bluuebunny/crossref_metadata_2025 huggingface dataset:
Family Climate and Expressed Emotion in the Course of Alcoholism
Authors: FICHTER MANFRED M. , GLYNN SHIRLEY M. , WEYERER S. , LIBERMAN ROBERT P. , FRICK ULRICK
Published: July 2004

Family‐based predictors of relapse were examined in 100 alcoholics who participated in a 12‐week treatment program with 6‐month and 18‐month followups. “Expressed Emotion” (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self‐reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6‐month followup and 30% at 18‐month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: “Critical Comments,”“Emotional Overinvolvement,” and “Warmth.” A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the “survival function” of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.
Therapist‐Parent Interaction Patterns in Home‐Based Treatments: Exploring Family Therapy Process
Authors: de KEMP RAYMOND A.T. , VAN ACKER JULIAAN C.A.
Published: July 2004

At the current stage of development in the family therapy field, exploratory, small‐scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist‐parent interactions within family‐based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.
Toward a Developmentally Informed Narrative Therapy
Authors: STRAND PAUL S.
Published: July 2004

Narrative approaches to psychotherapy emphasize the impact of the stories or narratives we construct on our reality and behavior. However, little effort has been made to elucidate how individuals' differential capacities for meaning‐making influence the process of re‐storying lives. The present article introduces to family therapy a model of the changing nature of individuals' ability to create meaning. The model, referred to as developmental‐constructivism (Kegan, 1994), suggests that, in addition to contextual factors, individual differences in the capacity for organizing experience will influence therapeutic efforts to generate new and more adaptive narratives. The model is also presented as a heuristic for comparing and integrating two influential approaches to narrative therapy: the externalizing approach of Michael White and the solution‐focused approach of Steve de Shazer.
Toward an African American Genogram
Authors: WATTS‐JONES DARIELLE
Published: July 2004

This article addresses the inadequacy of the standard genogram for African American families because of its underlying assumption that “family” is strictly a biological entity. The author suggests that this assumption is not culturally valid for African American families who have a long history of defining “family” as a kinship based on biological and functional ties. Using this conceptualization, an African American genogram is proposed.
Marital Interactions of Male versus Female Alcoholics
Authors: HABER JON RANDOLPH , JACOB THEODORE
Published: July 2004

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the “no‐drink” session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no‐drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.
A Prospective Validation Study of Inclination, Belief, and Context Predictors of Family‐Focused Prevention Involvement
Authors: SPOTH RICHARD L. , REDMOND CLEVE , KAHN JEFFREY H. , SHIN CHUNGYEOL
Published: July 2004

Prior research by the authors tested a model of factors influencing parent inclination to participate in parenting interventions. Family context, belief, attitude, and inclination to participate variables from this model were used to predict the actual participation of 1,121 families in assessment and intervention activities of a family‐focused preventive intervention research project. Invitations to the project assessment and intervention components were, respectively, about 6 months and 10 months following the initiation of a telephone survey collecting predictor variable data. Logistic regression analyses examining each predictor individually showed that a number of family context, belief, attitude, and inclination variables were predictive of project participation. Subsequently, multiple logistic regressions were conducted, entering variables by blocks corresponding to theoretical model components. These analyses showed that prospectively stated inclination to participate in a parenting intervention and level of education were consistently significant predictors of both assessment participation and intervention enrollment. Implications for both research and practice are discussed.
Forbidden Suffering: The Pollyanna Syndrome of the Disabled and Their Families
Authors: SAETERSDAL BARBRO
Published: July 2004

Has suffering become an ugly word in the normalization debate? Are the disabled and their families forced into a Pollyanna1 culture in order to be acknowledged and accepted in good company as the worthy disabled? This essay poses a controversial question: I would like to start a debate and ask whether normalization also has an unseen, ideological downside.
Transforming Narratives: A Change Event in Constructivist Family Therapy
Authors: COULEHAN ROBIN , FRIEDLANDER MYRNA L. , HEATHERINGTON LAURIE
Published: July 2004

