Introduction to the special section on multicultural and community psychology: clinical psychology in context

Human behavior occurs in the contexts of culture and community. Yet, clinical psychology has traditionally focused on the individual, neglecting the individual's context. The purpose of this Special Section is to address the underlying conceptual issues in integrating multicultural and community psychology within a common framework. The integration of etic and emic approaches distinguishes the research programs in these articles from others that have solely focused on universal or culture-specific approaches. Issues facing ethnic minority populations are addressed, including identification of risk and protective factors, obstacles to mental health service use, and optimal treatment effectiveness. The integration of culture and community contexts into clinical psychology is necessary for it to remain relevant in an increasingly diverse 21st century.     

Section E9 of the American College of Medical Genetics technical standards and guidelines: Fluorescence in situ hybridization

This updated Section E9 has been incorporated into and supersedes the previous Section E9 in Section E: Clinical Cytogenetics of the 2008 Edition (Revised 02/2007) American College of Medical Genetics Standards and Guidelines for Clinical Genetics Laboratories. This section deals specifically with the standards and guidelines applicable to fluorescence in situ hybridization analysis.     

Section II: Special invited abstracts

Abstract Third International Congress of the Metastasis Research Society NIH Clinical Center, Bethesda, Maryland, U.S.A. 17–19 September 1990

Section II: Special invited abstracts     

Emotional availability: concept, research, and window on developmental psychopathology

The construct of emotional availability (EA) refers to the capacity of a dyad to share an emotional connection and to enjoy a mutually fulfilling and healthy relationship. The EA Scales were designed to assess multiple components of a relationship from the perspective of both partners. The four caregiver components include sensitivity, structuring, nonintrusiveness, and nonhostility; two scales measure the child's responsiveness to the caregiver and involvement of the caregiver. We describe the EA construct and introduce the papers in this issue, focusing on the contributions of this Special Section to a developmental psychopathology framework.     

Introduction to special section on theories of sexual aggression

Sexual aggression is a serious societal problem, yet treatments for sexual aggressors have generally been ineffective in part because of the lack of unified theories to guide treatment. This brief article introduces the Special Section, which includes five theories of sexual aggression.     

血清胱抑素C、D-二聚体与低密度脂蛋白联合检测在卵巢癌患者诊断中的价值研究

目的探究血清胱抑素C(Cys C)、D-二聚体与低密度脂蛋白(LDL)联合检测在卵巢癌患者诊断中的临床价值。方法回顾性分析2017年1月至2018年1月我院收治的240例卵巢肿瘤患者的临床资料,经术后病理组织学检查确诊为80例卵巢癌(卵巢癌组)和160例卵巢良性肿瘤(良性肿瘤组);另选取同期来我院行健康体检的100例妇女,作为对照组。采用乳胶增强免疫透射比浊法检测血清Cys C水平,采用免疫比浊法检测血清D-二聚体水平,采用化学发光法检测血清LDL水平。比较三组血清Cys C、D-二聚体及LDL水平,并评价这三种指标联合检测对卵巢癌的诊断价值。结果各组血清Cys C、D-二聚体及LDL水平比较:卵巢癌组上述指标均高于对照组和良性肿瘤组,比较差异具有统计学意义(P <0.05);良性肿瘤组血清Cys C、D-二聚体及LDL水平与对照组比较无统计学意义(P>0.05)。卵巢癌组血清Cys C、D-二聚体与LDL单独检测及联合检测的阳性率分别为65.00%、71.25%、68.75%、93.75%,均高于良性肿瘤组和对照组(P <0.05);卵巢癌组内比较,Cys C、D-二聚体与LDL三者联合检测的阳性率均高于三者的单独检测(P<0.05)。Cys C、D-二聚体与LDL三者联合检测诊断卵巢癌的灵敏度及准确率分别为93.75%、88.75%,均较单独检测高(P <0.05);而三者单独检测诊断的灵敏度、特异性及准确率比较无统计学意义(P>0.05)。结论血清Cys C、D-二聚体与LDL联合检测对卵巢癌的早期诊断具有重要的临床价值,可提高诊断的灵敏度及准确率。     

Developmental pathways in food allergy: a new theoretical framework

Background:  To date, there is no model of psychosocial development based on empirical food allergy (FA) research. This limits the ability of clinicians, researchers and policy-makers to predict and evaluate the real impact of FA on the child, with implications for prevention, treatment, intervention and health policy.
Objectives:  To provide an integrated conceptual framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour, with particular attention to transition points.
Method:  Fifteen focus groups meetings were held with 62 children (6–15 years). Developmentally appropriate techniques were designed to stimulate discussion, maintain interest and minimize threat to children's self-esteem. Data were analysed using grounded theory.
Results:  FA impacts directly on children's normal trajectory of psychological development in both an age- and disease-specific manner. Six key themes emerged from the analysis: 'meanings of food'; 'autonomy, control and self-efficacy'; 'peer relationships'; 'risk and safety'; 'self/identity'; and 'coping strategies'.
Conclusions:  Coping with FA is more than simply a strategy, it is a cumulative history of interactive processes (age, gender and disease specific) that are embedded in a child's developmental organization.
Clinical Implications:  The early recognition and incorporation of an FA-specific developmental framework into a treatment plan is essential and sets the stage for an effective medical care and the eventual transition from paediatric to adult care.
Capsule Summary:  This study represents a first attempt to provide an integrated developmental framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour.     

