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PubMed1994

Multiple relationships: does the new ethics code answer the right questions?

The new "Ethical Principles of Psychologists and Code of Conduct" (American Psychological Association, 1992) presented expanded attempts to clarify the ethical issues regarding multiple relationships and to provide useful guidance for psychologists. This article proposes that the new code fails to address adequately two basic questions necessary to provide psychologists with clear guidance: (a) What are multiple relationships? and (b) When do multiple relationships constitute unethical conduct? The article offers a definition of multiple relationships and identifies several dynamics operating within a professional relationship that are likely to be adversely affected by the imposition of a secondary relationship. Unethical multiple relationships are defined. Finally, the article suggests additions to the new code that would enhance its utility for psychologists.

Codes of Ethics↗
PubMed2005

Dyadic adjustment in chronic illness: does relationship talk matter?

Relationship talk involves talking about the nature and state of one's relationship. To determine the effectiveness of talking about the relationship when one spouse has a chronic illness, the study involved completion of a confidential questionnaire by 182 married couples. Ninety of these were couples in which both partners were healthy, and 92 were couples in which one spouse had a chronic illness. Results of multilevel modeling analyses showed that the association between relationship talk and dyadic adjustment was stronger for women than for men and for couples with an ill spouse than for couples where both spouses were healthy. These findings highlight the importance of taking a relationship perspective and suggest that relationship talk is a potentially useful tool couples can use in their repertoire of relationship-enhancing behaviors during chronic illness.

Adaptation, Psychological↗
PubMed1996

Relationship of dose of hemodialysis and cause-specific mortality.

A number of studies have found a relationship of lower all-cause mortality risk for ESRD patients treated with increasing dose of dialysis. The objective of this study was to determine the relationship of delivered dose of dialysis with cause-specific mortality. Data from the USRDS Case Mix Adequacy Study, which includes a national random sample of hemodialysis patients, were utilized. To minimize the contribution of unmeasured residual renal function, the sample used in this analysis (N = 2479) included only patients on dialysis for one year or more. Cox proportional hazards models, stratified for diabetes, were used to analyze the effect of delivered dose of dialysis (measured and reported by both Kt/V and URR) on major causes of death and withdrawal from dialysis, adjusting for other covariates including demographics, comorbid diseases present at start of study, functional status, laboratory values and other dialysis parameters. Patient follow-up for mortality was censored at the earliest of time of transplantation, 60 days after a switch to peritoneal dialysis or at the time of data abstraction. For each 0.1 higher Kt/V, the adjusted relative risk of death due to coronary artery disease was 9% lower (RR = 0.91, P < 0.05), due to other cardiac causes was 12% lower (RR = 0.88, P < 0.01), due to cerebrovascular disease (CVD) was 14% lower (RR = 0.86, P < 0.05), due to infection was 9% lower (RR = 0.91, P = 0.05), and due to other known causes was 6% lower (RR = 0.94, P < 0.05). There was no statistically significant relationship of Kt/V and risk of death among patients who died of malignancy (RR = 0.84, P = 0.10) or among patients whose death cause was missing (RR = 0.95, P = 0.41). The risk of withdrawal from dialysis prior to death due to any cause was 9% lower (RR = 0.91, P < 0.05) for each 0.1 higher Kt/V. The relationships of delivered dose of dialysis, as measured by URR, and cause-specific mortality were essentially similar in relative magnitude and statistical significance as the relationships observed using Kt/V as the measurement of dialysis dose, with the exception that the relationship was less significant for cerebrovascular disease and withdrawal from dialysis. The relationship of dialysis dose with risk of death due to each cause of death category except other cardiac causes and "other" causes appeared to be of greater magnitude and of greater statistical significance among diabetics than non-diabetics. These results indicate that low dose of dialysis is not associated with mortality due to just one isolated cause of death, but rather is due to a number of the major causes of death in this population. This study is consistent with hypotheses that low doses of dialysis may promote atherogenesis, infection, malnutrition and failure to thrive through a variety of pathophysiologic mechanisms. Further study is necessary to confirm these results and to test hypotheses that are developed.