One important clinical task in family therapy involves transforming the client's construction of the presenting problem from an individual, intrapersonal view to an interpersonal, relational, or systemic one (Sluzki, 1992). To study the transformation process in initial sessions, we sampled 8 families in which the referring parent requested help for a child's problem. The 8 therapists, trained and experienced inSluzki's (1992)narrative approach, attempted to facilitate a transformation in the parents' initial construction of the problem. In 4 sessions, the transformation was independently judged to be successful by the therapist and observers, while in 4 other sessions the transformation was judged to be unsuccessful. Videotapes of the 8 interviews were analyzed qualitatively, and the parents' verbatim descriptions of the problem were coded using the Cognitive Constructions Coding System (Friedlander, 1995). We compared the successful and the unsuccessful sessions and developed a conceptual model of the successful transformation process that included client performances as well as therapist operations (Greenberg, 1986). While many elements in the model were consistent withSluzki's (1992)“blueprint” transformation, several new elements were added. Practical implications are described, along with limitations and recommendations for future research.
Children's Attributions about Family Arguments: Implications for Family Therapy
Authors: WESTON HEATHER E. , BOXER PAUL , HEATHERINGTON LAURIE
Published: July 2004

Children's attributions about the causes of family arguments affect both their interpretations of the meaning of and their adjustment to such events. Children's attributions about family arguments are, therefore, of importance in family therapy, especially for therapists who work from a cognitive or constructivist perspective. In an exploratory study, we examined children's attributions about family arguments in two arenas: marital arguments and parent‐child arguments. Ninety‐two children, aged 5–12, listened to an audiotaped argument and answered a series of structured questions concerning different attributions about the causes of such arguments. Descriptive analyses of the most and least endorsed attributions provided an overall map of the “stories” children tell about the causes of family arguments, and showed that, in general, they are more likely to endorse multiple, interacting causes than internal, blaming attributions. Additionally, children of all ages made somewhat different attributions concerning mothers vs. fathers in marital arguments. Implications for family therapy and suggestions for future clinical research are discussed.
The Systemic View of Violence: An Ethical Perspective
Authors: McCONAGHY JOHN S. , COTTONE R. ROCCO
Published: July 2004

Systems theory has been critiqued by a number of feminist writers who felt that it did not adequately address the issues of violence and male domination in families. This essay argues that systems theory describes the world from an “exogenic” perspective — the scientific world of nature, which is intrinsically amoral. In the exogenic world all causality is circular, as nature maintains a system that has survived for billions of years. Bateson found “mind” to be within the system of nature, implying that mind must also be amoral. However, most people view the world from an “endogenic” perspective, a personal construction of reality molded by the environment in which they live, and which inevitably incorporates morality. Humans believe that violence is wrong, not for intellectual reasons, but for moral reasons. Implications for therapy are presented. A postmodern or constructivist position is taken as a way to acknowledge the influence of relationships on problems and definitions of problems, while allowing for a moral or legal consensus to pervade the therapeutic enterprise.
Engagement of African American Families in Research on Chronic Illness: A Multisystem Recruitment Approach
Authors: Holder Barbara , Turner‐Musa Jocelyn , Kimmel Paul L. , Alleyne Sylvan , Kobrin Sidney , Simmens Samuel , Cruz Illuminado , Reiss David
Published: July 2004

Our multisystem approach addressed the recruitment of African American families with a chronically, physically ill member. The approach focused on the social transactions between the family, the healthcare team, and the research staff, and the influence of these transactions on family recruitment. This multisystem approach included three core strategies: defining the membership of families in a culturally appropriate fashion and engaging those members; engaging the healthcare team; and building and maintaining the skills and morale of the research staff. A description of a longitudinal family health study and potential sources of recruitment biases is provided. Descriptive and bivariate analyses examined the effectiveness of the recruitment approach. A focus group explored the reciprocal process of family protectiveness that both facilitated and hindered family recruitment and the research staff's alliance with families and the dialysis staff. Discussion focuses on the family health study's recruitment rate, sampling biases, and methods for improving the effectiveness of the multisystem recruitment approach.
The Art of Recruitment: The Foundation of Family and Linkage Studies of Psychiatric Illness
Authors: BONVICINI KATHLEEN A.
Published: July 2004

