 For adults with OCD, cognitive therapy adapted for OCD may be considered as an addition to ERP to enhance long‑term symptom reduction.
1.5.2.4 For adults with OCD living with their family or carers, involving a family member or carer as a co‑therapist in ERP should be considered where this is appropriate and acceptable to those involved.
1.5.2.5 For adults with OCD with more severe functional impairment who are housebound, unable or reluctant to attend a clinic, or have significant problems with hoarding, a period of home‑based treatment may be considered.
1.5.2.6 For adults with OCD with more severe functional impairment who are housebound and unable to undertake home‑based treatment because of the nature of their symptoms (such as contamination concerns or hoarding that prevents therapists' access to the patient's home), a period of CBT by telephone may be considered.
1.5.2.7 For adults with OCD who refuse or cannot engage with treatments that include ERP, individual cognitive therapy specifically adapted for OCD may be considered.
1.5.2.8 When adults with OCD request forms of psychological therapy other than cognitive and/or behavioural therapies as a specific treatment for OCD (such as psychoanalysis, transactional analysis, hypnosis, marital/couple therapy) they should be informed that there is as yet no convincing evidence for a clinically important effect of these treatments.
1.5.2.9 When family members or carers of people with OCD or BDD have become involved in compulsive behaviours, avoidance or reassurance seeking, treatment plans should help them reduce their involvement in these behaviours in a sensitive and supportive manner.
1.5.2.10 Adults with OCD or BDD with significant functional impairment may need access to appropriate support for travel and transport to allow them to attend for their treatment.
1.5.2.11 Towards the end of treatment, healthcare professionals should inform adults with OCD or BDD about how the principles learned can be applied to the same or other symptoms if they occur in the future.
Psychological treatments for children and young people should be collaborative and engage the family or carers. When using psychological treatments for children or young people, healthcare professionals should consider the wider context and other professionals involved with the individual. The recommendations on the use of psychological interventions for adults may also be considered, where appropriate.
offering one or more additional sessions if needed at review appointments after completion of CBT.
1.5.2.13 In the psychological treatment of children and young people with OCD or BDD, healthcare professionals should consider including rewards in order to enhance their motivation and reinforce desired behaviour changes.
Current published evidence suggests that SSRIs are effective in treating adults with OCD or BDD, although evidence for the latter is limited and less certain. However, SSRIs may increase the risk of suicidal thoughts and self‑harm in people with depression and in younger people. It is currently unclear whether there is an increased risk for people with OCD or BDD. Regulatory authorities recommend caution in the use of SSRIs until evidence for differential safety has been demonstrated.
taking medication should not be seen as a weakness.
1.5.3.2 Adults with OCD or BDD started on SSRIs who are not considered to be at increased risk of suicide or self‑harm should be monitored closely and seen on an appropriate and regular basis. The arrangements for monitoring should be agreed by the patient and the healthcare professional, and recorded in the notes.
1.5.3.3 Because of the potential increased risk of suicidal thoughts and self‑harm associated with the early stages of SSRI treatment, younger adults (younger than age 30 years) with OCD or BDD, or people with OCD or BDD with comorbid depression, or who are considered to be at an increased risk of suicide, should be carefully and frequently monitored by healthcare professionals. Where appropriate, other carers – as agreed by the patient and the healthcare professional – may also contribute to the monitoring until the risk is no longer considered significant. The arrangements for monitoring should be agreed by the patient and the healthcare professional, and recorded in the notes.
1.5.3.4 For adults with OCD or BDD at a high risk of suicide, a limited quantity of medication should be prescribed.
1.5.3.5 When adults with OCD or BDD, especially those with comorbid depression, are assessed to be at a high risk of suicide, the use of additional support such as more frequent direct contacts with primary care staff or telephone contacts should be considered, particularly during the first weeks of treatment.
1.5.3.6 For adults with OCD or BDD, particularly in the initial stages of SSRI treatment, healthcare professionals should actively seek out signs of akathisia or restlessness, suicidal ideation and increased anxiety and agitation. They should also advise patients to seek help promptly if symptoms are at all distressing.
1.5.3.7 Adults with OCD or BDD should be monitored around the time of dose changes for any new symptoms or worsening of their condition.
1.5.3.8 For adults with OCD, the initial pharmacological treatment should be one of the following SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram.
1.5.3.9 For adults with BDD (including those with beliefs of delusional intensity), the initial pharmacological treatment should be fluoxetine because there is more evidence for its effectiveness in BDD than there is for other SSRIs.
1.5.3.10 In the event that an adult with OCD or BDD develops marked and/or prolonged akathisia, restlessness or agitation while taking an SSRI, the use of the drug should be reviewed. If the patient prefers, the drug should be changed to a different SSRI.
1.5.3.11 Healthcare professionals should be aware of the increased risk of drug interactions when prescribing an SSRI to adults with OCD or BDD who are taking other medications.
1.5.3.12 For adults with OCD or BDD, if there has been no response to a full course of treatment with an SSRI, healthcare professionals should check that the patient has taken the drug regularly and in the prescribed dose and that there is no interference from alcohol or substance use.
1.5.3.13 For adults with OCD or BDD, if there has not been an adequate response to a standard dose of an SSRI, and there are no significant side effects after 4–6 weeks, a gradual increase in dose should be considered in line with the schedule suggested by the Summary of Product Characteristics.
1.5.3.14 For adults with OCD or BDD, the rate at which the dose of an SSRI should be increased should take into account therapeutic response, adverse effects and patient preference. Patients should be warned about, and monitored for, the emergence of side effects during dose increases.
1.5.3.15 If treatment for OCD or BDD with an SSRI is effective, it should be continued for at least 12 months to prevent relapse and allow for further improvements.
1.5.3.16 When an adult with OCD or BDD has taken an SSRI for 12 months after remission (symptoms are not clinically significant and the person is fully functioning for at least 12 weeks), healthcare professionals should review with the patient the need for continued treatment. This review should consider the severity and duration of the initial illness, the number of previous episodes, the presence of residual symptoms, and concurrent psychosocial difficulties.
1.5.3.17 If treatment for OCD or BDD with an SSRI is continued for an extended period beyond 12 months after remission (symptoms are not clinically significant and the person is fully functioning for at least 12 weeks), the need for continuation should be reviewed at regular intervals, agreed between the patient and the prescriber, and written in the notes.
1.5.3.18 For adults with OCD or BDD, to minimise discontinuation/withdrawal symptoms when reducing or stopping SSRIs, the dose should be tapered gradually over several weeks according to the person's need. The rate of reduction should take into account the starting dose, the drug half‑life and particular profiles of adverse effects.
1.5.3.19 Healthcare professionals should encourage adults with OCD or BDD who are discontinuing SSRI treatment to seek advice if they experience significant discontinuation/withdrawal symptoms.
anxiolytics (except cautiously for short periods to counter the early activation of SSRIs).
1.5.3.21 Antipsychotics as a monotherapy should not normally be used for treating OCD.
1.5.3.22 Antipsychotics as a monotherapy should not normally be used for treating BDD (including beliefs of delusional intensity).
If initial treatment does not result in a clinically significant improvement in both symptoms and functioning, other treatment options should be considered. When additional treatment options also fail to produce an adequate response, multidisciplinary teams with specific expertise in OCD/BDD should become involved. Their role should include supporting and collaborating with those professionals already involved in an individual's care.
1.5.4.1 For adults with OCD or BDD, if there has not been an adequate response to treatment with an SSRI alone (within 12 weeks) or CBT (including ERP) alone (more than 10 therapist hours per patient), a multidisciplinary review should be carried out.
1.5.4.2 Following multidisciplinary review, for adults with OCD or BDD, if there has not been an adequate response to treatment with an SSRI alone (within 12 weeks) or CBT (including ERP) alone (more than 10 therapist hours per patient), combined treatment with CBT (including ERP) and an SSRI should be offered.
1.5.4.3 For adults with OCD or BDD, if there has not been an adequate response after 12 weeks of combined treatment with CBT (including ERP) and an SSRI, or there has been no response to an SSRI alone, or the patient has not engaged with CBT, a different SSRI or clomipramine should be offered.
1.5.4.4 Clomipramine should be considered in the treatment of adults with OCD or BDD after an adequate trial of at least one SSRI has been ineffective or poorly tolerated, if the patient prefers clomipramine or has had a previous good response to it.
1.5.4.5 For adults with OCD or BDD, if there has been no response to a full trial of at least one SSRI alone, a full trial of combined treatment with CBT (including ERP) and an SSRI, and a full trial of clomipramine alone, the patient should be referred to a multidisciplinary team with specific expertise in the treatment of OCD/BDD for assessment and further treatment planning.
1.5.4.6 The assessment of adults with OCD or BDD referred to multidisciplinary teams with specific expertise in OCD/BDD should include a comprehensive assessment of their symptom profile, previous pharmacological and psychological treatment history, adherence to prescribed medication, history of side effects, comorbid conditions such as depression, suicide risk, psychosocial stressors, relationship with family and/or carers and personality factors.
adding buspirone to an SSRI.
1.5.4.9 For adults with BDD, if there has been no response to treatment, or the patient is not receiving appropriate treatment, more intensive monitoring is needed because the risk of suicide is high in people with BDD.
1.5.4.10 Treatments such as combined antidepressants and antipsychotic augmentation should not be routinely initiated in primary care.
1.5.4.11 For adults with OCD or BDD who are at a significant risk of suicide, healthcare professionals should only prescribe small amounts of clomipramine at a time because of its toxicity in overdose. The patient should be monitored regularly until the risk of suicide has subsided.
1.5.4.12 An electrocardiogram (ECG) should be carried out and a blood pressure measurement taken before prescribing clomipramine for adults with OCD or BDD at significant risk of cardiovascular disease.
1.5.4.13 For adults with OCD or BDD, if there has not been an adequate response to the standard dose of clomipramine, and there are no significant side effects, a gradual increase in dose should be considered in line with the schedule suggested by the Summary of Product Characteristics.
1.5.4.14 For adults with OCD or BDD, treatment with clomipramine should be continued for at least 12 months if it appears to be effective and because there may be further improvement.
1.5.4.15 For adults with OCD or BDD, when discontinuing clomipramine, doses should be reduced gradually in order to minimise potential discontinuation/withdrawal symptoms.
Current published evidence suggests that SSRIs are effective in treating children and young people with OCD. The only SSRIs licensed for use in children and young people with OCD are fluvoxamine and sertraline. When used as a treatment for depression, SSRIs can cause significant adverse reactions, including increased suicidal thoughts and risk of self‑harm, but it is not known whether this same risk occurs with their use in OCD. SSRIs may be safer in depression when combined with psychological treatments (see the NICE guideline on depression in children and young people). Given that the UK regulatory authority has advised that similar adverse reactions cannot be ruled out in OCD, appropriate caution should be observed, especially in the presence of comorbid depression.
