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PubMed1994

Dungeons and Dragons: the use of a fantasy game in the psychotherapeutic treatment of a young adult.

A schizoidal young man made a methodical attempt at suicide. He revealed a paucity of object attachments leading to profound isolation. His early upbring led him to extreme isolation of affect and a fear of fragmentation. His inner life was not safely reachable by conventional therapy. After he became involved in playing a fantasy game, Dungeons and Dragons, the therapy was modified to use the game material as displaced, waking fantasy. This fantasy was used as a safe guide to help the patient learn to acknowledge and express his inner self in a safe and guided way. The patient ultimately matured and developed healthier object relations and a better life. The theoretical underpinnings of this process are explored, both in dynamic terms and in terms of the biologic correlation and equivalence of dreams and waking fantasy. The utility of this game as a vehicle for treatment of selected individuals is discussed.

Adult↗
PubMed1999

Structured teaching methods enhance skill acquisition but not problem-solving abilities: an evaluation of the 'silent run through'.

OBJECTIVES: We aimed to evaluate whether a structured teaching technique (the silent run through) was of benefit in the learning of a skill sequence, and whether it would affect students' ability to improve their problem-solving skills or ability to make judgements. DESIGN: Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills, by raters blind to the teaching techniques the students had received. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: Students who received the structured teaching were significantly better at reproducing a complex, sequential clinical skill (examination of a squint). There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station. Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills. CONCLUSIONS: This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning. In particular, a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal 'commentary' may be an effective way of teaching the sequential motor components of complex clinical skills.

Clinical Competence↗
PubMed1998

Attachment and feeding problems: a reexamination of nonorganic failure to thrive and attachment insecurity.

OBJECTIVE: To examine the relationship between attachment patterns, degree of security, and feeding problems. METHOD: Three groups of toddlers (age range = 12-37 months) were included: toddlers with infantile anorexia (n = 33), picky eaters (n = 34), and healthy eaters (n = 34). Participants in each group were matched for age, socioeconomic status, gender, and ethnicity. Attachment patterns and degree of attachment security were assessed through the Ainsworth Strange Situation. RESULTS: The infantile anorexia group exhibited a higher rate of insecure attachment relationships than the picky eater and healthy eater groups. When measured on a continuous scale, the infantile anorexia group also displayed a higher degree of insecurity than the other groups. Contrary to previous research, elevated rates of type D attachments were not present within the infantile anorexia group. CONCLUSIONS: Feeding problems and growth deficiencies can occur within the context of organized and secure attachment child-parent relationships. However, insecure attachment relationships may intensify feeding problems and may lead to more severe malnutrition. Implications for the treatment of specific feeding problems are discussed.

Analysis of Variance↗
PubMed2006

Effect of pierced metallic objects on SAR distributions at 900 MHz.

A study of the interaction between mobile phone antennas and a human head in the presence of different types of metallic objects, attached and pierced to the compressed ear, is presented in this article. Computed and measured results have been performed by considering a quasi-half-wavelength dipole as the radiating source and measurements with the DASY4 dosimetric assessment system. Two different human head models have been implemented: a homogeneously shaped sphere and a three-level head model with four different kinds of tissue. Antenna input impedance, reflection coefficient, radiation patterns, SAR distribution, absorbed power, and peak SAR values have been computed and measured for diverse scenarios, electromagnetic simulators, and organs. Despite the measuring accuracy limitations of the study, both simulated and measured results suggest that special attention has to be paid to peak SAR averaged values when wearing metallic objects close to the radiation source, since some increment of peak SAR averaged values is expected.

Cell Phone↗
PubMed1986

Considerations in the treatment of the adult blind patient.

This paper contends that blindness is not a single clinical determinant, but, rather, that there are two groups of blind people for whom the treatment considerations are quite different. For those congenitally blind, lack of vision can cause developmental difficulties, e.g., impairments in human attachment, object permanence, and self-representation. For those who later acquire blindness, the premorbid psychodynamics and object relationships are most important in understanding the person's reactions to his/her disability. Two adult cases are presented to illustrate these phenomena in the context of psychotherapy.

Adult↗
PubMed2005

Frameless versus classical intrauterine device for contraception.