Family and linkage studies of psychiatric illness involve special benefits and challenges in the field of scientific investigation. The success of a family or linkage study is dependent on the recruitment process. The most informative and reliable method of data collection in this field of investigation is through direct interviews with as many family members as possible. Although there are circumstances when direct interviewing is not possible, there are other circumstances, such as refusal of relatives to participate, that deserve closer scrutiny. The complexities involved in the recruitment process while conducting medical investigations have been explored in the literature. However, special issues relevant to the recruitment process merit further exploration for working with families in the context of family and linkage studies of psychiatric illness. Careful understanding of this critical topic may minimize the incidence of family nonparticipation in such research endeavors. This article addresses these issues as they relate to recruiting individuals and their families in this field of investigation. These issues include the role of attitudes, values and beliefs, family interaction and the identification of influential members, informal communication networking, informed consent while promoting the research, and ethical concerns.
The Effect of Tomm's Therapeutic Questioning Styles on Therapeutic Alliance: A Clinical Analog Study
Authors: DOZIER RICHARD M. , HICKS MARY W. , CORNILLE THOMAS A. , PETERSON GARY W.
Published: July 2004

Tomm (1988) suggests that circular and reflexive questions tend to elicit feelings of freedom/acceptance whereas lineal and strategic questions usually trigger feelings of judgment/constraint. Employing an analog methodology, each of Tomm's four questioning styles was portrayed in the form of a 5‐minute videotaped intake scenario. Forty family triads with a mother, father, and adolescent son were randomly assigned to one of four experimental conditions with ten families each. Each condition involved viewing one of four questioning style scenarios. All participants (N = 120 individuals — 40 mothers, 40 fathers, and 40 adolescent sons) completed the Family Therapy Alliance Scale (FTAS; Pinsof & Catherall, 1986) and a validity‐check instrument. The results indicated that circular and reflexive questioning styles elicited significantly higher (p < .001) alliance scores on the FTAS than did either lineal or strategic questions. Implications for the use of different types of questions in family therapy are discussed.
Beyond Bipolar Thinking: Patterns of Conflict as a Focus for Diagnosis and Intervention
Authors: SIMON FRITZ B.
Published: July 2004

Most family typologies in the history of family therapy organized the observation according to bipolar scales. The implied assumption of such models is that the attribution of the one observational characteristic is inevitably bound to the negation of its opposite characteristic. This article presents a formal observational schema that has the possibility to grasp contradictory, conflicting characteristics. Using this schema, one can develop a clinically relevant family typology, making distinctions between different patterns of interaction by which conflicts and antagonistic tendencies in families are organized. Clinical observation and experience suggests that one can distinguish families with members with psychosomatic, manic‐depressive, and schizophrenic symptoms by the way they overcome conflicts and ambivalence.
A Family Therapeutic Approach to Transgenerational Traumatization
Authors: de GRAAF THEO K.
Published: July 2004

The phenomenon of transgenerational traumatization has currently become widely recognized and described, although the task of disentangling the underlying interactional mechanisms remains a difficult one. These transgenerational mechanisms were first detected in families of the survivors of the Holocaust, but they may be equally prominent in families of parents who have been traumatized in other ways, for example, as victims of child neglect and abuse, as orphaned children, or during military service. In cases in which parents have themselves been subjected to early parental deprivation, one or more children may become projectively identified with a parent's (posttraumatic) “bad child”‐self, whereas the parent him/herself has identified with — enacts the role of — the idealized internal “martyr” parent. A case study is presented describing the individual and family therapeutic treatment of a woman who, as a child, had been traumatically separated from her parents.
Rape Flashbacks: Constructing a New Narrative
Authors: PENN PEGGY
Published: July 2004

This article offers an approach to the dissolution of rape flashbacks when the usual treatment of talk and group support doesn't work. The client, with her family, constructs a new rape scenario to replace her abusive story. In the new story, the client introduces a chosen protective figure into the flashback, which has the effect of interrupting the old scenario so that it cannot take place in the same way again. This approach relies on the client finding a new or freed voice in the treatment conversations in order to tell her story differently. The new, repopulated story eventually has the effect of altering her memory and renewing her life direction and belief in herself.
Conflict and Aggression in Couples Therapy: A Self Psychological Vantge Point
Authors: LIVINGSTON MARTIN S.
Published: July 2004

The intent of the present essay is to correct the misconception that self psychology fails to deal with conflict and aggression. Self psychology does, in fact, have a definite view of conflict and aggression that leads to clear implications for treatment. I will focus upon the applicability of these ideas to psychoanalytic work with couples. Clinical material will be presented in order to illustrate the application of these concepts. Conflict and aggression are not seen as an interference or resistance to be handled or removed. Instead, the occurrence of conflict and aggression may be viewed as an opportunity to address underlying issues. The aim of technique thus becomes the deepening of therapeutic process. The key issue is not the management of conflict and rage. It is the strengthening of functions of affect regulation, containment, and self‐cohesion. The emphasis is on the underlying narcissistic vulnerability of both members of the couple, especially during times of conflict. The therapist's attunement to underlying vulnerability is an important aspect of a self psychological approach.
Have You Heard the Latest Rumor About…? Solution‐Focused Therapy as a Rumor
Authors: MILLER GALE , de SHAZER STEVE
Published: July 2004