Preparing clients for group therapy: A critical review and theoretical formulation

This paper reviews the experimental literature on procedures for preparing clients for group therapy. Procedures which have been used are described, results are summarized, and methodological and conceptual critiques, as well as suggestions for improvement, are provided. Bandura's (1977) model regarding the development of expectations and their influence on behavior is proposed as a conceptual framework. Development of positive selfefficacy and outcome expectations regarding a carefully (theoretically and/or empirically) derived set of “appropriate” client behaviors is suggested as the primary goal of preparatory procedures. Application of this conceptual model is elaborated on and explication of how it can help refine investigation efforts is offered.     

A biological continuum based approach for efficient clinical classification

Clinical feature selection problem is the task of selecting and identifying a subset of informative clinical features that are useful for promoting accurate clinical diagnosis. This is a significant task of pragmatic value in the clinical settings as each clinical test is associated with a different financial cost, diagnostic value, and risk for obtaining the measurement. Moreover, with continual introduction of new clinical features, the need to repeat the feature selection task can be very time consuming. Therefore to address this issue, we propose a novel feature selection technique for diagnosis of myocardial infarction – one of the leading causes of morbidity and mortality in many high-income countries. This method adopts the conceptual framework of biological continuum, the optimization capability of genetic algorithm for performing feature selection and the classification ability of support vector machine. Together, a network of clinical risk factors, called the biological continuum based etiological network (BCEN), was constructed. Evaluation of the proposed methods was carried out using the cardiovascular heart study (CHS) dataset. Results demonstrate a significant speedup of 4.73-fold can be achieved for the development of MI classification model. The key advantage of this methodology is the provision of a reusable (feature subset) paradigm for efficient development of up-to-date and efficacious clinical classification models.     

Expanding Our Strategies to Study the Process of Change

The conceptual and methodological framework proposed by Doss (this issue) makes valuable suggestions for strategic choices in future research. This commentary addresses conceptual and terminological distinctions adopted by Doss, as well as his criticism of add-on/ dismantling studies. We also suggest research topics and methodological developments that could be integrated in Doss's framework to further expand understanding of therapeutic change.     

On ‘The Hatred of Learning from Experience’: A Work Journal Revisited

In January 1999, I started a two-year course in psychodynamic counselling. One of the course requirements was to produce several work journals each term. They could be on any topic the student wished to think about or explore that pertained to the course, be it clinical or theoretical work, or professional/personal development. Three months later, I wrote one on Bion's (1962) concept of ‘the hatred of learning from experience’, after a seminar on his work. In Section 1, I present the work journal itself, in which I described my difficulties with anxiety about the course in relation to this concept: how I felt I needed to be a perfect student who ‘knew everything’; my intolerance of making mistakes; and my hatred of not knowing; in tandem with my envy of others' knowledge. In Section 2, I describe my current understanding of what I was rather desperately attempting to work out in the journal – taking into consideration both my emerging feelings, in light of my own history and state of mind, together with what I had come to understand – that the course was poorly structured and did not provide an adequately safe framework for clinical work and learning. This resulted in my decision to leave. In Section 3, I write about the arduous but ultimately rewarding process of returning to training, eventually culminating in my qualification as a psychodynamic psychotherapist. My final thoughts are presented in Section 4.     

Recent trends in research on teacher-child relationships

Theoretical and empirical work on relationships between teachers and children relies on developmental systems theory as the foundational conceptual model, drawing heavily from basic work in attachment as well as research on social development. Recently, the focus on relational processes in effort to support children's development in the classroom has proliferated, with multiple disciplines and fields engaging in research on teacher-child relationship quality to understand and improve the experiences and learning of students. This paper updates the conceptual framework and continues the necessary integration between disciplines by exploring three areas of research: (1) concordance between children's relationships with teachers and parents; (2) the moderating role of teacher-child relationships for the development of at-risk children; and (3) training teachers from a relational perspective. Each of the three areas of research on teacher-child relationships is examined in light of recent findings and considers implications for understanding the nature and impact of relationships between teachers and children.     

A developmental psychopathology perspective on emotional availability research: current trends and challenges

Studies using the Emotional Availability Scales have burgeoned in the past decade. The collection of papers included in this Special Section represents the latest innovations in research with this paradigm. Consistent with a developmental psychopathology perspective, these papers evaluate emotional availability in a variety of typical, at-risk, international, and intergenerational samples of children and caregivers, with many utilizing longitudinal designs or employing measures from multiple levels of analysis. One study begins to translate findings from this body of research into a promising intervention program. Although further growth and refinement in research with this paradigm is needed, the results to date begin to place the construct of emotional availability into a complex, dynamic biopsychosocial context, and promise to inspire a new generation of studies. In this commentary, some of the key contributions and challenges of this collection of studies are highlighted using a developmental psychopathology framework.     