1.5.5.1 For a child or young person with OCD or BDD, if there has not been an adequate response within 12 weeks to a full trial of CBT (including ERP) involving the family or carers, a multidisciplinary review should be carried out.
1.5.5.2 Following multidisciplinary review, for a child (aged 8–11 years) with OCD or BDD with moderate to severe functional impairment, if there has not been an adequate response to CBT (including ERP) involving the family or carers, the addition of an SSRI to ongoing psychological treatment may be considered. Careful monitoring should be undertaken, particularly at the beginning of treatment.
1.5.5.3 Following multidisciplinary review, for a young person (aged 12–18 years) with OCD or BDD with moderate to severe functional impairment, if there has not been an adequate response to CBT (including ERP) involving the family or carers, the addition of an SSRI to ongoing psychological treatment should be offered. Careful monitoring should be undertaken, particularly at the beginning of treatment.
1.5.5.4 For a child or a young person with OCD or BDD, if treatment with an SSRI in combination with CBT (including ERP) involving the family or carers is unsuccessful or is not tolerated because of side effects, the use of another SSRI or clomipramine with careful monitoring may be considered, especially if the child or young person has had a positive response to these alternatives in the past. This should also be in combination with CBT (including ERP).
In adults with OCD treated by medication, there is some clinical trial evidence regarding the onset of therapeutic response, the dose needed, the rate of increase of dose, the duration of treatment and the likelihood of relapse on discontinuation. Trials of these aspects have not been done in children and/or young people, but the following good practice for prescribing SSRIs or clomipramine is based on adult trials and clinical experience.
1.5.6.1 An SSRI should only be prescribed to children and young people with OCD or BDD following assessment and diagnosis by a child and adolescent psychiatrist who should also be involved in decisions about dose changes and discontinuation.
1.5.6.2 When an SSRI is prescribed to children and young people with OCD or BDD, it should be in combination with concurrent CBT (including ERP). If children and young people are unable to engage with concurrent CBT, specific arrangements should be made for careful monitoring of adverse events and these arrangements should be recorded in the notes.
1.5.6.3 Children and young people with OCD or BDD starting treatment with SSRIs should be carefully and frequently monitored and seen on an appropriate and regular basis. This should be agreed by the patient, his or her family or carers and the healthcare professional, and recorded in the notes.
1.5.6.4 A licensed medication (sertraline or fluvoxamine) should be used when an SSRI is prescribed to children and young people with OCD, except in patients with significant comorbid depression when fluoxetine should be used, because of current regulatory requirements.
1.5.6.5 Fluoxetine should be used when an SSRI is prescribed to children and young people with BDD.
1.5.6.6 For children and young people with OCD or BDD who also have significant depression, the NICE recommendations for the treatment of childhood depression should be followed and there should be specific monitoring for suicidal thoughts or behaviours.
1.5.6.7 Children and young people with OCD or BDD starting treatment with SSRIs should be informed about the rationale for the drug treatment, the delay in onset of therapeutic response (up to 12 weeks), the time course of treatment, the possible side effects and the need to take the medication as prescribed. Discussion of these issues should be supplemented by written information appropriate to the needs of the child or young person and their family or carers.
1.5.6.8 The starting dose of medication for children and young people with OCD or BDD should be low, especially in younger children. A half or quarter of the normal starting dose may be considered for the first week.
1.5.6.9 If a lower dose of medication for children and young people with OCD or BDD is ineffective, the dose should be increased until a therapeutic response is obtained, with careful and close monitoring for adverse events. The rate of increase should be gradual and should take into account the delay in therapeutic response (up to 12 weeks) and the age of the patient. Maximum recommended doses for children and young people should not be exceeded.
1.5.6.10 Children and young people prescribed an SSRI, and their families or carers, should be informed by the prescribing doctor about the possible appearance of suicidal behaviour, self‑harm or hostility, particularly at the beginning of treatment. They should be advised that if there is any sign of new symptoms of these kinds, they should make urgent contact with their medical practitioner.
1.5.6.11 Where children or young people with OCD or BDD respond to treatment with an SSRI, medication should be continued for at least 6 months post‑remission (that is, symptoms are not clinically significant and the child or young person is fully functioning for at least 12 weeks).
1.5.6.12 Children and young people with OCD or BDD and their families or carers should be advised about the possible side effects of clomipramine, including toxicity in overdose.
1.5.6.13 Before starting treatment with clomipramine in children and young people with OCD or BDD, an ECG should be carried out to exclude cardiac conduction abnormalities.
1.5.6.14 For a child or young person with OCD or BDD, if there has not been an adequate response to the standard dose of clomipramine, and there are no significant side effects, a gradual increase in dose may be cautiously considered.
1.5.6.15 Treatment of a child or young person with OCD or BDD with clomipramine should be continued for at least 6 months if the treatment appears to be effective, because there may be further improvement in symptoms.
1.5.6.16 In children and young people with OCD or BDD, an attempt should be made to withdraw medication if remission has been achieved (that is, symptoms are no longer clinically significant and the child or young person is fully functioning) and maintained for at least 6 months, and if that is their wish. Patients and their family or carers should be warned that relapse and/or discontinuation/withdrawal symptoms may occur. They should be advised to contact their medical practitioner should symptoms of discontinuation/withdrawal arise.
1.5.6.17 For children and young people with OCD or BDD, to minimise discontinuation/withdrawal symptoms on reducing or stopping antidepressants, particularly SSRIs, the dose should be tapered gradually over several weeks according to the individual's need. The rate of reduction should take into account the starting dose, the drug half‑life and particular profiles of adverse effects.
1.5.6.18 Children and young people with OCD or BDD should continue with psychological treatment throughout the period of drug discontinuation because this may reduce the risk of relapse.
1.5.6.19 Tricyclic antidepressants other than clomipramine should not be used to treat OCD or BDD in children and young people.
1.5.6.20 Other antidepressants (MAOIs, SNRIs) should not be used to treat OCD or BDD in children and young people.
1.5.6.21 Antipsychotics should not be used alone in the routine treatment of OCD or BDD in children or young people, but may be considered as an augmentation strategy.
1.6.1.1 People with severe, chronic, treatment‑refractory OCD or BDD should have continuing access to specialist treatment services staffed by multidisciplinary teams of healthcare professionals with expertise in the management of the disorders.
the compulsions and avoidance behaviour are so severe or habitual that they cannot undertake normal activities of daily living.
1.6.1.3 A small minority of adults with long‑standing and disabling obsessive‑compulsive symptoms that interfere with daily living and have prevented them from developing a normal level of autonomy may, in addition to treatment, need suitable accommodation in a supportive environment that will enable them to develop life skills for independent living.
1.6.1.4 Neurosurgery is not recommended in the treatment of OCD. However, if a patient requests neurosurgery because they have severe OCD that is refractory to other forms of treatment, the following should be taken into consideration.
Existing published criteria (such as Matthews and Eljamel, 2003) should be used to guide decisions about suitability.
Multidisciplinary teams with a high degree of expertise in the pharmacological and psychological treatment of OCD should have been recently involved in the patient's care. All pharmacological options should have been considered and every attempt should have been made to engage the individual in CBT (including ERP) and cognitive therapy, including very intensive and/or inpatient treatments.
Standardised assessment protocols should be used pre‑ and post‑operation and at medium‑ and long‑term follow‑ups in order to audit the interventions. These assessment protocols should include standardised measures of symptoms, quality of life, social and personality function, as well as comprehensive neuropsychological tests.
Services offering assessment for neurosurgical treatments should have access to independent advice on issues such as adequacy of previous treatment and consent and should be subject to appropriate oversight.
Post‑operative care should be carefully considered, including pharmacological and psychological therapies.
Services offering assessment for neurosurgical treatments should be committed to sharing and publishing audit information.
1.6.1.5 For children and young people with severe OCD or BDD with high levels of distress and/or functional impairment, if there has been no response to adequate treatment in outpatient settings, or there is significant self‑neglect or risk of suicide, assessment for intensive inpatient treatment in units where specialist treatment for children or young people with OCD or BDD is available should be offered.
1.7.1.1 When a person of any age with OCD or BDD is in remission (symptoms are not clinically significant and the person is fully functioning for 12 weeks), he or she should be reviewed regularly for 12 months by a mental health professional. The exact frequency of contact should be agreed between the professional and the person with OCD or BDD and/or the family and/or carer and recorded in the notes. At the end of the 12‑month period if recovery is maintained the person can be discharged to primary care.
1.7.1.2 OCD and BDD can have a fluctuating or episodic course, or relapse may occur after successful treatment. Therefore, people who have been successfully treated and discharged should be seen as soon as possible if re‑referred with further occurrences of OCD or BDD, rather than placed on a routine waiting list. For those in whom there has been no response to treatment, care coordination (or other suitable processes) should be used at the end of any specific treatment programme to identify any need for continuing support and appropriate services to address it.
 Department of Health (2004) Organising and Delivering Psychological Therapies. London: Department of Health.
 Citalopram does not have a UK Marketing Authorisation for use in OCD in adults at the date of publication (November 2005).
 Fluoxetine does not have a UK Marketing Authorisation for use in BDD at the date of publication (November 2005).
 Buspirone does not have a UK Marketing Authorisation for use in BDD at the date of publication (November 2005).
 Refer to the Summary of Product Characteristics for details about appropriate dosage.
 Clomipramine does not have a UK Marketing Authorisation for use in OCD or BDD in children and young people at the date of publication (November 2005).
 Sertraline has a UK Marketing Authorisation for use in OCD in children 6 years and older at the date of publication (November 2005).
 Fluvoxamine has a UK Marketing Authorisation for use in OCD in children 8 years and older at the date of publication (November 2005).
 Fluoxetine does not have a UK Marketing Authorisation for use in OCD in children and young people at the date of publication (November 2005).
 Depression in children: identification and management of depression in children and young people in primary care and specialist services. NICE guideline CG28.
 Matthews K, Eljamel MS (2003) Status of neurosurgery for mental disorder in Scotland. Selective literature review and overview of current clinical activity. British Journal of Psychiatry 182:404–411.


