Interpersonal attraction and direct–indirect supervisor influence as predictors of counselor trainee effectiveness.

Examined the process of supervision as a sample of the social influence model by assessing the effect of counselor trainees' (CTs) interpersonal attraction to their supervisors (SUs) and the SU's style of influence as determinants of CT effectiveness. An experimental design was used, with 3 measures of the dependent variable CT effectiveness: clients' and SUs' perceptions of client outcome and SUs' perceptions of CT effectiveness on the Counselor Evaluation Rating Scale. Results of statistical analyses show that CTs who were attracted to their SUs were rated as more effective by SUs on 2 measures, although attraction was not related to clients' perceptions of outcome. A direct style of supervision was related to CT effectiveness, but on only 1 of 3 measures of the dependent variable. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of the microbiology laboratory in monitoring and identifying resistance: use of molecular biology

Antimicrobial resistance is an increasing problem in the United States. Early detection of emerging trends in antimicrobial resistance may facilitate implementation of effective control measures. Most antimicrobial susceptibility testing is qualitative, in that it categorizes isolates as susceptible, intermediate, or resistant. This approach is relatively inexpensive and generally adequate for clinical purposes. Qualitative susceptibility testing has some limitations for monitoring for emerging resistance. Selective quantitative susceptibility testing may be useful in detecting early trends toward elevated minimal inhibitory concentrations. Molecular methods have a role also in characterizing mechanisms of resistance and in the typing of resistant strains to determine patterns of spread. Laboratory monitoring of emerging resistance must be associated with an effective infection control policy and a willingness to modify practice in a rational manner based upon the trends detected.     

Implementing a comprehensive program for the prevention of conduct problems in rural communities: the Fast Track experience. The Conduct Problems Prevention Research Group

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

The interpreter in an intercultural clinical milieu

This article serves as a primer for those beginning clinical research in complementary and alternative medicine. The authors provide a basic overview of important experimental design and statistical issues, of which clinical researchers in the area of complementary and alternative medicine must be aware when attempting to demonstrate the effectiveness of particular treatment modalities. As the article suggests, science is an inferential process, and experimental investigations can vary greatly in methodological integrity. Key concepts in clinical outcome research such as internal validity, statistical conclusion validity, and the appropriate measurement and operational definitions of outcomes are discussed. New scientific approaches that are evolving because of paradigm shifts in science (e.g., chaos theory) are also reviewed. Suggestions are provided to further develop an understanding of clinical outcome research methodology.     

Estimating the nonlinear and interactive effects of latent variables.

Describes a procedure that enables researchers to estimate nonlinear and interactive effects of latent variables in structural equation models. Given that the latent variables are normally distributed, the parameters of such models can be estimated. To do this, products of the measured variables are used as indicators of latent product variables. Estimation must be done using a procedure that allows nonlinear constraints on parameters. The procedure is demonstrated in 3 examples. The 1st 2 examples use artificial data with known parameter values. These parameters are successfully recovered by the procedure. The final complex example uses national election survey data. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraabdominal polymicrobial infection due to antimicrobial resistant anaerobes

Successful treatment of surgical infections includes both the implementation of careful operative technique and the choice of appropriate antimicrobial agent. Because of advances in the techniques used for anaerobic specimen collection and culture, anaerobic bacteria are now predominantly recovered from a variety of intra-abdominal and post-operative soft tissue infection. Furthermore, some anaerobes including Bacteroides and Prevotella, like some aerobic bacteria, have acquired resistance to the commonly used antimicrobial agent. The underestimation of resistant anaerobes other than Bacteroides in infective sites may lead to incorrect choices of antimicrobial agent for empirical therapy and thus to clinical failures of therapy. Surgeons should be more interested in the polymicrobial infecting flora to improve the clinical outcome of such infections.     

Efficacy of a brief worksite intervention to reduce smoking: The roles of behavioral and implementation intentions.

