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Clinical interviewing is a flexible method for gathering assessment information and initiating psychotherapy. Clinical interviews can be used to establish therapeutic relationships, provide role inductions for psychotherapy, gather assessment information, develop case formulations/treatment plans, and for implementing therapeutic interventions. When used for assessment or intake purposes, clinical interviews focus on specific content, such as psychodiagnosis, mental status, and suicide risk. Although central to psychodiagnostic assessment, interview reliability and validity can be adversely affected by noncredible client responding (e.g., the over- or underreporting of symptoms). To address noncredible client responding, clinicians need to (1) be aware of the potential for inaccurate reporting, (2) adopt a “scientific mindedness” approach, (3) manage their countertransference, (4) use specific questioning or interpersonal strategies, and (5) triangulate data by using information from multiple sources. Undoubtedly, technology and other forces may change how future clinicians conduct clinical interviews; however, it is likely that clinical interviews will remain foundational to psychological assessment and treatment.
Objectives: With comparable baseline performance on executive functions (EF) and memory between Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), it is currently unclear if both diseases can be distinguished longitudinally on these measures reliably. Methods: A total of 111 participants (33 AD, 31 bvFTD, and 47 controls) were followed-up annually over a 4-year period and tested on measures of EF, memory, and orientation. Linear mixed-effect models were constructed using disease severity as a nuisance variable to examine profiles of neuropsychological performance decline. Results: At baseline, overlap in terms of cognitive impairment between bvFTD and AD on multiple EF, memory, and orientation measures was present. Longitudinally, only disinhibition (Hayling total errors) appeared sensitive to discriminating AD from bvFTD; however, only after the first annual follow-up. Subgroup analyses on smaller samples revealed comparable profiles on EF tasks at baseline and over time between bvFTD and AD who presented with impaired EF at presentation, and on memory and orientation tasks between AD and bvFTD who presented with severe amnesia. Conclusions: Our results replicate previous findings showing only moderate discriminability between AD and bvFTD at clinical presentation on EF and memory measures. More importantly, we also show that longitudinal trajectories strongly overlap for both dementias on these measures. Disinhibition emerged as the sole measure that in the long run was significantly more impaired in bvFTD. Future studies should use tests designed to target cortical regions that are specifically impaired in bvFTD, such as the ventromedial prefrontal cortex, to improve the accurate discrimination of these diseases. (JINS, 2017, 23, 34–43)
The Library & Archives at Kew hold one of the world’s greatest collections of botanical illustration, assembled over the last 200 years. A resource well-known to the natural history community, it contains much to interest art historians. Using this historically rich heritage our forward thinking includes acquisition of more contemporary items and the formulation of a digital strategy for 21st-century access and exploitation.
Van de Vliert embraces a “supply side” model of human needs, underplaying a “demand” model whereby individuals, motivated by psychological needs, develop coping strategies that help them meet their personal goals and collectively exert an influence on social and economic systems. Undesirable climates may inflate the value of financial capital, but they also boost the value of social capital.
Objectives: The aim of this study was to develop a decision support tool to assess the potential benefits and costs of new healthcare interventions.
Methods: The Canadian Partnership Against Cancer (CPAC) commissioned the development of a Cancer Risk Management Model (CRMM)—a computer microsimulation model that simulates individual lives one at a time, from birth to death, taking account of Canadian demographic and labor force characteristics, risk factor exposures, and health histories. Information from all the simulated lives is combined to produce aggregate measures of health outcomes for the population or for particular subpopulations.
Results: The CRMM can project the population health and economic impacts of cancer control programs in Canada and the impacts of major risk factors, cancer prevention, and screening programs and new cancer treatments on population health and costs to the healthcare system. It estimates both the direct costs of medical care, as well as lost earnings and impacts on tax revenues. The lung and colorectal modules are available through the CPAC Web site (www.cancerview.ca/cancerrriskmanagement) to registered users where structured scenarios can be explored for their projected impacts. Advanced users will be able to specify new scenarios or change existing modules by varying input parameters or by accessing open source code. Model development is now being extended to cervical and breast cancers.