text:
Omise Acquisition Rumor Leads to OmiseGO (OMG) Pump and Dump
A report published Friday claims the Thailand-based payment gateway has been acquired for $150 million.
The price of OmiseGO (OMG), a token underpinning a second-layer solution for scaling on Ethereum, pumped more than 12% on Friday on the back of an unconfirmed report that claimed the project's "sister" (originally parent) company, Omise, was acquired for $150 million by Thailand's largest private company, Charoen Pokphand Group (CP Group).
According to the report by The Block, several inside sources confirmed the deal, which allegedly brings Omise, one of the largest payment gateways in Thailand with a presence in Singapore, Japan and Indonesia, under the ownership of the Chearavanont family, Asia's fourth-wealthiest family.
However, in a strange twist, Omise and OmiseGo founder Jun Hasegawa took to Twitter to refute the claims made in the article, indicating that the company has reached out to The Block to "rectify the article."
The article The Block published on acquisitions of Omise (Payment Gateway) is false. We have reached out to the The Block to rectify the article and take the necessary actions. #omise #omisego
— JUNΞ (@JUN_Omise) March 30, 2019
The Block has yet to publish a redaction and the lead writer, Frank Chaparro, has doubled down on the info he received from the anonymous sources. However, the article has been updated to reflect Omise's denial of the acquisition and the fact that OmiseGo, a subsidiary of Omise Holdings, was responsible for the 2017 ICO of OMG, not Omise.
Omise (Payment Gateway) has NOT been acquired by any company.
A recent article published by The Block, made false claims that we were recently acquired by CP Group.
We would like to confirm that this information is false.
For any further queries please reach us at pr@omise.co
— Omise (@Omise) March 30, 2019
This latest drama comes around a month after OmiseGo launched Plasma MoreVP (More Viable Plasma) on the Ethereum testnet. The project more recently introduced a new architecture for building plapps (plasma apps) on one generalized plasma chain by establishing a clean separation between the plasma layer and the application layer.
🚀 IRS Finds Only 0.04 Percent of Filers Report Cryptocurrency Assets in 2017
After jumping to $2.10 on the news, OMG is now down 5% on the day to $1.89, giving the altcoin a market cap of $265.4 million.
More: Thailand's richest company acquires firm behind OmiseGo token for more than $100 million
Similar: Trade Alert: OmiseGO (OMG) Pumps 8% on Plasma Protocol Alpha Release
OMGUSD Rates by TradingView
SOURCEThe Block
Sunday Crypto Market Gainers: BSV, VGX, THETA, SEELE, EON