The effectiveness of worksite interventions to reduce smoking needs to be enhanced because randomized controlled trials to date have produced mixed findings. The present study tested the ability of social-cognitive variables to mediate the past behavior-future behavior relationship and the effectiveness of implementation intentions to break the past behavior-future behavior relationship in a brief theory-based worksite intervention designed to reduce smoking. Smoking behavior and psychosocial orientation to quit (operationalized by theory of planned behavior variables and temptations) were measured at baseline; participants (N=90) randomized to the experimental condition were also asked to form an implementation intention in their place of work. Identical measures taken 2 months postbaseline revealed that intention was a potent mediator of the past behavior-future behavior relationship. More important, significantly more people quit smoking in the experimental condition than in the control condition. Decomposition of these effects showed that implementation intentions worked best for individuals who were more motivated to quit at baseline and suggest that harnessing both motivational and volitional processes might enhance the effectiveness of worksite smoking cessation programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simultaneous Design and Control of Stiffened Laminated Composite Structures

The problem investigated here concerns the simultaneous design and control of structures. The structure considered is a laminated stiffened composite plate for which an optimum control system is designed by the minimization of an appropriate performance index with respect to both the control forces and structural design variables consisting of stiffener areas and the number of plies of a given orientation. To ensure a physically realistic structure appropriate constraints on the stiffener sizes, total weight, and structural frequencies are imposed. Nonlinear mixed‐integer programming is used to force the number of plies to take on integral values. The entire problem is posed as a three‐level optimization problem. Using the well‐known independent modal space control method, effects of plate geometry, initial disturbance conditions, and control effort penalty parameters on the optimal design are considered. The minimization process requires derivatives of eigenvalues and eigenvectors with respect to the design variables. These derivatives can be computed by an involved analytical procedure or a relatively simple finite‐difference procedure. This paper also examines the computer cost‐effectiveness of these two procedures for the sensitivity‐derivative calculations.     

Radial glia and cell debris removal during lesion-regeneration of the lizard medial cortex

By challenging the efficiency of some of our most useful antimicrobial weapons, bacterial antibiotic resistance is becoming an increasingly worrying clinical problem. A good antibiotic is expected to exhibit a high affinity for its target and to reach it rapidly, while escaping chemical modification by inactivating enzymes and elimination by efflux mechanisms. A study of the behaviour of a beta-lactamase-overproducing mutant of Enterobacter cloacae in the presence of several penicillins and cephalosporins showed that the minimum inhibitory concentration (MIC) values for several compounds were practically independent of the sensitivity of the target penicillin binding protein (PBP), even for poor beta-lactamase substrates. This apparent paradox was explained by analysing the equation that relates the antibiotic concentration in the periplasm to that in the external medium. Indeed, under conditions that are encountered frequently in clinical isolates, the factor characterizing the PBP sensitivity became negligible. The conclusions can be extended to all antibiotics that are sensitive to enzymatic inactivation and efflux mechanisms and must overcome permeability barriers. It would be a grave mistake to neglect these considerations in the design of future antibacterial chemotherapeutic agents.     

Efficacy of Biofilms under Toxic Conditions

Response of biofilms to toxic compounds has been modeled using Monod-type inhibition kinetics. Biofilm inhibition due to substrate, secondary substrate, and product is considered. For biofilm inhibition due to substrate and secondary substrate with high inhibitory substances, the model predicted the biofilm effectiveness factor to be higher than unity. On the other hand, for slightly inhibitory substances, substrate limitations within the biofilm due to mass transfer resistance resulted in a reduction in biofilm effectiveness factor as its thickness increased. In case of product inhibition, the effectiveness factor of the biofilm was always lower than one due to accumulation of product leading to higher concentrations within the biofilm than in the bulk. The generalized models developed for effectiveness factors under various conditions of inhibition can be used as a predictive tool in design of wastewater treatment systems.     

Cognitive-behavioral treatment for adolescent pathological gamblers

This study evaluated the effectiveness of a cognitive-behavioral treatment for adolescent pathological gamblers. Perception of control and severity of the problem served as dependent variables. Four adolescent pathological gamblers meeting DSM-III-R criteria were treated in a multiple baseline design across individuals. Results showed clinically significant changes for all subjects; they remained abstinent at 1-, 4-, and 6-month follow-ups. The clinical implications of these results are discussed.     

Needs assessment and implementation of an employee assistance program: promoting a healthier work force

1. The functions of a continuous quality improvement tool used by Deming--the Plan, Do, Check, Act Cycle--can be applied to the assessment, implementation, and ongoing evaluation of an Employee Assistance Program (EAP). 2. Various methods are available to assess the need for an EAP. As much data as possible should be collected to qualify and quantify the need so that management can make an informed decision and develop measures to determine program effectiveness. 3. Once an EAP is implemented, it should be monitored continually against the effectiveness measures initially developed. Using a continuous quality improvement process, the occupational health nurse and the EAP provider can establish a dynamic relationship that allows for growth beyond the original design and increased effectiveness of service to employees.     