Adult↗
PubMed1992

An investigation of the relationships between rate and driving force in simple uncatalysed and enzyme-catalysed reactions with applications of the findings to chemiosmotic reactions.

Both the rate and the driving force of a reaction can be expressed in terms of the concentrations of the reactants and products. Consequently, rate and driving force can be expressed as a function of each other. This has been done for a single-reactant, single-product, uncatalysed reaction and its enzyme-catalysed equivalent using the van't Hoff reaction isotherm and Haldane's generalized Michaelis-Menten rate equation, the primary objective being explanation of the exponential and sigmoidal relationships between reaction rate and delta mu H+ commonly observed in studies on chemiosmotic reactions. Acquisition of a purely thermodynamic rate vs. driving-force relationship requires recognition of the intensive and extensive variables and maintenance of the extensive variables constant. This relationship is identical for the two reactions and is hyperbolic or sigmoidal, depending on whether the equilibrium constant is smaller or larger than unity. In the case of the catalysed reaction, acquisition of the purely thermodynamic relationship requires the assumption that the enzyme be equally effective in catalysing the forward and backward reactions. If this condition is not met, the relationship is modified by the enzyme in a manner which can be determined from the ratio of the Michaelis constants of the reactant and product. Under conditions of enzyme saturation in respect to reactant+product, the rate vs. driving-force relationship is determined exclusively by the thermodynamics of the reaction and a single kinetic parameter, the magnitude of which is determined by the relative effectiveness of the enzyme in catalysing the forward and backward reactions. In view of this finding, it is pointed out that, since the catalytic components of chemiosmotic reactions appear to be saturated with respect to the reactant-product pair that is varied in experimental rate vs. delta mu H+ determinations, and that, since many complex enzymic reactions conform to the simple Michaelis-Menten equation with respect to a single reactant-product pair when the concentrations of all other reactants and products are maintained constant, one might expect to be capable of simulating the experimental relationships simply from knowledge of the thermodynamics of the reaction and the relative effectiveness of the catalytic component in catalysing the forward and backward reactions using the simple Michaelis-Menten equation. That this expectation appears to be largely correct is demonstrated with model reactions.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1976

The relationship between lower incisor inclination and various reference lines.

The relationship between the inclination of the lower incisors and different cranial reference lines has been studied in a group of 60 children including 35 males and 25 females between the ages of 7-12 years. Following a 3-4 year observation period, 30 of these children were reexamined to study the relationship between changes in the position of the lower incisors and various craniofacial variables brought about by growth. In analysing the results obtained, an attempt was made to distinguish between those relationships which were to a certain extent due to a topographical relationship between the variables involved and those relationships which were of a biological character. The results obtained from the first registration indicated a strong correlation between Ll-NB mm and Ll-ML degrees and Ll-NB degrees. In addition, the connection between lower incisor inclination and the basal bone relationship (ANB degrees) was found to be strongly significant. The angle ML/NL was found to be correlated only with the inclination of the lower incisors to the mandibular line. Regarding the growth changes occurring during the observation period, no significant correlation could be found between, on the one hand, changes in lower incisor orientation and, on the other hand, changes in the angle ML/NL. The absence of this relationship has been interpreted as being due to the influence of environmental factors in the form of tongue and lip function.

Adolescent↗
PubMed2002

'Partnership': a co-operative inquiry between Community Mental Health Nurses and their clients. 2. The nurse-client relationship.

This paper describes the output of a co-operative enquiry between Community Mental Health Nurses and their clients. Two nurses and two clients volunteered to participate as co-researchers and co-subjects with two facilitators in a co-operative inquiry group. The subject of the inquiry, agreed by the group, was the relationship between the nurse and client. The description of the nurse-client relationship and the influences on it is extremely rich and potentially useful with implications for clinical and managerial practice. Despite the limitations of the study, co-operative inquiry appears to be a useful vehicle for contributing to an increased understanding of the nurse-client relationship with potential for further research and development. Unsurprisingly, when both the relationship characteristics and the health care context are appropriate there seems to be more positive outcomes for both nurse and client. Within the current health policy context there are increased external demands with the potential to disrupt this relationship. Nurses need to be aware of the potential effects of these so that the relationship and the client do not suffer and health service managers need to be aware of the contribution their behaviour may have on the nurse-client relationship.