Part-time officers represent different groups of students, run campaigns and hold the full-time officers accountable. They volunteer their energy and time to run campaigns to make University life better for Swansea University students – they're pretty special people.
Lucia is a 3rd year Product Design Engineer student, and your Women's Officer. She's here to represent students who identify as female by campaigning on issues that affect women in Swansea University.
Sam is studying for his PhD in Economics and is your LGBT+ Open Place Officer. He works in partnership with the Union to hold events on issues to do with the LGBT+ community and represent LGBT+ students at Swansea University.
Marcelo, a History and Politics student in his second year, is your International Officer. He's here to represent International students at Swansea University by organising events and taking any issues to the Uni.
Ana is a third year Biology student and your Environment Officer. She leads on environmental campaigns and issues, and is part of the NUS Green Impact Award.
Travis is a second year Aerospace Engineer, and your BME Officer. He's here to represent students who identify as BME and listen to their issues.
Jasmine, a second year Psychology student, is your Students with Disabilities Officer. She's here to represent Swansea University students and deal with anything related to disabilities.
Saira, who studies Law, is your Mature Students Officer.
She's on hand to represent mature students here at Swansea and deal with any issues they face.
Greta is a second year Psychology student and your Mental Health Awareness Officer. She's here to represent Swansea University students and conduct campaigns and events on mental health issues that could affect Swansea University students.
Next articleCan a film be more than just a film?


