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The reliability of a modified helper behaviour rating system.

Response mode analysis seeks to classify the utterances of psychotherapists and others offering personal help, with respect to the interpersonal function of the utterance. It is applicable in diverse settings, and irrespective of the theoretical orientation of the helper or the researcher. The present study presents reliability data on a new such system of analysis, incorporating a novel mode, termed exploration. Intermediate between interpretation and reflection, this mode taps the theoretically important effort by the helper to construct a frame of reference shared with the client. Results indicated that the additional precision gained by the introduction of this new mode was not accompanied by any loss in reliability as compared with previous research. Overall, the system achieved acceptable reliability although the data cautioned against overinterpretation of the codings of individual response units.

Counseling↗

Statistical process control for radiotherapy quality assurance.

Every quality assurance process uncovers random and systematic errors. These errors typically consist of many small random errors and a very few number of large errors that dominate the result. Quality assurance practices in radiotherapy do not adequately differentiate between these two sources of error. The ability to separate these types of errors would allow the dominant source(s) of error to be efficiently detected and addressed. In this work, statistical process control is applied to quality assurance in radiotherapy for the purpose of setting action thresholds that differentiate between random and systematic errors. The theoretical development and implementation of process behavior charts are described. We report on a pilot project is which these techniques are applied to daily output and flatness/symmetry quality assurance for a 10 MV photon beam in our department. This clinical case was followed over 52 days. As part of our investigation, we found that action thresholds set using process behavior charts were able to identify systematic changes in our daily quality assurance process. This is in contrast to action thresholds set using the standard deviation, which did not identify the same systematic changes in the process. The process behavior thresholds calculated from a subset of the data detected a 2% change in the process whereas with a standard deviation calculation, no change was detected. Medical physicists must make decisions on quality assurance data as it is acquired. Process behavior charts help decide when to take action and when to acquire more data before making a change in the process.

Humans↗

Seismic anisotropy: tracing plate dynamics in the mantle.

Elastic anisotropy is present where the speed of a seismic wave depends on its direction. In Earth's mantle, elastic anisotropy is induced by minerals that are preferentially oriented in a directional flow or deformation. Earthquakes generate two seismic wave types: compressional (P) and shear (S) waves, whose coupling in anisotropic rocks leads to scattering, birefringence, and waves with hybrid polarizations. This varied behavior is helping geophysicists explore rock textures within Earth's mantle and crust, map present-day upper-mantle convection, and study the formation of lithospheric plates and the accretion of continents in Earth history.

Journal Article↗

Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care.

OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory.

Aged↗

Effect of encouragement on walking test performance.

Walking tests, frequently used to document effects of treatment on exercise capacity, have never been standardised. We studied the effects of encouragement on walking test performance in a randomised study that controlled for the nature of the underlying disease, time of day, and order effects. We randomised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks. Simple encouragement improved performance (p less than 0.02 for the six minute walk), and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres. Age and test repetition also affected performance. These results demonstrate the need for careful standardisation of the performance of walking tests, and suggest caution in interpreting studies in which standardisation is not a major feature of the study design.

Chronic Disease↗

Variational charge renormalization in charged systems.

We apply general variational techniques to the problem of the counterion distribution around highly charged objects where strong condensation of counterions takes place. Within a field-theoretic formulation using a fluctuating electrostatic potential, the concept of surface-charge renormalization is recovered within a simple one-parameter variational procedure. As a test, we reproduce the Poisson-Boltzmann surface potential for a single-charged planar surface both in the weak-charge and strong-charge regime. We then apply our techniques to non-planar geometries where closed-form solutions of the non-linear Poisson-Boltzmann equation are not available. In the cylindrical case, the Manning charge renormalization result is obtained in the limit of vanishing salt concentration. However, for intermediate salt concentrations a slow crossover to the non-charged-renormalized regime (at high salt) is found with a quasi-power-law behavior which helps to understand conflicting experimental and theoretical results for the electrostatic persistence length of polyelectrolytes. In the spherical geometry charge renormalization is only found at intermediate salt concentrations, in agreement with previous numerical results.

Biophysical Phenomena↗

Personality.

Explore the source record for details and available documents.

Aggression↗

The mother's participation in infant carrying in captive groups of Leontopithecus chrysomelas and Callithrix jacchus.

