An application of the concept of the therapeutic alliance to sadomasochistic pathology

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.     

Analogical transfer, problem similarity, and expertise.

When we encounter a new problem, we are often reminded of similar problems solved earlier and may use the solution procedure from an old problem to solve a new one. Such analogical transfer, however, has been difficult to demonstrate empirically, even within a single experimental session. This article proposes a framework for conceptualizing analogical problem solving that can account for the conflicting findings in the literature. In addition, the framework leads to two predictions concerning the transfer behavior of experts and novices. These predictions concern both positive and negative transfer and are based on the different types of features included in the problem representations of experts and novices. First, when two problems share structural features but not surface features, spontaneous positive transfer should be more likely in experts than in novices. Second, when two problems share surface but not structural features, spontaneous negative transfer should be stronger for novices than for experts. These predictions were supported by the results of three experiments involving college students solving a complex arithmetic word problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of ultrafiltration on blood use for atrial septal defect closure in infants and children

BACKGROUND: Infants and children undergoing open cardiac operations have a high incidence of blood product transfusion. Ultrafiltration has been shown to reverse hemodilution and improve myocardial function and hemodynamics after cardiopulmonary bypass (CPB). METHODS: The effect of ultrafiltration on the amount of blood transfusion and hospital charge in 39 consecutive patients who underwent elective atrial septal defect repair was examined. Patients in group I (n=26) had a conventional cardiopulmonary circuit prime with blood, whereas 13 patients had bloodless prime (group II). Ultrafiltration was used immediately after weaning from CPB in group II. The patients in group I received blood products after discontinuation of CPB to achieve a hematocrit of 30%. The amount of blood product used, hematocrit immediately after CPB and on arrival in intensive care unit, postoperative hemodynamics and saturations, total operating room charge, blood charge, hospital stay, and hospital charge were compared. RESULTS: Mean body weight (15.8 kg in group I versus 17.5 kg in group II) and preoperative hematocrit values (35.6% in group I versus 34.2% in group II) were similar. Mean hematocrit immediately after CPB was 22% and 14% in group I and II, respectively (p < 0.0001). The mean hematocrit upon arrival to the intensive care unit was 34% in group I and 22% in group II (p < 0.0001). The amount of blood product transfusion was 32 mL/kg in group I and 3 mL/kg in group II patients (p < 0.0001). The patients in group II had significantly less blood bank charges; however, operating room charges and total hospital charges were similar between the two groups. CONCLUSIONS: Elective atrial septal defect repair was performed with no blood product transfusion without increased morbidity or hospital stay. Ultrafiltration can be used to reverse hemodilution resulting from a bloodless CPB prime without an increase in hospital charge.     

On predicting success in training for men and women: Examples from Marine Corps clerical specialties.

The presence of differences between prediction systems for men and women is investigated through a detailed study of clerical occupational specialties in the U.S. Marine Corps. When various measures of ability were used to predict success of recruits in training, sizeable differences in regression equations were found between men and women. The study showed that selected deletion of extraneous Armed Services Vocational Apptitude Battery (ASVAB) variables maintained overall predictive efficiency but did not entirely remove the differences between subgroup regressions. When the attainment of a high-school diploma was considered, however, subgroup differences between predicted scores were substantially reduced. Implications of these empirical results for the general problem of military personnel selection are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A probabilistic contrast model of causal induction.

Deviations from the predictions of covariational models of causal attribution have often been reported in the literature. These include a bias against using a consensus information, a bias toward attributing effects to a person, and a tendency to make a variety of unpredicted conjunctive attributions. It is contended that these deviations, rather than representing irrational biases, could be due to (a) unspecified information over which causal inferences are computed and (b) the questionable normativeness of the models against which these deviations have been measured. A probabilistic extension of Kelley's analysis-of-variance analogy is proposed. An experiment was performed to assess the above biases and evaluate the proposed model against competing ones. The results indicate that the inference process is unbiased. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alterations in pulmonary surfactant composition and activity after experimental lung transplantation

BACKGROUND: Adenosine has been reported to mediate the necrosis-limiting effects of ischemic preconditioning; however, it is unclear how this mediation occurs. The present study was undertaken to test the hypothesis that ischemic preconditioning increases 5'-nucleotidase activity and adenosine release during sustained ischemia and subsequent reperfusion. METHODS AND RESULTS: After thoracotomy, the left anterior descending coronary artery was cannulated and perfused with blood redirected from the left carotid artery in 32 dogs. Ischemic preconditioning was produced by four cycles in which the coronary artery was occluded and then reperfused for 5 minutes each. After the last cycle of ischemia and reperfusion, the coronary artery was occluded for 40 minutes. This was followed by 120 minutes of reperfusion. In the control group, the coronary artery was occluded for 40 minutes and reperfused for 120 minutes without ischemic preconditioning. The plasma adenosine concentration was measured and blood gases were analyzed in coronary arterial and venous blood samples taken during 120 minutes of reperfusion. Myocardial 5'-nucleotidase activity was measured before and at 40 minutes of sustained ischemia with and without ischemic preconditioning. The adenosine concentration in coronary venous blood during reperfusion was significantly higher in preconditioned hearts than in the control hearts: 1 minute after the onset of reperfusion, 546 +/- 57 versus 244 +/- 41 pmol/ml; 10 minutes after, 308 +/- 30 versus 114 +/- 14 pmol/ml; 30 minutes after, 175 +/- 24 versus 82 +/- 16 pmol/ml, respectively (p < 0.01). Ectosolic and cytosolic 5'-nucleotidase activities increased in both endocardial and epicardial myocardium in the ischemia-preconditioned hearts. Furthermore, 40 minutes of ischemia increased 5'-nucleotidase activity in ischemia-preconditioned hearts more than in control hearts. CONCLUSIONS: Ischemic preconditioning increases adenosine release and 5'-nucleotidase activity during sustained ischemia and subsequent reperfusion.