This essay treats solution‐focused therapy as a rumor. Solution‐focused therapy is a series of stories that members of diverse therapist communities tell one another. Our version of this rumor stresses how solution‐focused therapy is a job involving language games, political relations, and ethical issues. We use this starting point to tell a story that links solution‐focused therapy to Wittgenstein's philosophy of language, and to aspects of postmodernist social thought. We also discuss how solution‐focused therapy is organized as a politics of possibilities.
The King Is Dead; Long Live the King: Narrative Therapy and Practicing What We Preach
Authors: DOAN ROBERT E.
Published: July 2004

Narrative therapy has been associated with the assumptions of postmodernism and social constructionism; both of which support the notion that there are no truths, just points of view. Thus, narrative therapists have sought to privilege the voices of their clients in the process of delivering them from the oppressive weight of dominant, cultural grand narratives. Have they been as willing and adept at respecting the voices of other professionals, and their colleagues within the narrative camp? This question is discussed in relation to the underlying assumptions that inform narrative practice. It is concluded that narrative has perhaps unwittingly fallen prey to the human tendency to reify metaphors and make gurus of leaders.
Not Just a Time‐Out: Change Dynamics of Prayer for Religious Couples in Conflict Situations
Authors: BUTLER MARK H. , GARDNER BRANDT C. , BIRD MARK H.
Published: July 2004

For religious couples, the spiritual domain stands alongside biological, psychological, and systemic domains as an influence upon interaction and mechanism for change. A qualitative methodology consisting of structured interviews of religious spouses was used to investigate effects of prayer on couple interaction during conflict. A reliable description of the dynamics of prayer across spouse interviews was extracted by four analysts using a group interpretive procedure. Findings suggest that prayer invokes a couple‐God system, which significantly influences couple interaction during conflict. Overall, prayer appears to be a significant “softening” event for religious couples, facilitating reconciliation and problem solving. Prayer 1) invokes an experience of relationship with Deity; 2) deescalates hostile emotions and reduces emotional reactivity; 3) enhances relationship and partner orientation and behavior; 4) facilitates empathy and unbiased perspective; 5) increases self‐change focus; and 6) encourages couple responsibility for reconciliation and problem solving. Therapists' support of religious couples' use of prayer as a change mechanism is considered.
Depressive Symptoms among Spousal Caregivers of Institutionalized Mates with Alzheimer's: Boundary Ambiguity and Mastery as Predictors
Authors: KAPLAN LORI , BOSS PAULINE
Published: July 2004

The goal of this study was to identify factors that predict whether or not community‐dwelling spouses experience depressive symptoms upon institutionalization of a mate with Alzheimer's disease. Eighty‐four community‐dwelling spouses (50 wives/34 husbands) completed questionnaires. Boundary ambiguity alone accounted for 51% of the variability in the depressive symptoms score, while mastery alone was found to account for 32%. The total explained variance, when controlling for demographic variables, was 68%. In the stepwise regression analysis, it was observed that mastery did not add significantly to the explanation of the depressive symptom score over and above boundary ambiguity. However, boundary ambiguity and mastery were somehow linked together and were powerful in explaining caregiver symptoms of depression. If a goal is to keep caregivers healthy, then interventions and education about how to live with ambiguity and how to be masterful in spite of the ambiguous status of one's mate seem necessary. Clinical implications are discussed. Future research might build upon this study's limitations for an even better understanding of factors that relate to caregiver depressive symptoms.
Marital Interaction in Dyadic and Triadic Contexts: Continuities and Discontinuities
Authors: DEAL JAMES E. , HAGAN MARGARET STANLEY , BASS BRENDA , HETHERINGTON E. MAVIS , CLINGEMPEEL GLENN
Published: July 2004

