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Analytic impasse and the third: clinical implications of intersubjectivity theory.

The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifically, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-reflection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specific modifications of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality.

Humans↗

[What is a safe principle for therapeutic decision?].

In surgery (as in other disciplines of medicine) a causal therapy is connected with a causal diagnosis. Many physicians confine themselves to symptomatic measures which are useless beyond self-healing or introduce some kind of poly-pragmasia. Sometimes between those extreme positions there is a need of deliberations "as if" or primarily diagnostic operations. Diagnostics as a whole consist of logical as well as of psychological elements. Approximation is made either by some kind of hypothetico-deductive calculations or using some kind of pattern recognition. Anamnesis and immediate personal examination yield a preliminary diagnosis in about 80%. Yet a diagnosis of this sort has to be verified or falsified by scientific methods. The final decision is a function of both the theory of probability and the theory of utility. The combination is demonstrated by the so-called decision matrix and the so-called decision tree, going from simple models to complicated ones.

Computers↗

Advanced practice nurses: change agents for clinical practice.

The article presents the role of advanced practice nurses as change agents in the clinical setting. Research utilization is needed to shape and form the basis of nursing practice. As change agents, the advanced practice nurses in one institution established a research-based minimal stimulation protocol for the very low-birth weight infant and implemented it using a video presentation. Knowledge of change theory, research utilization, and video production was necessary in making this project a success.

Clinical Nursing Research↗

Does physiotherapy management of low back pain change as a result of an evidence-based educational programme?

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care.

Diffusion of Innovation↗

Structural family therapy: its application to Chinese families.

In summary, it can be stated that structural family therapy, for a variety of reasons, offers an appropriate treatment model for dysfunctional Chinese families. Since the family, not the individual, is the more important unit in Chinese culture, the model offers the opportunity for the total family to participate in changing dysfunctional individual and family patterns. The model focuses upon structure, which is the essence of the Chinese family. In addition, it is problem- and growth-oriented, creates a nondefensive atmosphere in which family members can change, and works toward helping family members improve communication and modify behavior. It is important to stress that it does not focus upon helping family members make significant changes in their value system. Furthermore, the model can be applied to most problem areas, because it is assumed that the presenting problem is reinforced by family structure and repetitive patterns. Consequently, family interactional patterns that reinforce the presenting problems are the major focus of the treatment. Finally, the model allows for the utilization of theories and practice principles of other clinical approaches. Structural family therapists assume the role of authority figures who are experts in family therapy. They view the family within the context of its environment, are sensitive to the cultural norms of the group with which they are working, and utilize supportive services as an integral part of treatment. More important, therapists believe in the power of families to make changes and work toward helping them become involved in a new process of interaction that will lead to satisfactory changes.

Acculturation↗

The psychological assessment of object representation.

In 1976, Blatt, Brenneis, Schimek, and Glick developed a comprehensive scale for assessing the organization and content of the "concept of the object" in Rorschach responses. Utilizing developmental theory, they developed procedures for assessing the representation of human figures on the Rorschach in terms of the degree of differentiation, articulation, and integration. This analysis of Rorschach responses has proven to be of considerable value in clinical research and has provided empirical data for the study of severe psychopathology. The present paper considers the clinical utility of this conceptual scheme. Five prototypic patients, each representing a particular diagnostic category, were selected for study on the basis of clinical case records. The object representations of the five cases are presented and analyzed in detail, and conclusions are drawn about possible configurations of object representations in different forms of psychopathology. The value of a systematic assessment of object representations for differential diagnosis as well as for the study of change in the psychotherapeutic process is considered. This approach to Rorschach interpretation represents an integration of object relations theory into Rorschach methodology. These new concepts of test assessment and interpretation offer the promise of providing a methodological framework and theoretical foundation for further innovative use of the Rorschach and other projective procedures.

Adolescent↗

The effect of fear-arousing communications on cigarette smoking: an expectancy-value approach.