BACKGROUND: The frameless intrauterine device (IUD) dispenses with the frame in the classical IUD and holds the device in the uterus by anchoring one end of a nylon thread in the fundal myometrium, to which copper sleeves are attached. OBJECTIVES: This review examines the hypothesis that the frameless IUD Gynefix reduces risk of expulsion and pregnancy, and the problems of bleeding and pain necessitating early removal. SEARCH STRATEGY: We searched the Cochrane Controlled Trial Register (Cochrane Library Issue 2, 2004), MEDLINE, and Popline from 1980 to March 2004, and reference list of articles. SELECTION CRITERIA: We selected for the review randomised trials that compared the frameless device to a classical framed device for contraception. DATA COLLECTION AND ANALYSIS: Both authors extracted data independently. We contacted study author for additional data. We calculated rate ratios and rate differences for cumulative rates for each outcome at yearly intervals. We used the inverse variance-based method to combine trials, and tested the results for heterogeneity. MAIN RESULTS: Four trials were included in the review involving 5,939 women randomised to either a frameless device or TCu380, with data up to eight years for the largest, and with a total experience of 23,180 years. Apart from one small trial, nulliparous women were excluded from the trials. The two earlier trials used a prototype introducer and there was a higher expulsion rate at one year (relative risk 2.48, 95% confidence intervals 1.89 to 3.26). However, between two and six years in the large WHO trial the risk of pregnancy was lower with the frameless device (relative risk 0.53, 95% confidence intervals 0.32 to 0.91). In a recent trial using GyneFix with a new introducer early expulsions and pregnancies were not statistically different from the control device. Removals rates for excessive bleeding and/or pain were no different between the devices (relative risks 0.92, 95% confidence intervals 0.74 to 1.14, at one year and 1.13, 0.93 to 1.37, at six years). There was a tendency towards fewer removals for pain in early years but no difference at six years (relative risk 1.13, 95% confidence intervals 0.93 to 1.37). AUTHORS' CONCLUSIONS: There is insufficient data to show that problems of early expulsions have been overcome with the modified introducer used in GyneFix. Apart from that, the frameless device performs similarly to TCu380, and appears to have a lower pregnancy rate in later years, although the absolute difference is small.

Contraception↗
PubMed1999

Social influences on endocrine activity in guinea pigs, with comparisons to findings in nonhuman primates.

Guinea pigs exhibit a rich and varied social organization. Studies in recent years have demonstrated that social stimuli have widespread neuroendocrine effects in guinea pigs. Here, effects on the hypothalamic-pituitary-adrenal, adrenal medullary/sympathetic, and hypothalamic-pituitary-gonadal systems of both adult and developing guinea pigs are reviewed. These systems respond to various social variables, or factors that affect social variables, including: separation from attachment objects, housing conditions, changes in housing, the familiarity of the environment in which social interactions occur, foraging conditions, surrogate-rearing, agonistic interactions, and the establishment of dominance rank. Similarities and differences between these findings and those in nonhuman primates are discussed. It is argued that the guinea pig is well suited for the study of socioendocrine effects throughout the life span, and can provide a valuable complement to nonhuman primate research in this area.

Animals↗
PubMed2000

Activation of mitogen-activated protein kinase through alpha5/beta1 integrin is required for cell cycle progression of B progenitor cell line, Reh, on human marrow stromal cells.

OBJECTIVE: Attachment to bone marrow (BM) stromal cells is crucial for the normal growth and development of B-cell progenitors (pro-B). However, the molecular mechanisms by which contact facilitates the proliferation of pro-B cells are not completely understood. This study was performed to investigate this interaction. MATERIALS AND METHODS: A model pro-B cell line (Reh) and a human BM stromal cell line (KM102) were used. Flow cytomery was used for cell cycle analysis. Western Blotting and immunoprecipitation were utilized to examine the levels of cyclin-dependent kinase (cdk) and p27(Kip1). RESULTS: Attachment to both KM102 and normal BM stromal cells significantly promoted the growth of Reh cells. Pretreatment of Reh cells with anti-integrin beta1 or alpha5 monoclonal antibody (mAb), but not alpha4 or ICAM-1 mAb, abrogated this enhancement of proliferation. Furthermore, stroma attachment resulted in shortening of the G(1) phase of cell cycle, significant increases cdk2 activity, degradation of cdk inhibitor p27-GST protein, and decrease in levels of p27(Kip1) protein. In addition, solid-phase cross-linking of alpha5 via immobilized antibody also resulted in extracellular signal-regulated (ERK)-2 kinase phosphorylation, increase in cdk2 activity, decrease in levels of p27(Kip1) protein, and enhanced proliferation that was inhibited by treatment with PD98059, a specific ERK inhibitor. CONCLUSION: Integrin alpha5beta1-mediated stroma contact promotes the proliferation of B-cell progenitors through the activation of ERK-2, which in turn modulates cell cycle regulation machinery including induction of cdk2 activity and degradation of p27(Kip1) and contributing to acceleration of the G(1) phase of cell cycle progression.