While the systemic metaphor used in much current family research requires examination of the interrelationships among individuals, relationships, and the family as a whole, work on triadic relationships has generally been missing. This research examined the presence of second‐order effects in marital interaction: changes in interactions between spouses when the husband‐wife dyad became a parent‐parent‐child triad. Results indicated the presence of consistent context effects. Parental behavior when alone was not a good predictor of parental behavior in the presence of a child: behaviors occurred at significantly lower levels in parental dyads than in parent‐parent‐child triads, and correlations across the two contexts were less than consistent. Results are discussed in light of their implications for observations of families.
The Association between Parental Reports of Attachment Style and Family Dynamics, and Offspring's Reports of Adult Attachment Style
Authors: MIKULINCER MARIO , FLORIAN VICTOR
Published: July 2004

This research assessed the association between parents' reports of attachment styles and their perceptions of family environment, on the one hand, and offspring's reports of adult attachment styles, on the other. The sample included 98 Israeli young adults who completed the adult attachment style scale, and their mothers and fathers who completed this scale, as well as FACES III, and the conflict and expressiveness subscales of the Family Environment Scale. Findings revealed associations between parents' and offspring's reports of attachment styles, which were qualified by gender matching. They also indicated independent and differential contributions1 of the examined dimensions of perceived family environment to offspring's attachment styles. The discussion attempts to integrate attachment theory with a family system perspective.
Physical “Phantasies” and Family Functions: Overcoming the Mind/Body Dualism in Somatization
Authors: REDEKOP FRED , STUART SCOTT , MERTENS CAROL
Published: July 2004

In this article, we examine some of the ways in which family therapists have conceptualized the experience of illness of unexplained physical origin. We argue that opinions about the etiology of somatic symptoms should not be the primary focus of therapeutic work with people who share the prototypical characteristics of what has been defined as “somatization disorder.” We suggest that current research in neurobiology can expand the linguistic resources of clinicians and help them avoid perpetuating unhelpful dichotomies between the mind and the body.
A Culturally Sensitive Approach to Therapy with Immigrant Families: The Case of Jewish Emigrants from the Former Soviet Union
Authors: SLONIM‐NEVO VERED , SHARAGA YANNA , MIRSKY JULIA
Published: July 2004

This article is based on accumulated clinical experience in Israel with families that emigrated from the former Soviet Union. It describes a culturally sensitive systemic intervention with two such families: a single‐parent family, and a family that exhibited physical violence. Relevant cultural characteristics of family patterns and parent‐child relationships in Jewish‐Soviet families are reviewed. It is demonstrated how a cross‐cultural perspective may affect the interpretation of presented problems and result in a less pathological perspective. It is further illustrated how universal intervention techniques combined with culturally sensitive approaches may produce positive effects in therapy.
Bone marrow biopsy in Hodgkin's lymphoma
Authors: Franco Vito , Tripodo Claudio , Rizzo Aroldo , Stella Mario , Florena Ada Maria
Published: July 2004

Abstract:  In the study of patients with Hodgkin's lymphoma (HL) the evaluation of bone marrow biopsy (BMB) can be difficult. In this review we analyze the main diagnostic features and the clinical risk factors of BM involvement. Although the role of BMB is criticized by some authors, its value is irreplaceable in the staging of HL and in the diagnosis of primary medullary HL. The Ann Arbor staging committee criteria should be revised and updated in the light of the current immunohistochemical studies that give a fundamental help in the diagnostic process. A single BMB should be adequate for diagnosis in most instances. In cases of suspicious involvement a controlateral BMB could be performed.
Ehlers–Danlos Syndrome (EDS) focusing on oral symptoms: a questionnaire study
Authors: Hagberg C , Berglund B , Korpe L , Andersson‐Norinder J
Published: July 2004

Structured Abstract

Authors – Hagberg C, Berglund B, Korpe L, Andersson‐Norinder J

Objectives – To study the prevalence of oral problems reported among a large group of adults with Ehlers–Danlos Syndrome (EDS). Furthermore, to compare proportions of disorders and general psychological well‐being with those in a cohort of randomized population‐based controls.

Design – A questionnaire study.

Setting and Sample Population – A total of 265 persons with EDS (response rate 77%) and 750 controls (response rate 63%) in a population‐based cohort. Sixty persons were excluded from the EDS group (support members, children, undiagnosed EDS) leaving a final study group of 144 adults. The final control group consisted of 331 persons since many had sent back unanswered questionnaires.

Experimental Variables – Questions concerning general and oral symptoms, VAS scales for masticatory muscle pain ratings and General Health Questionnaire (GHQ12) questions were included.

