Categorical or Dimensional: How Do Attachment Measures Inform Clinicians in Couple Therapy?

Self-report measures of adult romantic attachment have been widely used in research but their application in clinical practice has not been adequately examined. One important issue is the selection of a practical and reliable attachment measure that therapists can rely on in couple therapy. In the present study, the three-category Attachment Style Prototype (Hazan & Shaver, 1987) representing the original classic conceptualization of attachment, and the Experiences in Close Relationships (Brennan, Clark, & Shaver, 1998), a more recent scale with two dimensions representing a new conceptualization, were compared. Experiences in Close Relationships data were also used to establish four clusters based on the scores of the two dimensions. The Experiences in Close Relationships and Attachment Style Prototype categories were related in meaningful ways; however, Attachment Style Prototype was less effective in detecting a group of insecurely attached individuals who tended to self-identify as securely attached. Experiences in Close Relationships clearly shows an advantage over Attachment Style Prototype in clinical application, and therefore was recommended. Examples of the clinical utilization of Experiences in Close Relationships in couple therapy were provided using Experiences in Close Relationships scores from couples seeking therapy.     

加速康复外科和传统外科在肋骨骨折围手术期的应用比较

目的：比较加速康复外科（fast track surgery,FTS）理念和传统外科方法在肋骨骨折围手术期的应用。方法选择肋骨骨折患者84例,围手术期应用加速康复理念42例（FTS组）,应用传统外科手术42例（传统组）,将两组手术后疼痛VAS评分、血清白蛋白检测结果、肠鸣音恢复时间、首次通气时间、术后并发症（消化道症状、消化性溃疡、胸腔出血、肺不张、肺部感染、胸腔积液、心脏并发症、泌尿系统并发症、切口感染、深静脉血栓）发生率、住院时间及住院总费用、患者满意度等进行比较。结果 FTS组术后疼痛VAS评分较传统组低,血清白蛋白较传统组高,肠鸣音恢复时间及首次通气时间提前,术后并发症发生率较低,住院时间缩短,住院费用降低,患者满意度提高,两组比较差异有统计学意义（P＜0．05）。结论 FTS应用于肋骨骨折围手术期患者的术后疼痛VAS评分低,营养状况较好,肠道恢复较早,术后并发症发生率较低,住院时间缩短,治疗费用降低,患者满意度提高,值得进一步推广。     

Review of mixed treatment comparisons in published systematic reviews shows marked increase since 2009

ObjectivesTo identify and summarize published systematic reviews that report results of meta-analyses that combined direct and indirect comparisons.Study Design and SettingNarrative review of mixed treatment comparisons (MTCs) reported in systematic reviews of health interventions. MEDLINE, MEDLINE In-Process, Embase, CINAHL, DARE, the Cochrane Database of Systematic Reviews, and SIGLE were searched for reviews published up to June 2012 in which a meta-analysis had been conducted that combined direct and indirect comparisons among more than two interventions.ResultsReviews reporting MTCs are difficult to identify when searching major databases. These databases offer no way to identify MTCs, and authors use various names when reporting them. Of the 201 eligible reviews identified, more than three-quarters had been published in full. MTC methods have been used to study a wide range of clinical topics. The reported use of these methods has increased rapidly since 2009, and results from MTCs are commonly used in health policy decisions, through the evidence considered in health technology assessments.ConclusionIn view of the increasing use of MTCs, indexing of this study type in databases and a consensus on terminology and standards for conduct and reporting would be timely.     

Associative binding in early childhood: Evidence from a preferential looking paradigm

Relational memory processes are responsible for forming representations that bind together the co-occurring elements of an experience. These processes provide a foundation of episodic memory, the capacity to remember specific events about one's past. In the present research, we used a visual comparison paradigm to determine whether toddlers can form memories for the relation between co-occurring items. In Experiment 1, 66 2-year-olds viewed pairs of cartoon faces (AB; CD) and did not show a significant novelty preference for the violated associations (i.e., did not look longer at AD rearranged pair than old AB pair when exposed to AD-AB). However, toddlers looked longest at the individual face (i.e., D) violating a studied pair, which appeared to be supported by visual preference for centrally located stimuli. In Experiment 2, 46 2-year-olds participated in a similar procedure, but faces violating the pair during test were located to the periphery (e.g., AB-AC). Under these conditions, toddlers looked longer at recombined pair AC. Overall, our results show that toddlers show some ability to make item-item associations but may need to overcome preferential looking biases to demonstrate this capacity. Furthermore, looking behaviors beyond overall novelty preference may be informative even when overall novelty preference is not found.     

