The Evidence Base Supporting the Subtyping of Gamblers in Treatment

Introduction Recent reviews found problem gamblers are heterogeneous and recommended subtyping gamblers in treatment studies. Objective Review factors (stage of change, preferred gambling activity, co-occurring disorder, and temporal instability of symptoms) for subtyping by evaluating the evidence for their effects on gambling treatment. Methods Literature review, evidence grading. Results Evidence is limited that any of the reviewed factors affects gambling treatment. Substantial evidence from prospective studies and other evidence from cross-sectional studies and the strong placebo response among pathological gamblers support the temporal instability of gambling symptoms. Conclusions Multiple studies are needed to develop the evidence base needed to subtype gamblers in treatment. Changes in the diagnostic criteria of pathological gambling may be necessary, especially to specify the persistence of gambling-related symptoms.     

浅谈基因治疗的现状及其面临的困境

基因治疗将在未来的疾病治疗中扮演重要的角色，然而这一新颖的技术却面临着诸多问题，本文论述了基因治疗的发展现状及其所面临的技术难题。     

Breast Cancer Risk Assessment and Counseling: A Clinician's Guide

Abstract: Most individuals concerned about hereditary breast cancer risk will neither order nor benefit from genetic testing at the present time. Many will, however, seek information about their risk and testing. Risk assessment services, in addition to providing information about hereditary risk and genetic testing, need also to include assessment of non-hereditary risks, information about how to evaluate risks, early detection modalities, the etiology of cancer, and assistance in devising follow-up health care plans. Psychosocial factors, particularly those pertaining to the individual's past history with illness and beliefs about causes and prognosis, must be taken into account to provide relevant information that is understood. A case history with examples of some of the types of information that lead to informed consent in a cancer risk assessment setting is provided.     

Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving, the challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.     

Psychosocial effects of vitiligo

A limited number of studies have paid attention to the psychosocial well-being of patients affected with vitiligo. We review the psychosocial effects of vitiligo, how patients deal with them and the psychiatric morbidity in vitiligo patients. Given the appreciable comorbidity, it is important to consider these observations in the management of patients, for example in patient-physician interaction but also in treatment strategies and evaluation of treatments. The effects of the psychological state on the disease itself together with the potential therapeutic implications are reviewed. Based on these data, we suggest how to further improve patient's management.     

Irritable bowel syndrome: The role of psychosocial factors

The irritable bowel syndrome (IBS) is a very common disorder of intestinal function characterized by variable symptoms of abdominal pain, diarrhea, constipation and bloating. The spectrum of severity ranges from mild symptoms, not worthy of clinical attention, to intense and continuous symptoms associated with impaired health-related quality of life and high health care use. Psychosocial disturbance is commonly found among patients with irritable bowel, but until recently, its precise role in the disorder was uncertain. The data now suggest that irritable bowel is not a psychiatric disorder per se, but psychosocial factors including life stress, psychiatric comorbidity and abnormal illness behavior, among others, influence how the illness is experienced and acted upon. Patients with mild symptoms usually respond to education, reassurance, dietary modification and, when needed, antimotility agents. However, patients with more severe symptoms, who usually have greater psychosocial disturbance, will also require behavioral interventions, and possibly psychopharmacological agents. In sum, a graduated, multicomponent plan of care that includes dietary, behavioral and pharmacological treatments is recommended.     

The effects of problem-solving training on two problem-solving tasks

The present study assessed the effects of problem-solving (D'Zurilla & Goldfried, 1971) training on two problem-solving tasks. Sixty-one subjects were assigned randomly to and trained in one of the following groups: general orientation (GO)-problem definition (PD)-generation of alternatives (GA)-decision making (DM), GO-PD-GA, GO-PD-DM, GO-GA-DM, GO, and a control group. The six groups did not differ significantly at pretesting on the measures of selecting the best alternative solution and describing problem-solving behaviors used to solve problems. Training was significantly effective on selecting the best alternative solution for all groups compared with the control group at the time of posttesting. The GO-PD-GA-DM and GO-PD-DM groups described significantly more problem-solving behaviors than the GO-PD-GA, GO-GA-DM, and GO groups. All five treatment groups performed significantly better than the control group at the time of post-testing. At follow-up 1 month after posttesting, groups trained with the PD component selected significantly better alternatives than the groups without PD training. Groups trained with the DM component described significantly more problem-solving behaviors at follow-up than the groups trained without the DM component.     

Global bifurcation structure of chaotic neural networks and its application to traveling salesman problems

This paper studies global bifurcation structure of the chaotic neural networks applied to solve the traveling salesman problem (TSP). The bifurcation analysis clarifies the dynamical basis of the chaotic neuro-dynamics which itinerates a variety of network states associated with possible solutions of TSP and efficiently ‘searches’ for the optimum or near-optimum solutions. By following the detailed merging process of chaotic attractors via crises, we find that the crisis-induced intermittent switches among the ruins of the previous localized chaotic attractors underly the ‘chaotic search’ for TSP solutions. On the basis of the present study, efficiency of the ‘chaotic search’ to optimization problems is discussed and a guideline is provided for tuning the bifurcation parameter value which gives rise to efficient ‘chaotic search’.     

Numerical method for weights adjustment in minimax multi‐model LQ‐control

The minimax linear quadratic problem, where ‘max’ is taken over a finite set of indices (models) and ‘min’ is taken over the set of admissible controls, is considered. The solution is obtained by the robust optimal control application. The control turns out to be a linear combination of the controls optimal for each individual model. This paper develops a numerical method for the optimal weights adjustment. An example shows a quick convergence of the proposed procedure. Copyright © 2007 John Wiley & Sons, Ltd.