Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

On-demand Virtual Neonatal Intensive Care units supporting rural, remote and urban healthcare with Bush Babies Broadband

Premature and ill term babies born in regional Australia must be moved to another hospital with Neonatal Intensive Care Unit (NICU) facilities. Transferred pre-term and critically ill term babies have higher mortality rates and much higher rates of long term disability than similar babies born in hospitals with NICU facilities. This paper details the Bush Babies Broadband project that aims to significantly improve the quality of treatment for babies born in rural, remote as well as urban areas by providing the first on-demand virtual NICU architecture in Australia. Real-time data collected from medical monitors and ventilators attached to the baby, audiovisual streams and static physiological data such as X-ray images are transmitted to the consulting Neonatologist to gain a better picture of the patient's condition than is currently available. The key contribution of this significant research is the infrastructure providing a mechanism for Neonatologists to receive information directly from a regional hospital, thereby preventing, in some cases, the immediate need to move the baby. A key benefit of this framework is that it is available to link regional hospitals with the supporting NICU Neonatologist ‘on demand’ eliminating the need to establish permanent point to point connections. This paper further describes the application of that architecture to a specific pilot connecting the Bathurst regional hospital with Neonatologists within the NICU at Nepean Hospital, Penrith Australia.     

The Witchfinder-General and the Will-o'-the-Wisp: The myth and reality of Internet control

Internet pornography, especially child pornography, has been a significant concern in British society for several years. This article seeks to examine the prevalence and impact of such material, the way public concern has developed, and media and legislative reactions to this concern. It suggests that a more rational debate of the actual and likely dangers in this sphere is necessary in order both to protect and serve the interests of justice.     

Cutting stress off at the pass: Reducing vigilance and responsiveness to social threat by manipulating attention.

Personality processes relating to social perception have been shown to play a significant role in the experience of stress. In 5 studies, the authors demonstrate that early stage attentional processes influence the perception of social threat and modify the human stress response. The authors first show that cortisol release in response to a stressful situation correlates with selective attention toward social threat. Second, the authors show in 2 laboratory studies that this attentional pattern, most evident among individuals with low self-esteem, can be modified with a repetitive training task. Next, in a field study, students trained to modify their attentional pattern to reduce vigilance for social threat showed lower self-reported stress related to their final exam. In a final field study with telemarketers, the attentional training task led to increased self-esteem, decreased cortisol and perceived stress responses, higher confidence, and greater work performance. Taken together, these results demonstrate the impact of antecedent-focused strategies on the late-stage consequences of social stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What's the use of being happy? Mood states, useful objects, and repetition priming effects.

Two experiments involving 99 undergraduate participants sought to examine the influence of mood states on encoding speed within lexical decision and pronunciation tasks. Mood states were measured naturalistically in Experiment 1 and manipulated in Experiment 2. Stimuli consisted of nouns representing useful (e.g., food) and nonuseful (e.g., lint) objects. Mood states had no implications for initial encoding speed. However, when the same words were presented a 2nd time (i.e., repeated), happy individuals displayed a tendency to encode useful words faster than nonuseful ones. Thus, mood states influenced repetition priming on the basis of stimulus valence. The authors propose that happiness sensitizes individuals to useful or rewarding objects, which in turn creates a stronger memory trace for such stimuli in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hemodialysis in the United Kingdom

Hemodialysis was a neglected aspect of nephrology in the UK. At the request of the Renal Association, the first UK Haemodialysis Masterclass was organized in 2007. The articles in this supplement arose from that meeting. Here, an overview of UK hemodialysis services and nephrology training is presented as background. Government‐funded dialysis should be provided to all UK citizens who require it. In 2005, there were 17,645 patients receiving hemodialysis, 5057 on peritoneal dialysis and 19,074 with kidney transplants, looked after by 359 nephrologists working in 73 National Health Service renal units. Renal replacement therapy incidence and prevalence remain comparatively low, at 108 and 694 per million population, respectively. Whether this represents inadequate provision or genuinely lower need remains unclear. The Renal Association sets clinical practice guidelines for dialysis, and audits performance via the UK Renal Registry. Postgraduate medical education is undergoing radical change in the UK. This is driven by the reduction in trainee doctors' working hours to 48 hr/week (mandated by the European Working Time Directive), and the governments' wish to reduce the duration of training, but also by a desire to formalize training, Our challenge is to continue to produce talented clinical nephrologists educated in breadth and depth, despite the reduced emphasis on clinical experience and omission of period of scientific research. The future for hemodialysis services in the UK is, however, promising with an expansion in the number of specialists and dialysis centers, and a growing interest in dialysis practice and research.     

Alternatives to standard hemodialysis

Survival of patients on hemodialysis remains poor, but the benefits of increasing urea clearance have probably been maximized within our current treatment schedules. Long dialysis sessions (8 hr) produce impressive outcomes, with mortality 53% to 55% lower than conventional schedules. Even increasing from 4 to 5 hr may improve survival. Increased frequency of dialysis (6 times weekly) produces impressive reductions in left ventricular mass and could conceivably be implemented in‐center. Preliminary data suggest a 61% reduction in mortality with increased frequency. Nightly dialysis combines longer sessions with increased frequency and has produced remarkable clinical gains in blood pressure, left ventricular mass, serum phosphate, and sleep apnea. However, the data are mainly from case series and impact on mortality remains unknown. Expansion of home hemodialysis would be necessary for this modality to grow. Convective therapies remove middle molecules more effectively, and observational data suggest hemodiafiltration has the potential to improve mortality by 35% to 36%. Hemodiafiltration has the advantage of being relatively easy to implement. The uremic milieu is complex and further investigation of the underlying pathophysiology is needed to inform future dialysis interventions. The survival data above are from observational studies, and hence benefits are likely to be exaggerated. Randomized trials of dialysis interventions are desperately needed. They remain difficult to perform, because of the complexity of both the patient population and the interventions, and because of limited available funding.     

Systems that Should Have Failed: Critical Infrastructure Protection in an Institutionally Fragmented Environment

Recent years have witnessed major governmental initiatives regarding critical infrastructure protection (CIP). During that same time, critical infrastructures (CIs) have undergone massive institutional restructuring under the headings of privatization, deregulation and liberalization. Little research has gone into understanding the interactions between these two developments. In this article, we outline the consequences of institutional restructuring for the changing ways in which CIs ensure the reliability and security of their networks and services. Neither Normal Accident Theory nor High‐Reliability Theory can account for reliability under these conditions. We then investigate the implications of these findings for CIP.