This paper describes a model, derived from subjective expected utility ( SEU ) theory, which attempts to explain the effects of a fear-arousing communication about smoking and lung cancer on smokers' decisions to try to stop smoking. According to the model, the strength of the smoker's intention to try to stop smoking will depend on three factors: (1) the utility of lung cancer; (2) the perceived reduction in the risk of getting lung cancer that follows from successfully stopping smoking (probability difference); and (3) the subjective probability of successfully stopping smoking, or confidence. The usefulness of this model vis-á-vis one based on the amount of fear aroused by the communication was investigated in two experimental studies conducted in the field in which smokers watched either a videotape about smoking or one on a different health topic. The smoking videotape influenced not only attitudes and beliefs measured immediately after exposure but also subsequent self-reports of behavior (whether or not the subject tried to stop smoking or to cut down in the 3-month period following exposure to the videotape). In accordance with predictions, the three variables specified by the model together affected intention to try to stop smoking, which in turn affected behavior. The effect of confidence on intention was relatively large. There was no evidence for the multiplicative combination of utilities and subjective probabilities predicted by a strict SEU model. Contrary to the predictions of the model, but consistent with previous research, the amount of fear aroused by the videotape had an independent effect on intention, suggesting that explanations of the effects of fear-arousing communications will have to incorporate both cognitive and emotional mediation processes.

Cognition↗

Definition and documentation: theory, measurement, and the courts.

Definition of terms and the selection criteria for operationalizing the standard of disability are critical to accessing accommodations. The purpose of this article was to examine the research surrounding definitiorns and selection criteria for learning disabilities and attention-deficit/hyperactivity disorder at the postsecondary level. Implications from and for the courts follow a critical analysis of the professional literature. The need for researchers to utilize theory-based models to investigate the multivariate relationships between and within constructs underlying current definitions and eligibility criteria is also disscussed.

Attention Deficit Disorder with Hyperactivity↗

Optimization of static field homogeneity in human brain using diamagnetic passive shims.

These preliminary studies demonstrate that static field inhomogeneity in the human inferior frontal cortex (IFC) is significantly diminished through placement of a small amount of strongly diamagnetic material in the roof of the mouth. As a result, susceptibility-related image artifacts in this region, as observed in blood oxygen level dependent (BOLD) functional MRI (fMRI), are considerably decreased without compromising the spatial or temporal resolution of the study. Simulations of the static field utilizing perturbation theory are shown, which support the experimental results. The limitations and possible future developments of the technique are described. The application of diamagnetic passive shimming on other regions of the brain is also discussed. Routine use of the proposed method within fMRI studies is practicable through subject-specific optimization of the technique utilizing the simulation algorithm.

Brain↗

Activity theory and medical informatics: usability, utility, and copability.

Working with health care today also means working with IT-systems. 'Human Factors' or 'user-friendly design' has been renowned as key factors for the development of safe and successful systems in many industries, not least in the IT-business. Likewise in the computerization of health care, the concepts of 'usefulness' and 'usability' will become key issues in the daily life (and death) in health care context at hospitals, at the GP's office, and in the home of the patient. Though it is a pressing problem, the literature is still very scarce on how to meet this challenge. Inspired by activity theory, this paper sets out to coin a term for an important way to ask questions when determining the usefulness of a medical IT-system. We normally ask two types of questions: 'How usable is the system?' (usability), and 'How functional is the system?' (utility). But most important, we will also have to ask: 'How well does the user cope with the new situation?' As a concept for the latter way of asking questions, we will suggest the term 'copability'.

Delivery of Health Care↗

Family theory and family therapy models: comparative review with implications for nursing practice.

