A feasibility study of a web-based performance improvement system for substance abuse treatment providers

We report here on the feasibility of implementing a semiautomated performance improvement system—Patient Feedback (PF)—that enables real-time monitoring of patient ratings of therapeutic alliance, treatment satisfaction, and drug/alcohol use in outpatient substance abuse treatment clinics. The study was conducted in six clinics within the National Institute on Drug Abuse Clinical Trials Network. It involved a total of 39 clinicians and 6 clinic supervisors. Throughout the course of the study (consisting of five phases: training period [4 weeks], baseline [4 weeks], intervention [12 weeks], postintervention assessment [4 weeks], sustainability [1 year]), there was an overall collection rate of 75.5% of the clinic patient census. In general, the clinicians in these clinics had very positive treatment satisfaction and alliance ratings throughout the study. However, one clinic had worse drug use scores at baseline than other participating clinics and showed a decrease in self-reported drug use at postintervention. Although the implementation of the PF system proved to be feasible in actual clinical settings, further modifications of the PF system are needed to enhance any potential clinical usefulness.     

A pilot study of an interactive web site in the workplace for reducing alcohol consumption

An interactive web-site-based intervention for reducing alcohol consumption was pilot tested. Participants were 145 employees of a work site in the Silicon Valley region of California, categorized as low or moderate risk for alcohol problems. All participants were given access to a web site that provided feedback on their levels of stress and use of coping strategies. Participants randomized to the full individualized feedback condition also received individualized feedback about their risk for alcohol-related problems. Some evidence was found for greater alcohol reduction among participants who received full individualized feedback, although due to difficulties in recruiting participants, the sample size was inadequate for evaluating treatment effects on drinking. The results provide preliminary support for using an interactive web site to provide individualized feedback for persons at risk for alcohol problems. However, the low participation rate (2.7%) suggests that such an intervention must address the challenges of recruiting employees through their work site.     

Anxiety and feedback negativity

It has been suggested that anxious individuals are more prone to feel that negative outcomes are particularly extreme and to interpret ambiguous outcomes as negative compared to nonanxious individuals. Previous studies have demonstrated that the feedback negativity (FN) component of event‐related brain potential (ERP) is sensitive to outcome evaluation and outcome expectancy. Hence, we predicted that the FN should be different between high trait‐anxiety (HTA) and low trait‐anxiety (LTA) individuals. To test our hypothesis, the ERPs were recorded during a simple monetary gambling task. The FN was measured as a difference wave created across conditions. We found that the amplitude of the FN indicating negative versus positive outcomes was significantly larger for LTA individuals compared to HTA individuals. However, there was no significant difference in the FN between groups in response to ambiguous versus positive outcomes. The results indicate that there is a relationship between the FN and individual differences in anxiety. We suggest that these results reflect the impact of anxiety on outcome expectation. Our results challenge the reinforcement learning theory of error‐related negativity, which proposes that ERN and FN reflect the same cognitive process.     

Effects of monetary reward and punishment on stimulus-preceding negativity

This study examined the effects of emotional valence on stimulus-preceding negativity (SPN) using reward and fine. A time estimation task under reward, punishment, combined, and control conditions was performed. Participants were rewarded for accurate responses in the reward condition, and were fined for incorrect estimations in the punishment condition. in the combined condition, correct responses were rewarded and incorrect responses were fined. In the control condition, neither a reward nor fine was used. Results showed a significant interaction of condition x hemisphere. The SPN at the left hemisphere was increased in the reward condition. For the punishment effect, although it evoked right hemisphere dominance, no conditional difference was apparent at the right hemisphere. These results suggest that the SPN is affected by positive emotion: The left hemisphere activation might represent a pleasant emotion accompanying monetary gain.     

Idazoxan increases perforant path-evoked EPSP slope paired pulse inhibition and reduces perforant path-evoked population spike paired pulse facilitation in rat dentate gyrus