Primary rat bone marrow cells were cultured on bacteriological grade polystyrene dishes which had been treated in selected areas with concentrated sulphuric acid. X-ray photoelectron spectroscopy, angle-resolved and imaging modes, and atomic force microscopy showed that the acid treatment brought about both chemical and topographical changes in the substratum surface. While the bone marrow cells attached to both treated and untreated areas of the surfaces of the dishes, the distribution of early mineralized extracellular matrix in these areas was reproducibily different. Thus, using extracellular matrix deposition as a marker, modification of the polymer surface resulted in the cells adhering to treated and untreated areas exhibiting different phenotypes.
The performance of biomaterials for in vivo and in vitro applications can depend critically on tissue cell adhesion and migration. We have been investigating the role that specific reversible interactions between cell adhesion receptors and complementary substratum-bound ligands play in the regulation of cell adhesion and migration. With an axisymmetric radial flow detachment assay (RFDA)  we measured cell-substratum adhesive strength for human smooth muscle cells (HSMCs) on surfaces coated with type IV collagen (CIV). We found that the critical shear stress for detachment increased linearly with increasing CIV coating concentration. Using time-lapse videomicroscopy and image analysis we tracked the movement of individual HSMCs over similar CIV-coated surfaces. Cell speed and persistence were determined for variations in CIV coating concentration by applying a persistent random walk model for individual cell movement. Cell speed reached a maximum at an intermediate concentration of CIV, supporting the hypothesis that an optimal cell-substratum adhesiveness exists for HSMC movement. This combination of techniques for measuring adhesion and motility provides a valuable tool to examine the role of cell-biomaterial interactions on cell behavior.
An in vitro rat bone marrow cell (RBMC) system was used to examine the structure of the interface established between calcium phosphates (Ca-P) and mineralized tissue. The Ca-P used, varied either in chemical structure or crystallinity. Therefore, not only the influence of chemical composition, but also the effect of degradation of Ca-P ceramics could be studied. The interfaces were examined with scanning and transmission electron microscopy (SEM and TEM).
SEM showed that deposition of mineralized extracellular matrix on the different materials examined varied both in time and morphology. Mineralization started with the formation of afibrillar globules with which collagen fibres became integrated. With TEM, three distinctly different interfacial structural arrangements were observed which were dependent on the presence or absence of an electron dense layer and/or an amorphous zone. The former was considered to be at least partially caused by protein adsorption, which would precede biological mineralization events, whereas the latter was considered to represent partial degradation of the ceramic surfaces.
The results of this study showed that interfacial reactions were not only influenced by the chemical structure, but also by the crystallinity of Ca-P ceramics. Thus, characterisation of Ca-P implant materials is of critical importance in achieving a better understanding of the phenomena that occur at the bone-biomaterial interface.
Cell-biomaterial interactions for different material compositions were evaluated through quantitative examination of in vitro cell spreading behavior and shear-induced cell detachment. Biomaterial substrates consisted of identically prepared, well characterized bulk samples of implant grade cp Ti, Ti-6AI-4V, and Synamel. 3T3 fibroblasts were seeded on the substrate surfaces and incubated for 2 hours. Adherent cell morphology was then examined using scanning electron microscopy and digital image analysis. The cell detachment response was measured using a parallel plate flow chamber. When categorized according to observed cell morphology, projected cell areas were found to be lognormally distributed for all biomaterials and ln(cell area) was significantly greater for Synamel, while no difference existed between cp Ti and Ti-6AI-4V. In addition, the average post-shear fraction of adherent cells was significantly greater for Synamel substrates, as compared to cp Ti and Ti-6AI-4V substrates. The results from this study indicate that in vitro cell adhesion and detachment behavior are measurably influenced by biomaterial substrate composition.
Using both in vivo and in vitro experiments we have demonstrated that: reconstituted collagen will undergo mineralization in a healing bony compartment; that this mineralization is the result of spontaneous precipitation of calcium salts due to the presence of alkaline phosphatase produced by the bone cells, and that once calcified, the collagen will undergo cellular resorption by tartrate-resistant multi-nucleate giant cells similar to osteoclasts. This sequence of events is quite different to that in the supra-bony soft-tissue compartment where no calcification of the collagen is apparent, the collagen matrix becomes infiltrated with fibroblast-like cells and little resorption of the matrix occurs during implantation.