Outcome Measure – Proportions of affirmative answers in EDS group and controls were compared. Mean values for ratings on VAS scales. Proportions of GHQ12 scores with a threshold score of four or more.

Results – The proportions of affirmative answers for persons with EDS concerning general health problems, oral problems and masticatory muscle symptoms were significantly higher compared with controls. In the EDS group those who had daily pain in the masticatory muscles had significantly higher mean values on the VAS scales compared with those who had pain a few days per month. A GHQ12 score of four or more was significantly more common in the EDS group than in the controls, suggesting that a decline in psychological well‐being was also more common in this group.

Conclusion – It is important that dental practitioners should be aware of the oral problems associated with EDS and the impact the disease has on quality of life.
Taking stock: from chasing occlusal contacts to vulnerability alleles
Authors: Stohler CS
Published: July 2004

Over the past 70 years, temporomandibular disorders (TMDs) have been subject to shifts in conceptual understanding. Unable to account for disease patterns, the mismatch between case assignment and treatment need, and very different interventions producing similar treatment outcomes (except for the risk to patients), emerging theories make persuasive arguments in support of alternative explanations.
Audit as a learning tool in postgraduate emergency medicine training
Authors: Brazil Victoria
Published: July 2004

Objective:  Educational activities for emergency medicine trainees need to be clinically focused, relevant, and ideally have the capacity to change practice and patient outcomes. It is proposed that the use of audit methods in educational sessions may address these learning needs. The aims of this project were to involve emergency medicine trainees in undertaking audits of ED patient care, and to evaluate the use of this technique in fulfilling training needs.

Methods:  Trainees were given clinical topics on which to develop a presentation at weekly education sessions within the ED. This presentation included a brief clinical audit concerning an aspect of the same topic. The audit question addressed one of the issues identified as standard of care in the trainee presentation and investigated our department's level of compliance with that standard. At the end of a 6‐month period, a questionnaire was given to all trainees involved, either as presenters or attendees at an audit presentation.

Results:  Trainees performing audits reported that this method was most useful for demonstrating the limitations of coding, giving a greater appreciation of poor documentation in medical records, and improving their presentation skills. Most trainees attending audit based presentations reported that this educational method gave them a greater appreciation of systems based practice, actually changed their clinical practice, and was more useful than traditional lectures.

Conclusions:  Audit should be a key component of emergency medicine education. Trainees perceive the technique as useful addressing a number of training needs in a clinical context.
Responding to formal complaints about the emergency department: Lessons from the service marketing literature
Authors: Doig Gavan
Published: July 2004

The ability to respond to formal complaints is a necessary part of emergency medicine practice. In spite of the significance of formal complaints there is little guidance within the medical literature to understand why patients complain or how to provide satisfaction to individuals who complain. Practitioners are usually left to their own devices in the style and substance of complaint responses even when working within a defined complaint management system. This article draws on relatively abundant literature in the service marketing field to provide an understanding of dissatisfaction, complaining and complaint handling. Having developed an appropriate theoretical framework the article provides guidance for applying these concepts in dealing with formal complaints.
Emergency management of the morbidly obese
Authors: Grant Peter , Newcombe Mark
Published: July 2004

Objectives:  To identify the difficulties encountered with the emergency management of morbidly obese patients and formulate recommendations to streamline care.

Methods:  An English language literature search was undertaken using Medline (1966–2003) with key words ‘morbid obesity’‘anaesthesia’‘imaging’‘obesity’‘emergency’‘transportation’‘retrieval’‘critical illness’ and ‘monitoring’. Potential articles were selected for content applicable to emergency medicine based on title and abstract and reviewed in detail. Reference lists were manually searched for further relevant articles. In view of the very limited systematic study in this area, all information deemed by the authors’ to be of assistance to the emergency physician was included regardless of evidence level. Additional information was sought from standard critical care textbooks and their bibliographies and through personal communication with local ambulance and retrieval services. The authors’ unpublished personal experience in providing emergency care to the morbidly obese was included for aspects of management not documented in medical literature.

Results:  Obesity levels and associated health problems are rapidly rising in Australia. Few studies were identified dealing with critical illness in the morbidly obese and none specifically addressing ED management. Problems identified included size related logistical issues, and limitations of physical assessment, monitoring and routine investigations. Invasive procedures, intubation and ventilation can be particularly problematic, and modified techniques may be required. Limited data indicates a poorer outcome from critical illness most marked in the case of blunt traumatic injury.