Adult↗
PubMed1998

Evolutionary relationships among the Braconidae (Hymenoptera: Ichneumonoidea) inferred from partial 16S rDNA gene sequences.

Phylogenetic relationships among the Braconidae were examined using homologous 16S rDNA gene sequence data. Analyses recovered the few well-supported relationships evident in this family from morphological analyses, viz the monophyly of the microgastroid complex of subfamilies, the monophyly of the cyclostome complex of subfamilies (= braconoids), a sister-group relationship between the Alysiinae and Opiinae, and a close relationship between the Helconinae and Blacinae. With respect to the braconoid complex of subfamilies, a sister-group relationship was recovered between Aphidiinae and Mesostoinae, and a clade composed of Gnamptodontinae + Histeromerinae + Rhyssalinae + Aphidiinae + Mesostoinae was also recovered. The Doryctinae and Rogadinae sensu lato (s.l.) were generally not resolved as monophyletic. With respect to the helconoid complex of subfamilies, a sister-group relationship was recovered between Sigalphinae and Agathidinae, whereas Neoneurinae fell out among other helconoid subfamilies. Other relationships among the helconoid subfamilies were unclear from these analyses. With respect to the microgastroid complex of subfamilies, our data conform to morphological estimates, recovering ((Microgastrinae + Miracinae) + Cardiochilinae) + Cheloninae. The topology of our trees suggests that the cyclostome subfamilies are a natural derived group, inferring that endoparasitism (not ectoparasitism) is the ancestral state for the Braconidae, unless all of the ectoparasitic ancestors of the helconoid + microgastroid subfamilies are now extinct.

Animals↗
PubMed1999

Sex, honesty and the supervisory relationship: a response to Ryan.

OBJECTIVE: An argument has been presented in this journal for a generally permissive attitude to consensual sexual relations between psychiatrists and trainee psychiatrists except in circumstances where there is a direct supervisory relationship. This paper challenges that view. METHOD: The arguments are reviewed. A developmental perspective of training is used to show that the autonomy of trainees is restricted in a manner similar to a student in relation to a teacher. This confers on psychiatrists a duty of care. RESULTS: On the basis of respect for autonomy, the strength of argument for a prohibition on consensual sexual relationships is strong for a young trainee, and weakens as a person proceeds through training and approaches the status of a colleague. A policy of restraint would facilitate the development of a general atmosphere of trust, which is an important requirement for good supervision and the basis of professional relationships. An ethical judgement cannot be made, however, without the consideration of other relationships and commitments existing outside the supervisory relationship for each person involved. CONCLUSIONS: In order to create a secure and unambiguous training environment that maximises trust, a general principle of prohibition on sexual relationships between psychiatrists and trainees is preferred, although circumstances exist where such relationships are not unethical.

Ethics, Medical↗
PubMed2003

Dose-response relationship for successful internal atrial defibrillation.

The dose-response relationship for successful defibrillation has been determined in man for the ventricle but not for the atrium. The purpose of this study was to determine the dose-response relationship for internal atrial defibrillation in humans. Seventy-seven consecutive patients underwent internal atrial defibrillation for acute (n = 14) or chronic AF (n = 63). Shocks were delivered in 40-V increments between electrodes positioned in the coronary sinus and the right atrium until successful conversion or a maximum of 400 V was reached. The shock strength versus success of shock data were subjected to a Kaplan-Meier survival analysis combined with a nonparametric probability analysis to arrive at the dose-response relationship. Using this relationship, comparisons were made between acute and chronic AF and clinical relevant conversion percentages (20, 50, 80 and 95%) were estimated and were compared with the conventional mean threshold. There were significant dose-response relationships in both patients groups (P < 0.05). The Kaplan-Meier analysis comparing patients with chronic and acute AF showed significant differences in their dose-response relationships (P < 0.001). The estimated shock intensity for 95% conversion in patients with acute and chronic AF was 279 V (2.9 J) and 433 V (6.6 J), respectively (P < 0.001). The conventional mean defibrillation threshold in patients with acute (192 +/- 15 V. 1.4 +/- 0.2 J) and chronic AF (343 +/- 8 V, 4.4 +/- 0.2 J) predicted the 60% and 45% chance of successful conversion, respectively. In conclusion, this study demonstrates that single shock conversion data can be used to determine a dose-response relationship, which can be used to estimate the shock intensity required for specific successful atrial defibrillation efficacy and to compare different clinical factors that affect defibrillation efficacy.