Sociodemographic,sexual, and reproductive variables associated with pregnancy among adolescents from low socioeconomic background

Adolescent pregnancy remains a public health concern in both developed and developing countries. Portugal and Brazil represent some of the best examples of this phenomenon. The present study aimed to identify sociodemographic, sexual, and reproductive health-related variables associated with adolescent pregnancy among students from low socioeconomic backgrounds in both countries. The sample included 984 female adolescents, among whom 215 became pregnant. Living with a partner and lack of information about sex and contraception from the family were the best explicative factors for pregnancy occurrence in both countries. Country-specific variables were also identified. Our results may contribute to developing global preventive interventions, addressing the school as an ideal setting for primary intervention and considering culture-specific characteristics of high-risk populations.     

RapidArc与Novalis Knife在多发脑转移瘤SRS中的剂量学比较

目的:比较基于多叶准直器的RapidArc与基于圆形限光筒的Novalis Knife在多发脑转移瘤立体定向放射外科（SRS）中的剂量学差异。方法:选取10例已进行Novalis Knife治疗的多发脑转移瘤患者（转移瘤3~5个/人）,共37个转移瘤。重新设计单中心、非共面4弧的RapidArc SRS计划,靶区处方剂量统一为16 Gy。比较Novalis Knife计划和RapidArc SRS计划中靶区的剂量适形度指数和均匀性指数、靶区周围剂量梯度指数、正常脑组织等剂量线体积（V16、V12、V9、V6、V3）以及治疗所需的机器跳数。结果:RapidArc SRS计划相较于Novalis Knife计划,适形度指数更接近于1（0.79[±]0.10 vs 0.50[±]0.22, P=0.000）,均匀性指数更接近于0（0.07[±]0.01 vs 0.15[±]0.07, P=0.000）,但靶区周围剂量梯度指数较大（15.92[±]12.43 vs 5.05[±]3.53, P=0.000）。对于正常脑组织等剂量线体积,RapidArc SRS计划中V16明显小于Novalis Knife计划（P=0.005）;两计划的V12、V9无明显差异（P=0.445, 0.059）;而RapidArc SRS计划中V6、V3明显大于Novalis Knife计划（P=0.005, 0.005）。RapidArc SRS计划的机器跳数明显少于Novalis Knife计划（P=0.005）。结论:RapidArc SRS计划通过设置单一治疗等中心可实现颅内多个转移瘤的同步放射外科治疗,具有更高的靶区剂量适形度及均匀性;但靶区周边剂量跌落陡度不及Novalis Knife计划,正常脑组织低剂量受照范围较大。治疗依从性较差的多发脑转移患者可考虑选择治疗效率更高的RapidArc技术,并根据临床实际情况调整剂量分割模式,以减少放射损伤风险。     

A Quantitative Study of Airway Changes on Micro-CT in a Mouse Asthma Model: Comparison With Histopathological Findings

Purpose

To evaluate airway changes in ovalbumin-induced asthmatic mice in terms of postmortem micro-CT images and pathological findings.

Methods

Asthma was induced in mice by intraperitoneal injection and nasal instillation of ovalbumin aluminium hydroxide into mice (experimental group, n=6), and another group of mice received intraperitoneal injection and nasal instillation of distilled phosphate-buffered saline (control group, n=6). Bronchial lumen area was measured in the main bronchial lumen of the distal third bronchial branch level (6 parts per each mouse) on axial scans of Micro-CT, using a Lucion''s smart pen (semi-automated) and a curve pen (manual). Bronchial wall thickness was obtained in 4 sections (2 levels on either side) after the third bronchial branch by measuring the diameter which was perpendicular to the longitudinal axis of the main bronchus on curved Multi-planar reconstruction (MPR) images. Histologic slides were obtained from the lesion that was matched with its CT images, and bronchial wall thicknesses were determined.

Results

The mean bronchial lumen area was 0.196±0.072 mm² in the experimental group and 0.243±0.116 mm² in the control group; the difference was significant. Bronchial wall thickness on micro-CT images (mean, 0.119±0.01 vs. 0.108±0.013 mm) and in pathological specimens (mean, 0.066±0.011 vs. 0.041±0.009 mm) were thicker in the experimental group than in the control group; bronchial wall thickness on micro-CT images correlated well with pathological thickness (for the experimental group, r=0.712; for the control group, r=0.46). The thick bronchial wall in the experimental group demonstrated submucosal hypertrophy along with goblet cell hyperplasia and smooth muscle hyperplasia.

Conclusions

The results of this study suggest that asthma may induce thickening of bronchial wall and narrowing of the lumen area on micro-CT images and that these results may significantly correlate with pathological findings.