Conclusion:  Very obese patients present a variety of logistical and medical challenges for EDs. A series of recommendations are made based on available data. Further studies in this area would be desirable to more specifically address ED issues.
Family member presence during resuscitation in the emergency department: An Australian perspective
Authors: Redley Bernice , Botti Mari , Duke Maxine
Published: July 2004

Objective:  The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice.

Methods:  A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations.

Results:  The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements.

Conclusion:  Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.
Phenytoin overdose complicated by prolonged intoxication and residual neurological deficits
Authors: Craig Simon
Published: July 2004

This report describes a case of massive phenytoin deliberate self‐poisoning, notable for delayed peak serum concentrations, multiple general complications, and permanent cerebellar injury. A 38‐year‐old 70 kg male patient presented to the ED after ingestion of at least 10 g of phenytoin 12–16 h earlier. Marked cerebellar dysfunction and persistent vomiting were observed, with an initial serum phenytoin concentration of 181 µmol/L. Initial conservative treatment (activated charcoal, whole bowel irrigation), and later attempts at charcoal haemoperfusion were unsuccessful. The serum phenytoin concentration peaked on day 15 (354 µmol/L). The patient developed seizures followed by a prolonged depression in conscious state requiring intubation. Multiple medical sequelae occurred and the patient was discharged to a rehabilitation facility 100 days after admission exhibiting signs consistent with permanent cerebellar dysfunction.
The role of physician staffing of helicopter emergency medical services in prehospital trauma response
Authors: Garner Alan A
Published: July 2004

The crewing of Helicopter Emergency Medical Service (HEMS) for scene response to trauma patients is generally considered to be controversial, particularly regarding the role of physicians. This is reflected in HEMS in Australia with some services utilizing physician crewing for all prehospital missions. Others however, use physicians for selected missions only whilst others do not use physicians at all. This review seeks to determine whether the literature supports using physicians in addition to paramedics in HEMS teams for prehospital trauma care.

Studies were excluded if they compared physician teams with basic life support teams (BLS) teams rather than paramedics. Ambulance officers were considered to be paramedics where they were able to administer intravenous fluids and use a method of airway management beyond bag‐valve‐mask ventilation. Studies were excluded if the skill set of the ambulance team was not defined, the level of staffing of the helicopter service was not stated, team composition varied without reporting outcomes for each team type, patient outcome data were not reported, or the majority of the transports were interhospital rather than prehospital transports.
Electrophysiological and molecular characterization of the inward rectifier in juxtaglomerular cells from rat kidney
Authors: Leichtle Anke , Rauch Ulrich , Albinus Margitta , Benöhr Peter , Kalbacher Hubert , Mack Andreas F. , Veh Rüdiger W. , Quast Ulrich , Russ Ulrich
Published: July 2004

Renin, the key element of the renin–angiotensin–aldosterone system, is mainly produced by and stored in the juxtaglomerular cells in the kidney. These cells are situated in the media of the afferent arteriole close to the vessel pole and can transform into smooth muscle cells and vice versa. In this study, the electrophysiological properties and the molecular identity of the K+ channels responsible for the resting membrane potential (∼−60 mV) of the juxtaglomerular cells were examined. In order to increase the number of juxtaglomerular cells, afferent arterioles from NaCl‐depleted rats were used, and > 90% of the afferent arterioles were renin positive at the distal end of the arteriole. Whole‐cell and cell‐attached single‐channel patch‐clamp experiments showed that juxtaglomerular cells are endowed with a strongly inwardly rectifying K+ channel (Kir). The channel was highly sensitive to inhibition by Ba2+ (inhibition constant 37 μm at 0 mV), but relatively insensitive to Cs+ and, with 142 mm K+ in the pipette, had a single‐channel conductance of 31.5 pS. Immunocytochemical studies showed the presence of Kir2.1 but no signal for Kir2.2 in the media of the afferent arteriole. In PCR analyses using isolated juxtaglomerular cells, the mRNA for Kir2.1 and Kir2.2 was detected. Collectively, the results show that Kir2.1 is the dominant component of the channel. The current carried by these channels plays a decisive role in setting the membrane potential of juxtaglomerular cells.
Laser Vibrometry Based Detection of Delaminations in Glass/Epoxy Composites
Authors: Amraoui M. Y. , Lieven N. A. J.
Published: July 2004