Aged↗
PubMed2000

Relationship between fetal femur diaphysis length and neonatal crown-heel length: the effect of race.

OBJECTIVE: To determine whether racial differences affect the relationship between the fetal femur diaphysis length and the neonatal crown-heel length. DESIGN: A prospective study in a teaching hospital with a multiracial population. SUBJECTS: Four hundred and fifty pregnant women (150 Malays, 150 Chinese and 150 Indians) who delivered live infants. METHODS: Ultrasound scan measurement of the fetal femur diaphysis length was carried out within 48 h of delivery in all cases. The relationship between the neonatal crown-heel length and the femur diaphysis length was obtained by regression using the method of least squares. Dummy or indicator variables were used to determine the effect of race on the relationship. RESULTS: The relationship between the neonatal crown-heel length and the femur diaphysis length in all three races was well described by a linear model but a quadratic model described the relationship better. There was no significant difference in relationship of the neonatal crown-heel length and the femur diaphysis length between the Malay and Chinese populations, but the relationship in the Indian population was significantly different was from both the Chinese and Malay. For a given femur diaphysis length, the crown-heel length of the Indian population was found on average to be 1.1 cm shorter than the crown-heel length of the Malay and Chinese populations. CONCLUSION: Differences in fetal body proportions exist between some races. The longer femur diaphysis length noted in certain races does not necessarily imply that the corresponding crown-heel length is longer. These inter-racial differences may increase the error of fetal weight and length estimates if formulae, which have been derived from samples racially dissimilar to that of the target population are used.

Adolescent↗
PubMed2000

Is there a positive volume-outcome relationship in peripheral vascular surgery? Results of a systematic review.

OBJECTIVES: to examine the evidence for the existence, or otherwise, of a positive volume-outcome relationship in the area of peripheral vascular surgery. DESIGN: systematic overview of prospective or retrospective volume-outcome studies. DATA SOURCES: seven bibliographic databases were searched for English-language articles published between 1986 and 1998. STUDY SELECTION: thirty-six articles published in peer-reviewed journals; excluding editorials, letters or abstracts; and addressing volume and outcome in peripheral vascular surgery. Criteria were applied and agreed by consensus between two of the authors. DATA EXTRACTION: the articles identified were independently assessed by two of the authors. Studies were categorised into three distinct areas - carotid endarterectomy- (17 studies), abdominal aortic aneurysm repair (16 studies) and other vascular interventions (four studies). Within each category studies were further classified according to full adjustment, partial adjustment or no adjustment for case mix. Where discrepancies arose, decisions were referred to a third author for arbitration. DATA SYNTHESIS: findings for carotid endarterectomy identified a positive volume-outcome relationship for both mortality and stroke at the physician level. There was less support for a positive relationship for mortality at the hospital level, and no evidence of benefits for stroke in higher volume hospitals. If only studies making a full adjustment for case mix are included, there is no clear support from statistically significant evidence for or against a positive volume-outcome relationship. For repair of unruptured abdominal aortic aneurysms there is evidence of a positive volume-outcome relationship at both the physician and hospital level, with evidence being particularly strong at the level of the hospital. For ruptured aneurysms the evidence is suggestive of there not being a positive volume-outcome relationship at the hospital level, while for physicians the evidence is more balanced with no clear support either way. For other vascular interventions there were insufficient studies (n=4) from which to draw meaningful conclusions. CONCLUSIONS: our results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design. Future studies should address these deficiencies by making full adjustment for case mix and by being prospective in design.

Aortic Aneurysm, Abdominal↗
PubMed2001

Effect of estrogen on serum DHEA in younger and older women and the relationship of DHEA to adiposity and gender.