Matt Golec wears multiple hats these days, though he is most widely known in the gaming world as the co-designer of Penny Press. Coming from his background in print journalism before diving into game design, Matt paired with Robert Dijkman Dulkes to create a game that showcased their mutual fascination with the Yellow Journalism era of newspapers.
Matt currently lives in the Upper Valley region of Vermont and keeps himself busy designing games, doing freelance writing, enjoying the outdoors (when he can), and being a full-time parent. The most recent addition to all that has been his interview series here at The Cardboard Republic, which focuses on exploring the often unreported roles that exist within the hobby industry.
What was your gateway game?
I played a bunch of games as a kid – Civilization, Star Fleet Battles, Car Wars, plus the usual mass-market titles – but Dungeons & Dragons was the game that changed my whole concept of what a game could be. I took a break from gaming from college through my 20s, then came back after the Catan / Euro renaissance, but those early D&D games, played with nothing more than paper, pencils and a couple six-sided dice, were how I got pointed down this path.
What was the last game you really enjoyed playing?
[As of September 2016] Pandemic Legacy really captured my imagination. I like games with campaigns and characters that carry over from session to session, such as Imperial Assault and Descent. Another game I enjoy a lot is Vikings. It's got a cool bidding wheel combined with meeple placement and a Carcassonne-like tile puzzle. Great fun!
I've made a semi-conscious effort to limit my collection to about 100 games. There's space considerations, of course, but there's also just so many games I can keep in my head. If a game doesn't totally grab me, or if I know I'm not going to play it, I'm happy shuffling it off to someone who'll get more enjoyment out of it.
What is your favorite type of game to play?
I generally like thematic games like Descent, and there's no shortage of great Euros, such as Vikings. If pressed, I might say I'm not into abstracts and war games, but then again I really dig Hanabi and Command and Colors: Ancients. I do appreciate how games today are really blurring the boundaries among genres, so you might find a thematic Euro on the game shelf sitting right next to a war-dexterity game.
How do you feel about Monopoly?
My son got (slightly) into Monopoly a few years back, so I've played it somewhat recently. It's not that bad, especially with the correct bidding / trading rules, but it's still too long for a roll-and-move game.