B-Lymphocytes↗
PubMed1989

Factors influencing cortisol and behavioral responses to maternal separation in guinea pigs.

Infant guinea pigs recently were found to respond to brief maternal separation with an increase in plasma cortisol levels. The present experiments were conducted to further characterize this response and compare it with the cortisol separation response previously observed in primates. In Experiment 1, separation of guinea pig pups from their mothers did not elevate the plasma cortisol levels of the pups at either 30 or 180 min when they remained alone in their home cages during the separation. Experiment 2 showed that cortisol levels of pups placed alone in a novel cage were greater at 30, 90, and 180 min than were those of pups placed in the cages together with their mothers. In contrast, the separated pups vocalized more than did pups tested with their mothers during the initial 30 min only. In Experiment 3, pups raised on inanimate surrogates responded less intensely to rearing-figure separation in terms of both cortisol and vocalizations than did mother-reared controls. Taken together, these results indicate both differences (response to home cage separation) and similarities (dissociation of cortisol and vocalization responses, effect of surrogate separation) in the separation responses of guinea pig and primate infants. The guinea pig model may provide a useful adjunct to primate studies for examining particular issues concerning physiological effects of brief separation from an attachment object.

Animals↗
PubMed2002

Candida albicans adherence to resin-composite restorative dental material: influence of whole human saliva.

OBJECTIVE: Attachment of Candida albicans to oral surfaces is believed to be a critical event in the colonization of the oral cavity and in the development of oral diseases such as Candida-associated denture stomatitis. Although there is considerable information about the adhesion of C albicans to buccal epithelial cells and prosthetic materials, there is very little information about the adhesion of C albicans to composite restorative materials. The purpose of this study was to investigate the degree of adhesion of C albicans to a resin-composite restorative material (Herculite). METHODS: The adhesion of 2 strains of C albicans, a germinative and a germ tube-deficient mutant, was studied by a visual method after incubating the fungus and the resin with and without human whole saliva. RESULTS: In absence of saliva, the adhesion of the C albicans germinative isolate to the resin showed an increase in parallel with the germination, reaching a maximum at the end of the experiment (120 minutes). However, no significant differences were observed in the adhesion of the agerminative mutant during the period of time studied. In the presence of saliva, the adhesion of both isolates to the resin was significantly lowered. CONCLUSION: Germination and the presence of human whole saliva are important factors in the adhesion of C albicans to the resin-composite restorative material Herculite.

Analysis of Variance↗
PubMed1998

"Full recovery" from schizophrenia in the long term: a ten-year follow-up of eight former schizophrenic patients.

The present study reports longitudinal data on individuals who ten years ago were fully recovered from a previously diagnosed schizophrenia. Seven out of ten subjects consented and were reexamined at the present follow-up, and data on an eighth subject was secured elsewhere. A semistructured interview was used to examine psychosocial functioning of the subjects in the follow-up period. Out of the six subjects with a confirmed diagnosis of schizophrenia, only three subjects were still fully recovered; one had a deteriorating course and two had a fluctuating course of illness. The results from the study indicate that recovery from schizophrenia may take the form of time-limited remissions for half of the reexamined subjects when strict criteria for full recovery are used. Protective factors such as willpower, a (partly) intact capacity for object attachment, and a supportive family may be important prerequisites for recovery. Two different courses of schizophrenia are illustrated by cases.

Adult↗
PubMed2001

The use of SPAMM to assess spatial distortion due to static field inhomogeneity in dental MRI.

