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This comment on Persinger's paper published in this journal in 1994 includes 4 studies not cited by Persinger. Each supports the inference of better health of those who practice Transcendental Meditation.
Files on all 48 Alberta patients under Warrants of the Lieutenant Governor were reviewed in late 1984, early 1985. Few were on Warrant as a result of unfitness to stand trial and all carried a primary diagnosis involving major mental disorder. More than half were considered paranoidal. Two-thirds of the population had killed someone or attempted to do so. Only eight had not previously been inpatients in psychiatric hospitals. Nearly half of the patients offended against relatives. Close to two-thirds had a previous criminal record. The Alberta Hospital's Forensic Service is described as is the province's Board of Review. Two brief case studies help portray the system of gradual release. The authors comment on the design of services for this group of patients known to be hard to treat and administer.
BACKGROUND: The habitual "any other comments" general open question at the end of structured questionnaires has the potential to increase response rates, elaborate responses to closed questions, and allow respondents to identify new issues not captured in the closed questions. However, we believe that many researchers have collected such data and failed to analyse or present it. DISCUSSION: General open questions at the end of structured questionnaires can present a problem because of their uncomfortable status of being strictly neither qualitative nor quantitative data, the consequent lack of clarity around how to analyse and report them, and the time and expertise needed to do so. We suggest that the value of these questions can be optimised if researchers start with a clear understanding of the type of data they wish to generate from such a question, and employ an appropriate strategy when designing the study. The intention can be to generate depth data or 'stories' from purposively defined groups of respondents for qualitative analysis, or to produce quantifiable data, representative of the population sampled, as a 'safety net' to identify issues which might complement the closed questions. SUMMARY: We encourage researchers to consider developing a more strategic use of general open questions at the end of structured questionnaires. This may optimise the quality of the data and the analysis, reduce dilemmas regarding whether and how to analyse such data, and result in a more ethical approach to making best use of the data which respondents kindly provide.
BACKGROUND: Assessment, as an inextricable component of the curriculum, is an important factor influencing student approaches to learning. If assessment is to drive learning, then it must assess the desired outcomes. In an effort to alleviate some of the anxiety associated with a traditional discipline-based second year of medical studies, a bonus system was introduced into the Histology assessment. Students obtaining a year mark of 70% were rewarded with full marks for some tests, resulting in many requiring only a few percentage points in the final examination to pass Histology. METHODS: In order to ascertain whether this bonus system might be impacting positively on student learning, thirty-two second year medical students (non-randomly selected, representing four academic groups based on their mid-year results) were interviewed in 1997 and, in 1999, the entire second year class completed a questionnaire (n = 189). Both groups were asked their opinions of the bonus system. RESULTS: Both groups overwhelming voted in favour of the bonus system, despite less than 45% of students failing to achieve it. Students commented that it relieved some of the stress of the year-end examinations, and was generally motivating with regard to their work commitment. CONCLUSIONS: Being satisfied with how and what we assess in Histology, we are of the opinion that this reward system may contribute to engendering appropriate learning approaches (i.e. for understanding) in students. As a result of its apparent positive influence on learning and attitudes towards learning, this bonus system will continue to operate until the traditional programme is phased out. It is hoped that other educators, believing that their assessment is a reflection of the intended outcomes, might recognise merit in rewarding students for consistent achievement.
Bruhn (1978) has offered some comments about criteria for CHAMPUS reimbursement. These criteria are CHAMPUS-specific and subject to modification for other health plans. Deviations are subject to peer review and may be approved for reimbursement. Expert opinion is widely solicited to justify the criteria.
Interest in psychotherapy integration, which has developed into an ongoing movement in the past decade or two, now appears to be capturing the interest among therapists and researchers in the clinical child area. The articles in this section deal specifically with the integration of basic research on language and cognition into the clinical arena, and the complementary use of concepts and interventions from different schools of thought. In commenting on these contributions, I have underscored the importance of using a broader historical and conceptual perspective, so that we can advance, rather than rediscover, what we already know.