Growing up, I was always partial to heroines in comic books, sci-fi, and fantasy. Some of my favorite characters growing up were The Huntress, Catwoman, Wonder Woman, Xena Warrior Princess, and Seven of Nine. Many people might point out that my interest in these characters as a teenage boy was probably less than virtuous. It could be argued that these characters are not exactly feminist role models, and were specifically designed to appeal to young men on a more primal level. I won't deny the latter, but I would argue to former. In my opinion, all those characters represent strong, independent women, and that was part of their appeal to me. So, here is to all the warrior women out there: happy international women's day!


text:
How a women's match changed the world of professional wrestling
The Road to Hell in a Cell
Sign in to playThe Road to Hell in a Cell
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Over the last ten years, the growth of extreme sports has been phenomenal. This three-part series explores the mad, bad and dangerous world of the adrenaline industry and those who work in it.
Xtremists
Guy Martin transforms iconic road vehicles into thoroughbred racing machines and pits them against the best of the best
Guy's Garage
The story of the World Cup that determined the future of English football - a watershed tournament for the team, fans, and the nation back home
Italia 90: When Football Changed Forever
We follow the group of boys determined to achieve their dreams of becoming professional footballers, at the prestigious Crystal Palace Football Club Academy
Football Dreams: The Academy
In the build-up to the 2022 World Cup squad announcements, England and Premier League footballer Jesse Lingard reveals how his mental health and home life have affected his on-pitch performance
The Jesse Lingard Story: UNTOLD
In 21st century Britain, what it means to be a man or a woman is changing. Eleven strangers of different gender identities and sexualities spend a week together - with explosive results.
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A series of films that reveal Guy Martin's complex character, revealing his candid thoughts on the dangers of the Isle of Man TT, and featuring exclusive access to his normally off-limits private life
Guy Martin's Passion for Life
Racing driver and double amputee Billy Monger trains alongside ParalympicsGB stars to gain an understanding of what it takes to be an elite athlete, under the guidance of Jonnie Peacock
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text: package mmath


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Q: Are there sandbox open-source Symfony2 projects to help learn? I have been reading through Symfony's documentation and with this being my first project on an MVC framework I'm taking my first steps in trying to put it all together.
Are there any open-source Symfony projects that showcase best practices to experiment around with with in terms:

*

*Security

*Routing

*Controllers

*Doctrine

*Twig

I know Symfony 2.6 had the "ACME Demo Bundle" but this was very limited. I'm thinking more along the lines of Microsoft Access' "Northwind" example database

A: There is the symfony demo:
https://github.com/symfony/symfony-demo
You can also read the best practices.

redpajama_set_name: RedPajamaStackExchange


Back in March, I had a blast working with Leah of Color Pop Events dreaming up this refreshing bridal brunch inspiration. With vibrant florals from Lindsay Rae Design and whimsical paper goods from Fourteen-Forty, everything came together perfectly at the wonderful venue, 91 Horatio in New York's Greenwich Village. See the full feature on Style Me Pretty here!


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← Obama's policy has no clothes
The US changes course →
How Herzog and Livni could win
Some of the members of the Joint Arab List. Haneen Zouabi is second from right.
Last week I suggested that the aptly misnamed "Zionist Union" party would do anything to get into power, even — for the first time in Israel's history — invite an Arab party into their coalition, and yesterday Tzipi Livni made it clear that she did not rule this out.
The Joint Arab List is polling around 12 mandates now, and has the potential to go much higher. While voter participation among Israeli Arabs has always been low, some Arab leaders that supported a boycott in the past are now urging them to vote. And there is a well-funded (by foreign money, of course) get-out-the-vote effort aimed at them.
The race is still neck-and-neck with a "poll of polls" showing Netanyahu's Likud and Herzog/Livni's Zionist Union within one seat of each other. While the parties that would form a right-wing coalition still expect to get about 10 more seats than the Left (even including the Arabs), an opportunistic 'center' party could be tempted to flip leftward.
After the votes are counted, the President (Reuven Rivlin) will give some Knesset member the job of forming a government "after consultation with representatives of party groups in the Knesset." This is usually understood to mean the one that is most likely to be able to form a coalition, but there is no legal requirement that this be so, at least in the first rounds. If that Knesset member doesn't succeed, then the President can choose someone else.
In October 2008, Ehud Olmert resigned as Prime Minister due to criminal allegations (he has since been convicted). His deputy, Foreign Minister Tzipi Livni, was unable to maintain the coalition, so new elections were held in February of 2009. Livni's party, Kadima, got the most votes with 28 seats to the Likud's 27. But the President, Shimon Peres, gave Netanyahu the first shot at forming a coalition, because more of the other parties were prepared to join with Netanayahu than Livni.
The background was the mushrooming evidence of Olmert's corruption, plus the negligence of the Olmert-Livni-Peretz government during the 2nd Lebanon War of 2006 (Labor's Amir Peretz had been Defense Minister, one of the worst in Israel's history). It was surprising and embarrassing that Olmert hung on as long as he did.
The left-leaning Peres did the right thing in this case even though he doubtless would have preferred Livni to his old enemy Netanyahu. But he had no choice; picking Livni would just have resulted in even more time without a government, and not only the party leaders but the nation had had more than enough of Kadima and Livni.
Nevertheless, if one party gets significantly more votes in the upcoming election than the others, I can see the President feeling that it would be 'more democratic' to give that party the first shot at forming a coalition, even if it is less likely to succeed based on initial consultations with party leaders. The pressure would be on everyone to get on board.
With a bit of luck, plenty of center-party cynicism, plus the Arab parties, it is imaginable that Herzog and Livni (they have a power-sharing agreement) could be the next Prime Ministers.
Of course it is by no means certain that the Arabs would agree to join a Zionist government, especially one led by a party called the "Zionist Union." But I wonder what would happen if promises of pro-Arab legislation, ministerial jobs and other perks are dangled in front of them. You can be sure that Herzog and Livni will pull out all the stops.
The Zionist Union's party list (without the Arab parties) has already been strongly criticized for being soft on anti-Zionism:
Bayit Yehudi candidate Ronen Shoval submitted a complaint to the Central Election Committee … which states that Labor-Hatnua's Hebrew name, "Zionist Camp," is misleading. …
For example, they quote [Zuheir] Bahloul as saying "our Palestinian identity is stronger than the Israeli one." MK Stav Shaffir's quote is taken from a book on the 2011 social protests, of which she was a leader, which said she called Hatikvah a racist song. MK Merav Michaeli once said in an Army Radio interview that mothers should not send their sons to the army as long as the "occupation" continues. Bayit Yehudi used several quotes for candidate Yossi Yona, including "I don't connect to this word, Zionism. It doesn't express who I am" and "Yom Hashoa and Nakba Day should be on the same day."
Shoval's complaint was turned down of course, but there is no doubt about the anti-Zionism of the Balad party, one of those that make up the joint list:
Balad is a political party whose stated purpose is the "struggle to transform the state of Israel into a democracy for all its citizens, irrespective of national or ethnic identity." It opposes the idea of Israel as a solely Jewish state, and supports its recasting as a binational state.
Balad also advocates that the state of Israel recognize Palestinian Arabs as a national minority, entitled to all rights that come with that status including autonomy in education, culture and media. Since the party's formation, it has objected to every proposed state budget on the grounds that they have discriminated against the Arab population.
The party supports creation of two states based on pre-1967 borders, with the West Bank, Gaza Strip, and East Jerusalem to constitute a Palestinian state and the implementation of UN Resolution 194 regarding the right of return to Palestinian refugees. [194 is interpreted by Arabs to mean that descendents of 1948 Arab refugees have a right of return to Israel — ed.].
It is unthinkable that representatives who agree with this platform can be part of the government of Israel. In fact, I believe that even the presence of a person like Balad member Haneen Zouabi in the Knesset is unacceptable. It simply stands in contradiction to Israel's Declaration of Independence as a Jewish and democratic state. Unfortunately, the Supreme Court places its understanding of 'democratic' above that of 'Jewish'. But that's another issue.
This entry was posted in Israeli Arabs, Israeli Politics. Bookmark the permalink.
1 Response to How Herzog and Livni could win
sabashimon says:
When it comes to the Israeli Left and their co-conspirators in the overwhelmingly Leftist Israeli Media, even the unthinkable is a very real possibility.
I for one vote to rename Israel "Chelm".
Any seconds?