The desensitization of oxytocin receptors in human myometrial cells is accompanied by down-regulation of oxytocin receptor messenger RNA

Clinicians providing care to elderly patients must appreciate the subtle clinical manifestations that herald the onset of life-threatening infectious disease. Aged patients with an infection may have neither fever nor leucocytosis, making diagnosis challenging. Often, the early features of infectious disease are nonspecific and may resemble inflammatory or neoplastic processes, or there may be insufficient time to await definitive laboratory confirmation, and empirical antimicrobial treatment must be initiated. Aging involves inevitable deleterious alterations in biological processes and, in many elderly patients, this is most strongly characterised by diminished renal functional capacity. This has a major influence on antimicrobial prescribing in the elderly, because therapeutic efficacy must be achieved while minimising the risk of drug-related toxicity. Before prescribing an antibiotic to an aged patient with an infection, the clinician must be cognisant of the patient's drug allergy history and the other drugs that the patient is taking. Ignorance of potential drug-drug interactions can result in ineffective treatment or enhanced toxicity. The therapy of elderly patients with infections is being expanded. To reduce costs and enhance the efficiency of care, systems have been developed to provide antimicrobial care in the home and in long term care facilities. Home healthcare has burgeoned, and drugs that are well tolerated, have a broad spectrum of activity and are simple to administer (e.g. ceftriaxone and fluoroquinolones) appear to be eminently suitable for this therapeutic role. Physicians must also be informed of the factors responsible for the emergence of resistant bacteria that are contributing to infections in institutional and community settings. Clinicians should strive to curb inappropriate antibiotic use to stem the tide of infections that are caused by multidrug-resistant bacteria.     

Influence of foods on the absorption of antimicrobial agents]

Understanding the interaction between foods and antimicrobial agents is an aspect of therapy which may have an important clinical repercussion, which is why it must not be forgotten. This study reviews the interactions of foods with the anti-microbial agents which occur at the level of absorption, considering the mechanisms involved. The food-drug interaction can cause an increase, a decrease, or a delay in the bio-availability of the anti-microbial agents; foods may have no affect on the absorption of the anti-microbial agents, or they may improve the gastrointestinal tolerance. The Food and Drug Administration's bioequivalency criteria for considering whether or not there is an alteration in absorption have an orientative function, as generally all studies are conducted on healthy volunteers, but in clinical practice one must consider the physiological and pathological condition of the patient. The composition of the diet as well as the volume of liquid administered are other aspects which should be considered, as these may exert a different effect depending on the type of drug. After ingesting fatty foods, there is an increased absorption of albendazole, griseofulvin, itraconazole, and mebendazole. All foods but especially carbohydrates reduce the absorption of isoniazide. Among the anti-HIV drugs, the following must be administered on an empty stomach: didanosine, indinavir zalcitabine , and zidovudine ; lamivudine can be administered either on an empty or on a full stomach, because although food delays the absorption, it does not affect the amount absorbed; the absorption of stavudine is not affected by foods; ritonavir should be administered together with tile meals, and saquinavir must be administered after ingestion of food. It is advisable to administer clarithromycin together with foods, and azythromycin on an empty stomach; the same holds true for perfloxacin and rifabutine as for lamivudine.     

The clinical use of hypnosis.

Reviews recent experimental evidence on the hypnotic treatment of obesity, cigarette smoking, alcoholism, clinical pain, warts, and asthma. It is concluded that although hypnosis may be effective with addictive behavior, the therapeutic success is attributable to nonhypnotic factors. In contrast, hypnosis appears to be of unique value in the treatment of clinical pain, warts, and asthma. Differential effectiveness may be attributable to the nature of the disorders or to the manner in which hypnosis is used in treating them. The relevance of hypnotizability to treatment is discussed, as is the need to distinguish between genuine and placebo-based hypnotic effects. It is concluded that future research must be more attentive to the (a) nature of the disorders and patient populations, (b) adequate implementation of therapeutic techniques, (c) context in which treatment is delivered, and (d) influence of hypnotic susceptibility and other S factors on outcome. (4? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immature chemodifferentiation of Purkinje cell synapses revealed by 5''-nucleotidase ecto-enzyme activity in the cerebellum of the reeler mouse

Data from child and adolescent emergency mental health screening episodes prior and subsequent to privatized Medicaid managed care in Massachusetts are used to investigate the relationship between payer source and disposition and to compare the match between clinical need and disposition level of care. Having Medicaid as the payer in the post-Medicaid managed care period decreased the odds of hospitalization by nearly 60%. None of the clinical need variables that contributed to hospitalization for Medicaid episodes in the pre-Medicaid managed care period were significant in the post-Medicaid managed care period. Multiple forces shaping professional standards, decision making, and quality of care are described. Public sector agencies must lay the groundwork for comprehensive evaluation prior to the implementation of privatized Medicaid managed care initiatives.     