Norepinephrine, acting via beta-adrenoceptors, enhances the perforant path-evoked potential in dentate gyrus. Using systemic idazoxan to increase norepinephrine, and paired perforant path pulses to probe early inhibition, previous investigators reported that idazoxan increased initial spike amplitude and increased somatic feedback inhibition. Here, feedback inhibition was re-examined in idazoxan-treated (5 mg/kg) rats under urethane anesthesia. To control for initial increased spike amplitude after idazoxan, evoked potentials were matched, pre- and post-idazoxan, on initial population spike. Input-output current profiles were also compared pre- and post-idazoxan. Saline- and timolol-filled micropipettes permitted evaluation of a contribution of local beta-adrenoceptors. As previously observed, initial spike amplitude was potentiated by idazoxan. Comparable spike potentiation was not seen on the timolol micropipette. Paired pulse inhibition of spike amplitude apparently increased, but input-output curve comparisons revealed a loss of feedback facilitation rather than an increase in feedback inhibition. Initial EPSP slopes were depressed after idazoxan in input-output curve data. EPSP slope feedback ratios were significantly reduced following idazoxan.These data suggest idazoxan has multiple effects on perforant path input to the dentate gyrus. Spike potentiation following idazoxan has previously been shown to depend on intact norepinephrine input. Here, the reduction in spike potentiation on the timolol pipette is consistent with other evidence that norepinephrine-mediated potentiation of the perforant path-evoked potential is dependent on local beta-adrenoceptor activation. The input-output data suggest a decrease in feedback facilitation after idazoxan is likely to account for the apparent increase in feedback inhibition previously reported. Decreased EPSP slope ratios with similar paired pulse intervals have been reported in novel environments. Since exposure to novel environments activates locus coeruleus neurons, norepinephrine may mediate the change in EPSP slope inhibition reported in awake rats.In summary, these results are consistent with the hypothesis that idazoxan potentiates granule cell responses to perforant path input in the dentate gyrus via increases in norepinephrine that lead to beta-adrenoceptor activation, and, further, that idazoxan reduces paired pulse feedback spike facilitation and enhances EPSP slope, but not spike, feedback inhibition.     

Derivative weighted active insulin control modelling and clinical trials for ICU patients

Close control of blood glucose levels significantly reduces vascular complications in Type 1 and Type 2 diabetic individuals. Heavy derivative controllers using the data density available from emerging biosensors are developed to provide tight, optimal control of elevated blood glucose levels, while robustly handling variation in patient response. A two-compartment glucose regulatory system model is developed for intravenous infusion from physiologically verified subcutaneous infusion models enabling a proof-of-concept clinical trial at the Christchurch Hospital Department of Intensive Care Medicine. This clinical trial is the first of its kind to test a high sample rate feedback control algorithm for tight glucose regulation. The clinical trial results show tight control with reductions of 79–89% in blood glucose excursions for an oral glucose tolerance test. Experimental performance is very similar to modelled behaviour. Results include a clear need for an additional accumulator dynamic for insulin behaviour in transport to the blood and strong correlation of 10% or less between modelled insulin infused and the amounts used in clinical trials. Finally, the heavy derivative PD control approach is seen to be able to bring blood glucose levels below the (elevated) basal level, showing the potential for truly tight control.     

浅谈护理专业心理护理技能的培养

目的:探讨如何培养护理专业学生学习心理护理技能。方法:分析学生学习心理护理技能的必要性,从实际教学中总结培养心理护理技能的方法。结果:总结出培养方式为:①明确心理护理重要性,使学生明确学习目的;②适当改变教学方法;③在教学中建立心理护理的典型护理模式;④锻炼学生具有敏锐的观察力;⑤锻炼学生具有灵活的应变力;⑥开发学生潜在创造力及自学能力;⑦注重良好医德的培养;⑧锻炼学生人际沟通能力。结论:高级护理专业心理护理的培养顺应了护理学科的发展,是生物医学模式向生物-心理-社会医学模式转化的需要,也是现代护理学科向更高更深层次方向迈进的必然趋势。     

Anticlastogenic effect of diosgenin on 7,12-dimethylbenz(a)anthracene treated experimental animals

The maintenance of stable test atmospheres in small-volume inhalation systems such as a nose-only exposure manifold requires rapid and appropriate responses to fluctuations in a number of parameters. For example, changes in flows or voltages can affect test compound generation efficiency and gas dilution ratios, resulting in excursions of the test concentration outside an acceptable range. A feedback control loop was designed that makes use of mass flow controllers in maintaining the target concentration of a test compound. The system was tested by generating ozone in a nose-only exposure manifold. An ozone analyzer provided updated concentration values every 30 s, which were compared to the user-defined target concentration recorded in the interface readout box. Values of gain, integral, and lead determining an appropriate response of the controller to concentration fluctuations were implemented based on proportional-integral-derivative control algorithms. Using this approach, the flow of ozone mixed with dilution air into the system was adjusted as required without user intervention, minimizing concentration overshoots upon system startup, maintaining an ozone concentration within a range 5% of the target concentration, and responding rapidly and efficiently to line disturbances.     

Reducing Alcohol Problems through Community Action Research Projects: Contexts,Strategies, Implications,and Challenges

Community-based action research projects may include a number of challenges. The secular context may impede a project; for example, reducing aggregate rates of drinking-related problems may involve curtailing very popular high-risk drinking occasions. These projects may also embrace important but unrealistic goals, require matching competing goals emerging from multifoci project teams, or involve convoluted funding arrangements. Attention to team development, priority setting, and project design and evaluation issues is essential. Many projects downplay conceptual issues, such as understanding the nature of communities, organizations, systems, their operation, and social change and prevention models. Focus populations, community members and leaders, change agents team members, funding agencies, and policymakers can benefit from these projects.