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Q: How could I remove duplicates if duplicates mean less than 30days? (using sql or pandas)
I want to delete records if the Date difference between two records is less than 30 days.
But first record of ID must be remained.
#example
ROW ID  DATE
1   A   2020-01-01 -- first
2   A   2020-01-03
3   A   2020-01-31
4   A   2020-02-05
5   A   2020-02-28
6   A   2020-03-09
7   B   2020-03-06 -- first
8   B   2020-05-07
9   B   2020-06-02

#expected results
ROW ID  DATE
1   A   2020-01-01
4   A   2020-02-05
6   A   2020-03-09
7   B   2020-03-06
8   B   2020-05-07

ROW 2,3 are within 30 days from ROW 1
ROW 5 is within 30 days from ROW 4
ROW 9 is within 30 days from ROW 8

A: You can try this:

*

*Convert date to datetime64

*Get the first date from each group df.groupby('ID')['DATE'].transform('first')

*Add a filter to keep only dates greater than 30 days

*Append the first date  of each group to the dataframe

Code:
df['DATE'] = pd.to_datetime(df['DATE'])

df1 = df[(df['DATE'] - df.groupby('ID')['DATE'].transform('first')) >= pd.Timedelta(30, unit='D')]
df1 = df1.append(df.groupby('ID', as_index=False).agg('first')).sort_values(by=['ID', 'DATE'])
print(df1)

   ROW ID       DATE
0    1  A 2020-01-01
2    3  A 2020-01-31
3    4  A 2020-02-05
4    5  A 2020-02-28
5    6  A 2020-03-09
1    7  B 2020-03-06
7    8  B 2020-05-07
8    9  B 2020-06-02

A: To cope with your task it is not possible to call any
vectorized methods.
The cause is that after a row is recognized as a duplicate, then
this row "does not count" when you check further rows.
E.g. after rows 2020-01-03 and 2020-01-31 were deleted (as
"too close" to the previous row) then 2020-02-05 row should be
left, because now the distance to the previous row (2020-01-01)
is big enough.
So I came up with a solution based on a "function with memory":
def isDupl(elem):
    if isDupl.prev is None:
        isDupl.prev = elem
        return False
    dDiff = (elem - isDupl.prev).days
    rv = dDiff <= 30
    if not rv:
        isDupl.prev = elem
    return rv

This function should be invoked for each DATE in the
current group (with same ID) but before that isDupl.prev
must be set to None.
So the function to apply to each group of rows is:
def isDuplGrp(grp):
    isDupl.prev = None
    return grp.DATE.apply(isDupl)

And to get the expected result, run:
df[~(df.groupby('ID').apply(isDuplGrp).reset_index(level=0, drop=True))]

(you may save it back to df).
The result is:
   ROW ID       DATE
0    1  A 2020-01-01
3    4  A 2020-02-05
5    6  A 2020-03-09
6    7  B 2020-03-06
7    8  B 2020-05-07

And finally, a remark about the other solution:
It contains rows:
3    4  A 2020-02-05
4    5  A 2020-02-28

which are only 23 days apart, so this solution is wrong.
The same pertains to rows:
5  A 2020-02-28
6  A 2020-03-09

which are also too close in time.


For the first time ever, Comic-Con, in association with the Casting Society of America, will host a casting panel.
Moderated by Lora Kennedy (Warner Brothers, EVP, Features Casting. CD, Man of Steel).
Randi Hiller (Walt Disney Studios, VP Casting. CD, The Avengers).