This case-controlled study consisted of 2 parts. The objective of part 1 was to determine the relationship between DHEA, body mass index (BMI), and age in young males, young females, and postmenopausal (PM) females. Part 2 examined the effects of estrogen on DHEA by analyzing the relationship between DHEA and age in young females on and off oral contraceptives (OCs) and PM females on and off estrogen or hormone replacement therapy (ERT/HRT). The study was performed at the Obstetrics and Gynecology Clinic, Texas Tech Health Sciences Center-Amarillo, Exercise Physiology Laboratory at Southeastern Louisiana University, and Woman's Health Research Institute, Woman's Hospital, Baton Rouge, LA. Part 1 groups consisted of: (1) young males between the ages of 18 to 40 years; (2) normally cycling females off OCs, ages 18 to 40 years; and (3) PM females older than 40 years not receiving ERT/HRT. Part 2 groups consisted of: (1) normally cycling females on OCs, ages 18 to 40 years;, (2) normally cycling females off OCs, ages 18 to 40 years; (3) PM females 50 years or older not receiving ERT/HRT; and (4) PM females 50 years or older receiving ERT/HRT. The main outcome measure was serum DHEA concentrations. For part 1, there were significant (P <.05) inverse relationships between DHEA and age for young males; young females, off OCs; PM females, no ERT/HRT r = -.44, -.26, and -.25, respectively. There were no significant relationships between DHEA and BMI for any of the groups. DHEA concentrations were significantly higher in young males than young females even after accounting for age. For part 2, DHEA concentrations were significantly higher in young females off OCs compared with young females on OCs, and significantly higher in PM women off ERT/HRT than those on ERT\HRT. There were significant inverse relationships between DHEA and age for young females and PM females on and off ERT/HRT. From these findings, we conclude that there is an inverse relationship between DHEA and age for young males, young females off OCs, and PM females, no ERT/HRT. No relationship between BMI and DHEA was observed in these same 3 groups. These results agree with previous findings in young men, but differ from previous findings in obese young females. The data also suggest that estrogen treatment (OCs and ERT/HRT) suppresses DHEA concentrations in premenopausal and PM females, and that DHEA declines with age in PM females regardless of estrogen treatment.

Adipose Tissue↗
PubMed2001

[Central Relationship Patterns in Comparison with Different Objects]

In the present study the Relationship Episode Paradigm Interviews of 70 female patients with different psychoneurotic diseases were analysed with respect to object-specific patterns with the CCRT method. The most frequent categories are the same in all relationship episodes and in subsamples of relationship episodes with mother and father. These categories are also predominant in episodes with women and men. Relationship episodes with mother do not differ from episodes with father, and relationship episodes with women do not differ from episodes with men. But there are substantial differences in relationship episodes with the mother and women and between episodes with the father and men. Patients recount much more positive relationship patterns with women and men than with their parents. This could be understood as a hint of interpersonal resources.

Journal Article↗
PubMed1982

[Low birth weight is a negative factor in the mother-infant relationship. (A study of 122 women following primary Caesarean section for breech presentation or repeat Caesarean section.) (author's transl)].

The mother-infant relationship was studied in the first days post-partum in 122 women following Caesarean section for breech presentation and following repeat Caesarean section. 1. Birth weight With low birth weights women had more rarely a good relationship to the infant in the early days post-partum. In only 20% of women with children under 3000 grams the early relationship was good compared to a good relationship in 61% with infants over 3500 grams birth weights. 2. Parity Less primiparae had good contact to the children in the first post-partum days (35%) than secondi and multiparae (54%). 3. Newborn care Women with difficulties to care for the newborn had good contact to the newborn in only 39% of the cases in the first post-partum days. Women without problems to care for the newborn had an early good relationship to the infant in 60% of the cases. 4. The personality of the mother Mothers with an intro-verted personality (according to MPI-E) and depressive tendencies (according to EDS) had significantly rarer close relationships to the newborn in the first post-partum days. According to these results the mother-infant relationship must be supported more vigorously in low birth weight infants not only in premature infants in the first days post-partum. Individual psychosocial factors must be taken into account which could make a satisfactory mother role more difficult.

Adolescent↗
PubMed2006

Relationships between three-body and two-body interactions in fluids and solids.