Comments on Tennant's article: What is a tumor promoter? [Editorial]. Environ Health Perspect 107:A390-A391 (1999).
Comments on Elwood's article: A critical review of epidemiologic studies of radiofrequency exposure and human cancers. Environ Health Perspect 107(suppl 1):155-168 (1999).
Summary comments on the psychosocial aspects of the International Conference on Radiation and Health highlighted the issues that were salient in the conference. There was a broad consensus that long-term psychosocial effects may turn out to be the most significant source of morbidity. In addressing health concerns there is a need to consider psychological responses, as they may be the source of the high rate of morbidity and use of health services. The public's response to radiation is one of anxiety, fear, and concerns about lack of control over modern technology. Aside from stress there may be alternative mechanisms that explain the high rates of morbidity, such as direct biological effects of radiation on the cardiovascular system. The issue of social stigma is not addressed in most studies of affected populations but may be a potent social force. There is a need for concerned scientists to reach a better consensus about the health effects of radiation and to communicate effectively with the lay public. We need more cross-cultural research on psychosocial aspects and how to more effectively help affected populations. There are auspicious beginnings in this direction.
Implementation of the Medicare Modernization Act (MMA) of 2003 poses challenges for policy makers and administrators, not the least of which is a provision that high-risk or targeted beneficiaries receive Medication Therapy Management (MTM) Services. To ensure that Congressional intent is carried out when Medicare Part D goes into effect in January 2006, the Centers for Medicare & Medicaid Services (CMS) is responsible for issuing regulations to operationalize MTM Services. This article comments on the policy and practice implications of providing such services, including recommendations of the American Society of Consultant Pharmacists (ASCP) and presents findings from the Medication Management Model and other community-based Pharmacist-centered interventions as examples of solutions to improve medication management and prevent medication-related problems in Medicare beneficiaries.
Antineutrophil cytoplasmic antibody (ANCA) tests are used to diagnose and monitor inflammatory activity in Wegener granulomatosis, microscopic polyangiitis and its renal-limited variant (pauci-immune crescentic glomerulonephritis), and Churg-Strauss syndrome. The International Consensus Statement on testing and reporting of ANCA states that ANCA are demonstrated most readily in these conditions by using a combination of indirect immunofluorescence (IIF) of normal peripheral blood neutrophils and enzyme-linked immunosorbent assays (ELISAs) that detect ANCA specific for proteinase 3 or myeloperoxidase. The group that produced the International Consensus Statement has developed guidelines for the corresponding quality control activities, examples of comments for various IIF patterns and ELISA results, and recommendations for ANCA testing when inflammatory bowel disease and other nonvasculitic ANCA-associated autoimmune diseases are suspected.
Diagnostic criteria for subtypes of delusional beliefs based upon content have rarely been the subject of comment. In this article, several influential accounts of persecutory delusions are reviewed; differences and difficulties are noted, and their potential effect on cognitive psychological investigations discussed. One method of ensuring that researchers study similar phenomena is to use a more detailed definition than currently available, and therefore a new set of criteria is offered. Finally, related methodological problems in this emerging research area are highlighted. The issues discussed may stimulate further research on the content of delusional beliefs.
A coherence theory describing the formation of a hologram by an interesting new technique is presented to improve the theoretical treatment given by Schilling and Templeton [Appl. Opt. 40, 5474 (2001)]. Properties of the hologram pattern are discussed, and some comments are made on its reconstruction.
I comment on the recent paper by Setälä et al. [J. Opt. Soc. Am. A 18, 678 (2001)]. In that paper the calculation is entirely and exactly adopted from our previous work except the evanescent-field propagator. I shall demonstrate that the replacement of the propagator flaws the calculation. In their paper the numerical results show rich subwavelength information at absolute far-field distances (four times larger than the wavelength). I shall point out that the evanescent resolution at far-field distances cannot be of subwavelength. In the paper by Setälä et al. the description of previous work is inaccurate and misleading. I shall give what I consider to be the correct guidelines for readers to learn about the standing controversy regarding the evanescent field of a dipole.