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Snap Judgment: A touch of the Irish
Calev Ben-David
The IRA and Sinn Fein have also committed themselves to the "power-sharing" process.
In the 1982 Irish movie Angel, set against the backdrop of the "troubles" in Northern Ireland, is a scene in which one character asks another, "Are you Protestant or Catholic?" "Neither," is the reply; "Actually, I'm Jewish." "Okay," responds the first character; "But tell me, are you a Protestant Jew, or a Catholic Jew?" When I first saw the film it reminded me of an experience I had just a year earlier while hitchhiking across Ireland. One day a garrulous middle-aged Irishman picked me up just south of the border between the Republic of Ireland and Northern Ireland. He wasted no time in bluntly asking me: "So tell me now, what do you think of the IRA?" In other words, was I a Catholic Jew, or Protestant Jew? It soon became clear he strongly preferred me to be the former - and in truth, my sympathies did lie strongly in that direction. Northern Ireland, I felt then and now, was largely a neocolonial British construct, and the Irish republican cause was at its heart a just one. Despite this though, to my driver's increasing displeasure, I condemned the IRA's terrorist tactics in the strongest possible terms. Nothing, I argued, not even centuries of English oppression and Protestant discrimination, justified the use of indiscriminate bombing attacks that deliberately targeted civilians. Although the discussion grew quite heated, fortunately (for me) my host's sense of Irish hospitality outweighed his political sensibility, and he resisted the temptation to dump me out of his car in the middle of Irish bog country. Still, while I failed to changed any Irish minds that day (or any other day), a quarter-century later it appears that all but the most extreme elements in Ireland now share the view that violence fails to serve the cause of Irish unity. As the AP reported earlier this month: "The Irish Republican Army has disbanded units for weapons-making, arms-smuggling, recruiting and training, an expert panel has reported, in dramatic findings that could boost chances for reviving a Catholic-Protestant administration in Northern Ireland. The leaders of Britain and Ireland warmly embraced the conclusions of the Independent Monitoring Commission, a panel that includes former chiefs of the CIA and Scotland Yard's anti-terrorist branch. In its 60-page report, the panel listed statistics and trends demonstrating the IRA has embraced non-violent politics and is determined to consign its terrorist capability to history." ONE CAN only pray that this is so. In the meantime, the developments in Ireland have apparently caught the attention of Ahmed Yousef, a senior communications adviser to the Hamas Palestinian prime minister, Ismail Haniyeh. In an op-ed published last week in The New York Times, Yousef argues that Israel and the international community accept from Hamas the concept of a hudna - an Arabic form of temporary truce - as a means of ending the current Israeli-Palestinian violence. Presumably, though Yousef never says so outright, this hudna would be in place of Hamas having to meet the three conditions - recognition of Israel's right to exist, honoring past agreements, and renouncing terrorism - that Israel, the United States and the European Union have all recognized as pre-conditions for allowing the Hamas government to receive foreign aid and engage in direct negotiations. In explaining the Hamas view of hudna, Yousef writes: "Such a concept - a period of non-war but only partial resolution of a conflict - is foreign to the West and has been greeted with much suspicion. Many Westerners I speak to wonder how one can stop the violence without ending the conflict. I would argue, however, that this concept is not as foreign as it might seem. After all, the Irish Republican Army agreed to halt its military struggle to free Northern Ireland from British rule without recognizing British sovereignty. Irish Republicans continue to aspire to a united Ireland free of British rule, but rely upon peaceful methods. Had the IRA been forced to renounce its vision of reuniting Ireland before negotiations could occur, peace would never have prevailed. Why should more be demanded of the Palestinians, particularly when the spirit of our people will never permit it?" Yousef's Orwellian arguments deserve a reply, if only because the Irish peace process, though different in many key respects, does offer some useful guideposts toward solving the conflict here. First off, there is nothing "foreign to the West" about stopping violence without resolving conflicts - indeed, this is the very basis of conflict-resolution in democratic societies. Nor is anyone - not the US, not the EU, and not the Israeli government - demanding that the Palestinians renounce their dreams of an independent Palestinian state. What is being demanded is specifically what was required of the IRA - that they renounce violence as the means of achieving that goal, and not just as a temporary measure. It's worth pointing out that the IRA also initially tried out its own version of a hudna, with its 1997 cease-fire declaration. But the British rightly insisted on sticking to the conditions of the Good Friday agreement, which also called for the group to decommission (disarm) its weapons and dismantle its military infrastructure. Hamas, in contrast, won't even agree to specifically repudiate terrorism, as it daily shoots rockets across the Gaza border into Sderot, threatens to launch a new wave of suicide bombings across Israel, and devotes its efforts, not to alleviating the hardships of Palestinian civilians, but to smuggling into Gaza bigger and badder weaponry with which to attack Israelis. The IRA and Sinn Fein, despite their hopes of one day seeing a united Ireland, have also committed themselves to the "power-sharing" process which recognizes the rights of Northern Ireland's Protestant majority and the legitimacy of the British government's constitutional claims on Irish soil. Hamas, again in stark contrast, can't even bring itself to acknowledge that Israel, in any size, shape or form whatsoever, has a right to exist at all. There's still plenty that can go off-track in the Northern Ireland peace process, especially the resistance of violent extremists to any form of compromise. But those who truly want a fair and just resolution to that conflict know it will only start to move in that direction if they stand firm on their insistence that the terrorism stop for good, and lay down their arms. And though it's a long way from Ireland to Israel, and the gulf between Jews and Arabs yawns deeper than the one that divides Catholics and Protestants, that's at least one touch of the Irish that holds no less true in this part of the world than the Emerald Isle. The writer is director of the Jerusalem office of The Israel Project. www.theisraelproject.org