We conclude that reconstituted collagen may be employed as both a tissue barrier, enhancing guided tissue regeneration, and a bone-substitute material, which becomes replaced by natural bone tissue.
Successful realization of large-scale product development programs is challenging because of complex product and process dependencies and complicated team interactions. Proficient teamwork is underpinned by knowledge of the manner in which tasks performed by different design participants fit together to create an effective whole. Based on an extensive industrial case study with a diesel engine company, this paper first argues that the overview and experience of senior designers play an important part in supporting teamwork by coordinating activities and facilitating proactive communication across large project teams. As experts move on and novices or contractors are hired, problems are likely to occur as tacit overview knowledge is lost. If informal, overview-driven processes break down, the risk of costly oversights will increase, and greater management overhead will be required to realize successful product designs. Existing process models provide a means to express the connectivity between tasks and components thus to compensate partially for the loss of tacit overview. This paper proposes the use of design confidence, a metric that reflects the designer's belief in the maturity of a particular design parameter at a given point in the process, to address the limitations of existing models. The applicability of confidence-based design models in providing overview, as well as their shortcomings, will be demonstrated through the example of a diesel engine design process. Confidence can be used to make overview knowledge explicit and convey additional information about the design artifact, thereby informing communication and negotiation between teams.
The pathogenesis of Ménière's disease is associated with a disorder of ionic homeostasis, with the pathologic correlate being endolymphatic hydrops. Despite uncertainty as to its particular mode of action, it is accepted wisdom that intra-tympanic gentamicin has a definite therapeutic role in the control of symptoms in patients who fail to respond to medical therapy. This study reports an evaluation of the efficacy of intra-tympanic gentamicin in the treatment of Ménière's disease and also presents a simple, reliable, safe method of administering gentamicin for this purpose.
A retrospective review of 56 patients undergoing intra-tympanic gentamicin treatment for Ménière's disease was conducted. Response to treatment was analysed using a patient survey and examination of pure-tone averages. An overall significant improvement in vertigo symptoms of 81.3 per cent was found. There was a 21.4 per cent rate of significant hearing loss, defined as greater than 10 dB, with an average loss in this group of 18.5 dB. A single dose of gentamicin applied directly to the round window resulted in a high rate of control of vertigo, with acceptably low rates of hearing loss.
DrScheme is a programming environment for Scheme. It fully integrates a graphics-enriched
editor, a parser for multiple variants of Scheme, a functional read-eval-print loop, and an
algebraic printer. The environment is especially useful for students, because it has a tower
of syntactically restricted variants of Scheme that are designed to catch typical student
mistakes and explain them in terms the students understand. The environment is also useful
for professional programmers, due to its sophisticated programming tools, such as the static
debugger, and its advanced language features, such as units and mixins. Beyond the ordinary
programming environment tools, DrScheme provides an algebraic stepper, a context-sensitive
syntax checker, and a static debugger. The stepper reduces Scheme programs to values,
according to the reduction semantics of Scheme. It is useful for explaining the semantics
of linguistic facilities and for studying the behavior of small programs. The syntax checker
annotates programs with font and color changes based on the syntactic structure of the
program. On demand, it draws arrows that point from bound to binding occurrences of
identifiers. It also supports α-renaming. Finally, the static debugger provides a type inference
system that explains specific inferences in terms of a value-flow graph, selectively overlaid on
the program text.
Rapid innovations and improvements in communication technologies have opened many new channels for health education and delivery, as well as disaster management. Theme 2 examined the role and applicability of these technologies to Disaster Medicine and Management and the various issues involved in their use.
Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set Action Plans that then were reported to the collective group of all delegates.
Main points developed during the presentations and discussion included harnessing convergence, seeking interoperability, building partnerships and making it appropriate. This group identified four Principles of Action underlying its plan: (1) investigate possibilities, (2) identify stake-holders, (3) invite participation, and (4) involve discussants in activities.
Action plans were categorized into three areas that included “thinking globally, acting regionally”, forming a telehealth advisory group, and increasing corporate partnerships.
Technology is opening many opportunities that have applications in disaster management. To optimize benefits, goals and standards must be agreed upon and implemented.