基于乌鸦搜索算法的行星滚柱丝杠参数优化

针对行星滚柱丝杠结构参数匹配问题,提出一种基于乌鸦搜索算法的参数优化模型.考虑行星滚柱丝杠螺纹啮合点位置的影响,建立丝杠、滚柱以及螺母空间螺旋曲面方程,得到螺纹啮合点处位置与螺纹牙厚之间的关系.根据螺纹副和齿轮副啮合关系,确定内齿圈和滚柱端部轮齿设计参数.利用空间螺旋曲面方程,获得螺纹啮合点处的法向量,并推导行星滚柱丝杠各零件间的受力关系.以行星滚柱丝杠结构参数作为设计变量,以螺母外径、丝杠中径、滚柱长度等参数最小为优化目标,考虑行星滚柱丝杠结构约束和主要承力部件强度约束,利用乌鸦搜索算法作为优化算法,建立行星滚柱丝杠参数优化模型,从而实现优化变量最佳匹配.最后,针对三种负载,利用该优化模型得到三组行星滚柱丝杠结构参数,并将其优化结果与国外产品手册进行对比,从而验证了本文优化模型有效性.     

Urinary tract infection in urology, including acute and chronic prostatitis

Heightened awareness of patients with increased risk for severe or potentially severe UTIs is paramount for early diagnosis and treatment. Urologic assessment of these patients is frequently necessary for cure and to prevent significant sequelae. Unresolved infections are usually caused by resistant bacteria and are treated by modification of therapy based on antimicrobial sensitivity testing. When unresolved bacteriuria is caused by organisms sensitive to the initial antimicrobial therapy, azotemia or a large bacterial mass density should be suspected. Recurrent infections at close intervals or with the same organism are usually caused by a bacterial focus in an acquired or congenital abnormality of the urinary tract, such as infection stones. The bacterial focus must be removed to cure the recurrent infections. If the bacterial focus within the urinary tract cannot be removed, long-term, low-dose antimicrobial suppression will prevent the morbidity of recurrent infections. Reinfection requires careful bacteriologic monitoring and low-dose prophylactic, intermittent, or postintercourse antimicrobial therapy. In the setting of prostatitis syndrome, the patient must first be classified into one of three categories: bacterial prostatitis, nonbacterial prostatitis, or pelviperineal pain syndrome. Bacterial prostatitis frequently responds to appropriate antimicrobial agents, whereas nonbacterial prostatitis and pelviperineal pain require an empiric multimodal approach.     

Design of experiments with multiple independent variables: A resource management perspective on complete and reduced factorial designs.

An investigator who plans to conduct an experiment with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy. Considerations in making design decisions include whether research questions are framed as main effects or simple effects; whether and which effects are aliased (confounded) in a particular design; the number of experimental conditions that must be implemented in a particular design and the number of experimental subjects the design requires to maintain the desired level of statistical power; and the costs associated with implementing experimental conditions and obtaining experimental subjects. In this article 4 design options are compared: complete factorial, individual experiments, single factor, and fractional factorial. Complete and fractional factorial designs and single-factor designs are generally more economical than conducting individual experiments on each factor. Although relatively unfamiliar to behavioral scientists, fractional factorial designs merit serious consideration because of their economy and versatility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major issues in user interface design for health professional workstations: summary and recommendations

Lack of good user interfaces has been a major impediment to the acceptance and routine use of health-care professional workstations. Health-care providers, and the environment in which they practice, place strenuous demands on the interface. User interfaces must be designed with greater consideration of the requirements, cognitive capabilities, and limitations of the end-user. The challenge of gaining better acceptance and achieving widespread use of clinical information systems will be accentuated as the variety and complexity of multi-media presentation increases. Better understanding of issues related to cognitive processes involved in human-computer interactions is needed in order to design interfaces that are more intuitive and more acceptable to health-care professionals. Critical areas which deserve immediate attention include: improvement of pen-based technology, development of knowledge-based techniques that support contextual presentation, and development of new strategies and metrics to evaluate user interfaces. Only with deliberate attention to the user interface, can we improve the ways in which information technology contributes to the efficiency and effectiveness of health-care providers.