Although theories of the family and theories of family therapy have different origins and purposes, both provide the basis for a family focused nursing approach. Family theory is a practice theory with a focus on health while family therapy is a practice theory with a focus on pathology. Thus, the contributions of each are different. For nurses to adapt and apply the principles of the two theories correctly, they first must understand whether application of a basic theory with a focus on health or a practice theory with a focus on pathology is appropriate in the particular nursing situation. For example, if a husband is hospitalized, recovering from a myocardial infarction, a family focused nursing approach is mandatory in providing optimal nursing care. Assessment of the family situation will provide clues for the functional or dysfunctional state of the family and the appropriateness of utilizing family theory or family therapy principles. If the current state of family relationships is optimal, application of family theory principles than can be applied to guide health promotion on a family level is appropriate. Organizational and dynamic aspects of the family promoting the husband's recovery can be accentuated, supported, and emphasized in the nursing care. However, if the current state of family relationships is pathological, application of family therapy principles is appropriate. Here the goal of the nursing care is restoration of functional organizational patterns and interactive processes between family members.

Family↗

A general zone theory of color and brightness vision. I. Basic formulation.

A general theory of color and brightness vision, developed from basic principles of the Helmholtz and Hering points-of-view on color vision is presented in a general mathematical form suitable for quantitative analysis. Visual sensation is described by a vector expressed in terms of Hering-like elements for color and brightness which underlie in their spatial-temporal variations the perceptions of form and change. The photic stimulus of vision is recognized to act first and only through photoabsorption producing a Helmholtz-like vector of quantum absorptions. The physiological transformation of the Helmholtz photochemical excitations into the Hering sensation responses is represented as a vector of general operators. The result is a mathematical framework encompassing traditional psychophysical and sensory scaling experiments. The theory is utilized to demonstrate that for many traditional (Class A) psychophysical observations, the physiological operator reduces to a linear (matrix) transformation. For static, uniform, focal stimulation, this reduction is seen to be the basis for earlier specific linear models of color vision. We also illustrate that static intensity-level effects (Bezold-Brücke hue shifts, unique hue invariance) can be modeled from the theory by power, but not logarithmic, intensity-level dependence for the sensation elements.

Color↗

Derivation of a rigorous equation for the calculation of the F-value in isothermal sterilization processes.

The use of simplified equations utilizing the Z- and F-values to calculate the level of sterilization achieved in isothermal processes is very common in industry. This method assumes that the Z-value is independent of temperature. This is a simplifying assumption that is not based on a physically realistic microbial inactivation model. In the present work the appropriate equations for the Z- and F-values were derived with kinetic theory and utilized to predict the level of sterility obtained during isothermal sterilization. The F-value obtained with the proposed equation was always higher than the F-value obtained when the simplifying assumption was made. Therefore, the use of the equation proposed here for the F-value results in more realistic and generous estimates of the lethal effect on microorganisms produced by isothermal sterilization processes. Tables of the F-values so obtained are provided.

Biotechnology↗

Brightening prospects for early cortical coding of perceived luminance: a high-density electrical mapping study.

Establishing the computational rules and neural substrates of brightness coding is a topic of both historical and contemporary interest. Two major classes of explanations for brightness illusions, such as brightness contrast, can be traced to Hering and Helmholtz. Hering's legacy is a low-level account in which brightness contrast results from obligatory lateral inhibitory interactions occurring at some level(s) in the visual system. Helmholtz offered a high-level account, positing a causal role for factors such as perceptual grouping, inferred illumination, and the extraction of surface properties such as orientation and reflectance. The tension between these theoretical viewpoints persists unabated to date. Intracranial electrophysiological recordings have revealed that brightness is represented in the firing rates of striate neurons, a fact consistent with low-level explanations. However, since the time-course of brightness-related responses relative to the onset of striate activity is undisclosed, it remains possible that striate activation might be temporally and causally secondary to higher-level computational processes. Knowledge of the timing of brightness-related neural activity is thus crucial to both constrain and adjudicate between these competing theories. We utilize high-density electrophysiological recording and a tachistoscopic brightness discrimination task to measure the time-course and scalp topography of brightness-related electrical potentials in human observers. Brightness perception is correlated with electrical activity at the earliest stages of visual cortical processing. These findings are interpreted to support Hering's low-level account of brightness for White's effect, and the results are discussed in the context of current theories of brightness perception.