In planning placement of dental implants using MRI, a SPAMM (spatial modulation of magnetization) magnetization preparation sequence was incorporated into a spin-echo imaging sequence. A phantom was imaged with a ferromagnetic object attached. Spatial distortion due to deviations in Larmor frequency was detected by a deviation of SPAMM lines. Both SPAMM line deviation and interline spacing were found to agree with a deltaB0 map generated from phase images. Imaging of a volunteer with and without typically used metallic implants positioned in a template showed SPAMM line deviations to correlate with expected deviations in vivo. SPAMM lines showed possible distortion due to chemical shift in the bone marrow and the presence of titanium implants to be insignificant. SPAMM may thus be used to provide a qualitative estimate of the accuracy of the MRI image when planning dental implants.

Calibration↗
PubMed1999

Homesickness in preadolescent and adolescent girls: risk factors, behavioral correlates, and sequelae.

Examined homesickness in 117 girls ages 8 to 16 during a 2-week stay at summer camp. (Homesickness is the distress or impairment caused by an actual or anticipated separation from home. It is characterized by acute longing and preoccupying thoughts of home and attachment objects.) Elevated preseparation levels of homesickness, high expectations of homesickness, negative separation attitudes, low decision control, and little previous separation experience predicted in-camp levels of homesickness. During the separation, homesickness was associated with insecure interpersonal attitudes, negative initial impressions of the novel environment, high perceived distance from home, and low perceived control. Female surrogate caregivers rated homesick girls as having lower social status and more somatic complaints, social problems, and externalizing behavior than less homesick girls. Although the prevalence, intensity, and longitudinal course of homesickness in girls did not differ from analogous samples of boys, girls' profile of risk factors, correlates, and sequelae is unique in its mixed behavioral presentation and small correlations with age and experience.

Adolescent↗
PubMed2004

Regionalization in Canada: a promising heritage to build on.

Regionalization has been a major policy experiment in Canadian healthcare. Objectives attached to this policy were ambitious and somewhat unrealistic. Regional health authorities have shown that they can play a useful role in implementing healthcare reform. However, their legitimacy is difficult to sustain, and they need to renew their roles in order to remain a valuable asset in the improvement of healthcare delivery. A model of leadership for RHAs based on content and process dimensions is proposed to support the development of their role in improving the delivery of care. RHAs need to depart from a too distant mode of managing healthcare and support more healthcare organizations in their search for innovative ideas and organizing models and strategies. By adopting such an approach to their roles, it is expected that RHAs will further contribute to the improvement of healthcare and consequently will gain legitimacy to develop more autonomous policies with regard to broad ideals such as democratization and health improvement.

Canada↗
PubMed2004

Three-dimensional polarimetric integral imaging.

A three-dimensional (3D) polarimetric image sensing and display technique based on integral imaging is proposed. Three-dimensional polarization distribution of reflected light from a 3D object can be measured as elemental image arrays by a rotating linear polarizer. After the measurement of the polarization of the 3D object, the 3D polarimetric object can be reconstructed optically by displaying the polarization-selected elemental images in spatial light modulators with two quarter-wave plates. Experimental demonstration of 3D polarimetric imaging of a 3D object attached to two orthogonal linear polarizers is presented. To the best of our knowledge, this is the first report on 3D polarimetric sensing imaging and 3D optical reconstruction by integral imaging.

Journal Article↗
PubMed2007

Preventing and treating homesickness.

Homesickness is the distress and functional impairment caused by an actual or anticipated separation from home and attachment objects such as parents. It is characterized by acute longing and preoccupying thoughts of home. Almost all children, adolescents, and adults experience some degree of homesickness when they are apart from familiar people and environments. Pediatricians and other health care professionals are in a unique position to assist families in understanding the etiology, prevention, and treatment of homesickness. In the case of planned separations, such as summer camp, techniques are provided that may aid in prevention. In the case of unanticipated or traumatic separations, such as hospitalization, effective treatment strategies are available.

Adolescent↗
PubMed1990

Facilitating growth and development: a paradigm case for modeling and role-modeling.

This article describes an example of a paradigm case for the nursing theory of modeling and role-modeling. A synthesis of the mid-range theoretical linkages of basic need satisfaction, object attachment, and growth and developmental processes derived from the theory and paradigm are described. These theoretical linkages guide the assessment, implementation, and evaluation of the nursing care and provide the basis for describing the dynamic nurse-client relationship.

Adult↗