Molecular dynamics data are reported for two-body and three-body interactions in noble gases at densities covering the gas, liquid, and solid phases. The data indicate that simple relationships exist between three- and two-body interactions in both fluid and solid phases. The relationship for liquids has a simple density dependence with only one external parameter. In contrast, the solid phase relationship depends both on density and on the square of density and requires the evaluation of two parameters. The relationships are tested for both system-size and temperature dependences. The values of the relationship parameters are only sensitive to system size when a small number of atoms are involved. For 500 or more atoms, they remain nearly constant. The relationships are valid for both subcritical and slightly supercritical temperatures. A practical benefit of the relationships is that they enable the use of two-body intermolecular potentials for the prediction of the properties of real systems without the computational expense of three-body calculations.

Journal Article↗
PubMed2006

Relationship between UDP-galactose 4'-epimerase activity and galactose sensitivity in yeast.

UDP-galactose 4'-epimerase (GALE) catalyzes the final step of the highly conserved Leloir pathway of galactose metabolism. Loss of GALE in humans results in a variant form of the metabolic disorder, galactosemia. Loss of GALE in yeast results in galactose-dependent growth arrest. Although the role of GALE in galactose metabolism has been recognized for decades, the precise relationship between GALE activity and galactose sensitivity has remained unclear. Here we have explored this relationship by asking the following. 1) Is GALE rate-limiting for galactose metabolism in yeast? 2) What is the relationship between GALE activity and galactose-dependent growth arrest in yeast? 3) What is the relationship between GALE activity and the abnormal accumulation of galactose metabolites in yeast? To answer these questions we engineered a strain of yeast in which GALE was doxycycline-repressible and studied these cells under conditions of intermediate GALE expression. Our results demonstrated a smooth linear relationship between galactose metabolism and GALE activity over a range from 0 to approximately 5% but a steep threshold relationship between growth rate in galactose and GALE activity over the same range. The relationship between abnormal accumulation of metabolites and GALE activity was also linear over the range from 0 to approximately 5%, suggesting that if the abnormal accumulation of metabolites underlies galactose-dependent growth-arrest in GALE-impaired yeast, either the impact of individual metabolites must be synergistic and/or the threshold of sensitivity must be very steep. Together these data reveal important points of similarity and contrast between the roles of GALE and galactose-1-phosphate uridylyltransferase in galactose metabolism in yeast and provide a framework for future studies in mammalian systems.

Cell Extracts↗
PubMedDate not supplied

Assessing the role of relationship conflict in sexual dysfunction.

Relationship conflict has long been thought to cause, maintain, and influence the therapeutic outcome of sexual problems in the absence of a physical cause. The results of conflict can influence partners' relationship satisfaction, and relationship satisfaction can influence sexual satisfaction. General relationship deficiencies, such as unresolved conflict, undermine the mutual acceptance that is important to healthy sexual functioning. The purpose of this article is to summarize some of the basic empirical findings of studies of conflict patterns in relationships and their role in sex dysfunction and to suggest a model for assessing relationship conflict as a feature of sexual dysfunction. Results from several studies indicate that couples with sexual problems may have conflict-management issues and employ distinct conflict-resolution styles compared to satisfied couples. Dysfunctional conflict resolution may be a cause or result of some sexual problems, whereas constructive interaction concerning conflict can add to emotional and sexual intimacy in a couple's relationship. These patterns warrant systematic attention in assessment and intervention in sex therapy.

Conflict, Psychological↗
PubMed1994

Addiction versus intimacy as related to sexual involvement in a relationship.

Forty couples aged 18-25 years who were in love relationships of three months or more were tested concerning the level of addiction or maturity in the relationship. The results of three questionnaires revealed significant positive correlations between the following: self-esteem and maturity, adjustment and maturity, adjustment and relationship satisfaction, relationship satisfaction and maturity, relationship satisfaction and self-esteem, sexual satisfaction and maturity, and sexual satisfaction and relationship satisfaction. In a multiple regression, three variables (adjustment, relationship satisfaction, and intercourse) predicted a significant amount of the variance surrounding the maturity variable. The results supported the hypotheses proposed.

Adolescent↗