Callithrix and Leontopithecus exhibit ecological differences that have implications for the patterns of infant care. In C. jacchus, which uses a small home range because it depends mainly on plant exudates, infants can forage independently early in their life. L. chrysomelas, which feeds mainly on fruits and insects, needs larger home ranges and, therefore, its infants have a more extensive period of dependence. Three families of C. jacchus and four families of L. chrysomelas were studied in captivity. The animals were observed starting from the birth of the infants up to their 8th week of age. Our results suggest that the pattern of infant transfer in L. chrysomelas did not follow the one reported for L. rosalia in that transfers from the mother occurred much earlier. L. chrysomelas infants were carried for about 15% of total time during the 8th week of life against less than 1% in C. jacchus in the same week. Infant care seems to be more extensive in L. chrysomelas than in C. jacchus, and the period of exclusive mother carrying in L. chrysomelas is shorter than that observed in L. rosalia.

Animals↗

Hormones associated with non-maternal infant care: a review of mammalian and avian studies.

Hormonal changes during non-maternal infant care have been demonstrated in many cooperatively breeding bird species, some monogamous rodents and two species of New World primates. Coevolution of hormones and social traits may have provided for the different breeding systems that occur today. Several hormones have been shown to covary with the breeding systems of vertebrates. Elevated levels of the hormone prolactin with male parenting behaviours are common to many birds, rodents and the callitrichid monkeys Callithrix jacchus and Saguinus oedipus. In birds, prolactin may be elevated in both male and female breeders during various stages of nest building, egg laying, incubating and feeding of young. Testosterone levels appear to have an inverse relationship to prolactin levels during infant care in birds and rodents, but this relationship has not been examined for primates. In cooperatively breeding birds, helpers who remain at the nest also have elevated levels of prolactin when displaying parental care behaviours. Prolactin levels are elevated in helper callitrichid monkeys during the postpartum period. Monogamous male rodents demonstrate elevated prolactin levels with parental care behaviour but, in contrast to the birds, the mechanisms mediating prolactin increase appear to differ for male and female rodents. Two factors may influence male parental behaviours and hormonal changes: stimuli from the pregnant female and stimuli from the newborn pups; whereas maternal behaviours are influenced by the maternal hormones of the female and the pup stimuli. An experiential factor may also influence male parental behaviours. Neuropeptides such as oxytocin and vasopressin appear to be involved in male rodent parental care and there may be an interaction between a series of hormones and neurosecretions and stimuli from mates and pups. Studies of Saguinus oedipus, the cotton-top tamarin, suggest that prolactin levels are responsive to stimuli from contact with infants and the level of infant care experience influences the levels of prolactin with male infant care. Father tamarins also have elevated levels of prolactin before the birth of infants suggesting that cues from the pregnant female are important. Prolactin's role in parental care may have evolved from prolactin's role in other reproductive functions. Hormonal regulation of non-maternal care may occur due to a complex interaction of many hormones and neurotransmitters. Studies described here should provide the impetus for further work on parental care hormones in a wide variety of primates.

Animals↗

Prolactin levels of fathers and helpers related to alloparental care in common marmosets, Callithrix jacchus.

Previous studies have suggested that prolactin may play a role in regulating allocare behaviour in cotton-top tamarins, Saguinus oedipus. In this study, we investigate the prolactin profile of 3 groups of captive common marmosets, Callithrix jacchus. Carrying behaviour in this species was observed after parturition. Prolactin assays of blood samples of both fathers and helpers (sub-adult non-fathers) in 3 family groups were taken for 8 weeks before and after birth of the infants. The after-birth condition was divided into 2 groups: carrying and non-carrying animals. The results suggest a relationship between prolactin levels and allocare behaviour, with carrying behaviour being associated with increased prolactin in both fathers and helpers. This suggests that extra prolactin is produced in response to physical contact, and may be associated with carrying behaviour. Also, prolactin production may be related to learning parental skills in Neotropical primates.

Animals↗

Allocare patterns among cercopithecines.

Cercopithecines show two general patterns of allocare. Many guenons permit extensive contact with young infants, while most baboons and macaques restrict early contact. Here social, ecological and life history variables among cercopithecines are examined for evidence of relationships with allocare patterns. This analysis suggests that in this group early allocare is most extensive in species with relatively relaxed social relationships among females, marked seasonal breeding and rapid rates of reproduction.

Animals↗

To help and not to harm: ethical issues in the treatment of chronic pain in patients with substance use disorders.