The Value of Ultrastructural Evaluation in the Diagnosis of Renal Tumors: A General Overview

The understanding of renal neoplasia has advanced significantly in the last 20 years. New challenges have arisen as a consequence of prolonged dialysis and renal transplantation becoming the therapeutic modes to deal with chronic renal disease. Immunosuppression resulting from primary disease processes or as a result of clinical intervention has resulted in an increase in neoplasia in general and changes in manifestations and clinical behavior of tumors. Special techniques such as immunocytochemistry and electron microscopy have provided information that has resulted in refinement of diagnostic and conceptual issues. The variable gross and histological manifestation of many of the renal neoplasms can be explained at least in part by reflecting on the new fundamental knowledge that has been acquired regarding renal developmental biology. A more aggressive approach from a therapeutic point of view placing emphasis on specific treatment protocols for the various nosologic entities further emphasizes the need to understand the advances that have taken place in the field. This article provides an overview of the subject, with emphasis on an overall conceptual understanding, to serve as a practical framework. The articles that follow address the specific current role of ultrastructure in the diagnosis and understanding of renal neoplasms.     

Training and assessment of medical specialists in clinical microbiology and infectious diseases in Europe

BackgroundThere is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe.ObjectivesTo describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID).SourcesNarrative review of developments over the past two decades and related policy documents and scientific literature.ContentResponsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021.ImplicationsThe revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists.     

Inter-organizational relationships of seven Veterans Affairs Medical Centers and their affiliated medical schools: results of a multiple-case-study investigation.

PURPOSE: This study describes the costs and and value added to Veterans Affairs Medical Centers (VAMCs) through their affiliations with medical schools. The study also creates a conceptual framework for evaluating the critical dimensions across which these affiliations vary. METHOD: Case studies of seven VAMCs' affiliations with medical schools, ranging from two highly affiliated VAMCs to one with only one funded residency position, were conducted in 1997 and 1998 using a survey and in-depth interviews with 78 key individuals at the institutions. The qualitative data were then used to develop a conceptual framework for evaluating these affiliations. RESULTS: The results are reported in two stages. In stage one, three organizing themes emerged from the data that formed the conceptual framework for evaluating affiliations: (1) the characteristics of each VAMC and its environment, (2) the characteristics of the relationships between each VAMC and its medical school affiliates, and (3) the costs and value that medical school affiliations add to VAMCs. The affiliations that were most beneficial to VAMCs were characterized by a relationship of trust, extensively shared education and research programs, and a high degree of physician interaction. The achievement of these characteristics is influenced by the distance between the VAMCs and their affiliated medical schools, the VAMCs' levels of organizational complexity, the degree of managed care penetration, and the continuity and academic orientation of leadership at the VAMCs. In stage two, study data were used to create a conceptual framework to evaluate the characteristics of VAMCs and their affiliations with medical schools. CONCLUSIONS: The study supplied data to construct a conceptual framework that describes many of the relationships among the different affiliations in the study. The framework offers a tool for evaluating the dimensions across which affiliations vary and how these differences influence the costs and value of medical school affiliations to VAMCs.     

Clinical Child Psychology Training: Report in the Hilton Head Conference

The purpose of this presentation is to give an overview of the National Conference on Training Clinical Child Psychologists that was held on Hilton Head Island, South Carolina, May 15-18,1985. The conference was sponsored by the Section on Clinical Child Psychology (Section 1 of Division 12, American Psychological Association). The history, goals, issues, format, recommendation as well as contextual issues are discussed. Implementation is discussed from the vantage point of internal and external pressures for the conference.     

An integral assessment framework of health status in chronic obstructive pulmonary disease (COPD)

Background: To date, many health status instruments exist, but the validity of these instruments is questionable. This is caused by the fact that health status is poorly defined.Purpose: To develop a validated framework that improves conceptual insight into health status and its domains.Methods: Based on theoretical and clinical considerations, we defined the domains of health status into concrete sub-domains by formulating conceptual models. Guided by these conceptual models, for each sub-domain, existing instruments were selected. We validated the conceptual models in the data of 168 COPD patients. Using factor analysis, underlying concepts in the data were identified.Results: The resulting framework included physiological functioning, complaints, functional impairment, and quality of life. These main domains were shown to be subdivided into 15 sub-domains.Conclusions: The present study shows that health status consists of conceptually distinct sub-domains. Integral assessment of health status thus entails measuring all sub-domains. Existing instruments measure only few sub-domains. Integral assessment of health status thus requires the combination of different instruments. The present framework of health status can help in composing such a battery of instruments. Patient profiles obtained by the framework are essential in individualizing treatment. The study was supported by grants from the Dutch Asthma Foundation, GlaxoSmithKline, and the Department of Medical Psychology and Department of Pulmonary Diseases of Radboud University, Nijmegen Medical Center. We are indebted to Dr. F. van den Elshout (pulmonologist, Rijnstate Hospital, Arnhem) and Dr. R. Bunnik (pulmonologist, Maas Hospital, Boxmeer) for their contribution in the patient recruitment, and to the multidisciplinary Taskforce Assessment of the Department of Pulmonary Rehabilitation Unit for their invaluable contributions to the development of the conceptual models.