A recent study of the influence of the Goos-Hänchen shift on the imaging properties of planar optical systems is commented on. It is shown that the model chosen for a description of the Goos-Hänchen shift must be modified considerably and that there is one more shift in total reflection that will also influence the imaging quality.
In this communication, certain comments are made on the paper by Kostenbauder et al., "Eigenmode expansions using biorthogonal functions: complex-valued Hermite-Gaussians,"J. Opt. Soc. Am. A 14, 1780 (1997).
We acknowledge the earlier work cited by Ditchburn in his comment [R. W. Ditchburn, J. Opt. Soc. Am. A 4, 405-406 (1987).] and point out a crucial difference between that work and our novel approach [L. E. Arend and G. T. Timberlake, J. Opt. Soc. Am. A 3, 235 (1986)]. Our procedure provides measurements uncontaminated by residual errors of stabilization. The visual system's extreme sensitivity to small temporal changes and the indirectness of the evidence cited by Ditchburn leave the meaning of stabilized-image reappearance unclear.
Modern intensive monitoring of the fetus during labor affords the opportunity for the greatest possible safety to the infant, whilst at the same time dispensing with unnecessary operations to terminate labor which can be dangerous for the mother and her child. Developments over the past 28 years, since cardiotocography has been in clinical use, have unfortunately also been accompanied by confusion and mistakes. We think that there are two main reasons for this: I. Many who use cardiotocography have not assessed its efficiency correctly. Heart rate pattern with all their variations have too often been regarded as the only diagnostic criteria for the determination of fetal hypoxia. However this procedure only allows a rough selection of actually endangered fetuses. In more than 50% of the cases with a suspicious or pathologic cardiotocogram there is no concrete clinical evidence of manifest danger of hypoxia. II. Investigations concerning the practical importance of monitoring the fetus during labor were often not based on actual clinical indications. Attempts were made to prove that continuous electronic monitoring of the fetal heart rate could be replaced by simple traditional auscultation. Furthermore due to failure to appreciate the real efficiency of cardiotocography, this truly excellent method was in fact blamed for the faults arising from wrong interpretation, instead of underlining the lack of logic of the investigators concerned. After all, several prospective studies, that have examined the efficiency of various monitoring strategies, demonstrate the shortcomings of these techniques in the clinical setting and have shown them to have no relevance in every practice. Presently the most suitable way to monitor the fetus during labor is to combine cardiotocography with a biochemical method. At the moment fetal blood analysis is the most suitable test to be performed in cases where the cardiotocogram is not normal. Then the role of fetal blood analysis is to find out whether in fact a danger of hypoxia is threatened or not. Today the most urgent task when monitoring the fetus during labor is not so much to reduce the number of cases of cerebral palsy since these are seldom caused by intrapartum asphyxia. The major objective is now recognised to be to prevent early morbidity of the fetus, newborn, and the consequences that flow from this. The excellent results of combined intensive monitoring of the fetus during labor are particularly well illustrated by the intrapartum mortality in our hospital during different periods when monitoring practice has been progressively and methodically improved by stages. During the period when monitoring consisted of simple auscultation used on its own, the intrapartum mortality was 0.56%. After the introduction of fetal blood analysis--at that time cardiotocography did not yet exist--the mortality sank to 0.32%. During the first ten years of cardiotocography combined with fetal blood analysis the mortality reduced further to 0.17%, and during the following 13 years it reached to a minimal level of 0.4%. Finally, in this review, other aspects are commented on such as oximetry. Oximetry, presently used as pulse oximetry, as an additional biochemical method will possibly be incorporated as the third method of monitoring the fetus during labor. Oximetry could also be used as an automatic alarm system in the labor ward when fetal O2 levels drop below a particular limit to draw the attention of the staff to the case concerned. Up to now this has not been convincingly achieved with the use of cardiotocography.