Patients with both chronic pain and substance use disorders are increasingly encountered in a variety of treatment settings. The treatment of these patients raises a number of ethical and patient care issues. Consultation-liaison psychiatrists possess the knowledge and skills to constructively address these issues. This chapter provides clinicians with a review of clinical and ethical dilemmas related to opioid treatment of chronic pain in patients with substance use disorders. The core conflict of beneficence and nonmaleficence will be explored in relation to the concepts of autonomy, justice, respect for persons, confidentiality, and informed consent. The thesis of this discussion focuses on the clinician's desire to provide compassionate care and relieve suffering, which sometimes conflicts with the clinician's desire to improve functioning, extend longevity, and enrich quality of life. A harm reduction model for clinical decision making is summarized.

Analgesics, Opioid↗

Association between interpersonal behaviour and helping alliance in substance-dependent patients.

This paper focuses on exploring the association between the patient's perception of his own interpersonal behaviour on the one hand, and that of the therapist's behaviour and of helping alliance on the other hand. A cross-sectional study was conducted, including 83 patients from substance dependence programs in The Netherlands. They completed the Helping Alliance Questionnaire (HAQ) and the Interpersonal Check List (ICL). Results indicate that the patient's perception of the therapeutic alliance, and his perception of his own and of the therapist's interpersonal behaviour are three separate domains, each playing their role in the context of the therapeutic relationship. Helping Alliance scores are predicted by both the patient's (complaisance) and the therapist's interpersonal behaviour (dominance). We conclude that patient's cognitions about himself and about his therapist do contribute significantly to the perception of the therapeutic relationship. Limitations to the study are discussed, as well as some clinical implications.

Adult↗

The role of pharmacies in the care of drug users: what has changed in ten years. The case of a Swiss region.

This article assesses changes over 10 years in the role of pharmacies in the care of drug misusers--needle/syringe provision and methadone treatment supervision--in the Swiss French-speaking Canton of Vaud (636,000 inhabitants, 238 pharmacies). A review of data collected in four surveys (1991, 1994, 1996, 2003) on the provision of sterile material (and methadone treatment supervision in 2003) including all the pharmacists of the Canton of Vaud was conducted, as well as a review of data of the monitoring of needle exchange programmes introduced since 1996 in this canton, and of methadone treatment statistics. In 2003, interviews with pharmacists complemented the survey. Pharmacies play an important role in the 'frontline' services to drug misusers: the provision of needles/syringes to drug users by pharmacies remains important in spite of a decrease in the provision of sterile material by them since the advent of needle exchange programmes, and they are included in the supervision of two thirds of the methadone treatments. However, they do not feel integrated enough in the network of care to drug misusers and ask for more training and better recognition of their role.

Commerce↗

Patterns of self-definition of asthma patients and normal persons in the Freiburg Personality Inventory.

The concept of the specificity of psychosomatic diseases (Alexander) is being differentiated at the time. In order to clarify some aspects of this problem, we want to investigate whether types of self-rating of normal persons differ from those of patients with bronchial asthma. In a second step we shall examine whether those types of self-rating can be found also in expert rating and third the differences between the two groups concerning their help-seeking behavior. For the purpose of this investigation the data of 135 patients with bronchial asthma (who had been investigated at the Heidelberg University Medical Department between 1979 and 1982) and of 330 persons of the Mannheim Cohort Study (who are a representative sample of the average urban population) have been reanalyzed. By means of the Freiburg Personality Inventory (FPI) data cluster analyses have been done. Evaluated by a group of 5 (5-cluster solution) the patterns of self-rating of patients with bronchial asthma do not differ significantly from those of normal persons. They had a high correlation to the expert rating and to other social-medically important outer criteria. The results indicate that the specificity of psychosomatic patients in relation to normal persons is not very convincing in a pattern of self-rating on the level of the FPI. Therefore, further research in this field seems to be necessary.

Adult↗

Relapse after short-term drug therapy in neurotic outpatients.

A 6-month follow-up of 184 anxious depressed neurotic outpatients who reported improvement after controlled drug trials of several weeks duration revealed an astonishing relapse rate of 81% for anxious and 87% for depressed patients. Early as compared to late relapse was associated with more chronicity and less improvement at the end of the drug trial, while type of drug received did not affect relapse. Onset of relapse had no effect on help-seeking behavior. At time of follow-up, non-relapsed patients had lowest and untreated relapsed patients had highest symptom levels. It was concluded that short-term drug treatment alone does not represent sufficient therapy for chronic neurotic anxious or depressed outpatients.

Adult↗