Adult↗

Dynamic systems and inferential information processing in human communication.

Research in human communication on an ethological basis is almost obsolete. The reasons for this are manifold and lie partially in methodological problems connected to the observation and description of behavior, as well as the nature of human behavior itself. In this chapter, we present a new, non-intrusive, technical approach to the analysis of human non-verbal behavior, which could help to solve the problem of categorization that plagues the traditional approaches. We utilize evolutionary theory to propose a new theory-driven methodological approach to the 'multi-unit multi-channel modulation' problem of human nonverbal communication. Within this concept, communication is seen as context-dependent (the meaning of a signal is adapted to the situation), as a multi-channel and a multi-unit process (a string of many events interrelated in 'communicative' space and time), and as related to the function it serves. Such an approach can be utilized to successfully bridge the gap between evolutionary psychological research, which focuses on social cognition adaptations, and human ethology, which describes every day behavior in an objective, systematic way.

Biological Evolution↗

Theoretical interpretation of electronic absorption and emission transitions in 9-acridinones.

Stationary absorption, fluorescence excitation and fluorescence spectra for 9(10H)-acridinone, 9(10-methyl)-acridinone, 2-methyl-9(10-methyl)-acridinone, 2-nitro-9(10-methyl)-acridinone, 9(10-ethyl)-acridinone and 9(10-phenyl)-acridinone dissolved in 1,4-dioxane, methyl alcohol or acetonitrile, as well as the available spectral characteristics reported by others were compared with those predicted theoretically at the semi-empirical PM3/CI (including the solvent effect within the COSMO model) or PM3/S levels of theory, in order to interpret spectral features of the compounds, i.e. the energies and probabilities of S0-->Sn, S0-->T1, T1-->T2, S1-->S0, T1-->S0 and S1-->T1 transitions. Calculations at the PM3 and PM3/CI levels of theory enabled the structural changes accompanying S0-->S1, S1-->T1 and T1-->S0 transitions to be investigated; they yielded, moreover, basic physicochemical characteristics of the molecules in the ground and excited electronic states. Theoretically predicted dipole moments and charge distributions in the S0, S1 and T1 states provided further insight into the nature of electronic transitions in 9-acridinones. The predicted characteristics correlate quite well with the available experimental ones, thus providing confirmation of the utility of theory in predicting the features of electronically excited molecules and interpreting the electronic transitions occurring in them.

Acridines↗

Mental economics and psychoanalytic theories of psychotic phenomena.

This paper describes the utility of the theory of mental economics (Freud, 1900) in explaining the phenomena that occur in the functional and organic psychoses. Wish (grandiose) delusions and thought disorders are the phenomena selected as illustrative. The paper also gives an account of how the pleasure principle provides the basis for a theory of psychopathogenesis. The viability of the economic theory is discussed. It is contrasted with the psychopathological theories of Klein, Fairbairn, and Kohut.

Humans↗

From theory to perioperative practice with Parse.

The operating room nurse today is often thought of as a task skilled, highly technical, process oriented, and efficient member of the operating room team. Too often her/his nursing education and preparation in practice, theory and discipline are overlooked. Perioperative nursing as a specialty is an important, vital factor in the success of the planned surgical intervention. Perioperative nursing practice involves caring for the patient; it is patient-centered rather than task oriented. The RN combines both the physiologic and psychosocial aspects of nursing in delivery of care. This is reflective of the theoretical model used to plan effective nursing care. The RN interacting with the preoperative patient has a focus on being in true presence with the patient (Parse, 1987). The interrelationship sets in motion utilization of theory, reflecting nursing knowledge and practice.

Human Development↗