The significant progress in sensing and data processing technology has made monitoring and damage detection of engineering structures increasingly attractive. This paper presents a reliable in-situ damage detection technique, which is based upon dynamic analysis of a composite structure using bonded piezo-ceramic patches as actuators and a Scanning Laser Doppler Vibrometer as a sensor. In addition, Neural Networks have been considered to be a viable tool for handling the large number of data. A multilayer perceptron (MLP) neural networks, was trained and tested using the slope, the y-intercept of the linear fit of the root mean square of the Frequency Response Function FRFrms and the Deviation of the FRFrms of a candidate composite structure.
Extraction of Periodic Components for Gearbox Diagnosis Combining Wavelet Filtering and Cyclostationary Analysis
Authors: Lin Jing , Zuo Ming J.
Published: July 2004

Wavelet filtering is combined with cyclostationary analysis for detection of gear tooth faults in a gearbox. The parameters of the wavelet filter are optimized by using the proposed entropy minimization rule. This method is shown to be effective in detecting gear faults when cyclostationary analysis by itself fails.
EXACT WAVE FUNCTIONS AND ENERGIES OF A NON-RELATIVISTIC FREE QUANTUM PARTICLE ON THE SURFACE OF A DEGENERATE TORUS
Authors: SCHULZE-HALBERG AXEL
Published: July 2004

We study the non-relativistic Schrödinger equation for a free quantum particle constrained to the surface of a degenerate torus, parametrized by its polar and azimuthal angle. On restricting to wave functions that depend on the polar angle only, the Schrödinger equation becomes exactly-solvable. We compute its physical solutions (continuous, normalizable and 2π-periodic) and the associated energies in closed form.
STUDY OF DISPERSION CHARACTERISTICS OF PLASMON–OPTICAL PHONON IN MULTICOMPONENT SUPERLATTICES
Authors: MISRA K. D. , MISHRA R. K.
Published: July 2004

Dispersion relations for two-component and three-component periodic optical semiconductor superlattices are derived. A systematic study of the interaction of bulk and surface plasmons with optical phonons is made in these superlattices to find out the factors which can influence the coupling between the two modes of vibration. Coupling between the plasmons and optical phonons in the bulk medium and surface of the two semi-infinite mediums gives rise to four modes (two symmetric and two antisymmetric) for the bulk mode and two for the mixed mode. The detailed calculation is presented for various types of multicomponent semiconductor superlattice structures.
Effects of gender and GH secretory pattern on sterol regulatory element-binding protein-1c and its target genes in rat liver
Authors: Améen Caroline , Lindén Daniel , Larsson Britt-Mari , Mode Agneta , Holmäng Agneta , Oscarsson Jan
Published: July 2004

We investigated whether the sexually dimorphic secretory pattern of growth hormone (GH) in the rat regulates hepatic gene expression of sterol regulatory element-binding protein-1c (SREBP-1c) and its target genes. SREBP-1c, fatty acid synthase (FAS), and glycerol-3-phosphate acyltransferase (GPAT) mRNA were more abundant in female than in male livers, whereas acetyl-CoA carboxylase-1 (ACC1) and stearoyl-CoA desaturase-1 (SCD-1) were similarly expressed in both sexes. Hypophysectomized female rats were given GH as a continuous infusion or as two daily injections for 7 days to mimic the female- and male-specific GH secretory patterns, respectively. The female pattern of GH administration increased the expression of SREBP-1c, ACC1, FAS, SCD-1, and GPAT mRNA, whereas the male pattern of GH administration increased only SCD-1 mRNA. FAS and SCD-1 protein levels were regulated in a similar manner by GH. Incubation of primary rat hepatocytes with GH increased SCD-1 mRNA levels and decreased FAS and GPAT mRNA levels but had no effect on SREBP-1c mRNA. GH decreased hepatic liver X receptor-α (LXRα) mRNA levels both in vivo and in vitro. Feminization of the GH plasma pattern in male rats by administration of GH as a continuous infusion decreased insulin sensitivity and increased expression of FAS and GPAT mRNA but had no effect on SREBP-1c, ACC1, SCD-1, or LXRα mRNA. In conclusion, FAS and GPAT are specifically upregulated by the female secretory pattern of GH. This regulation is not a direct effect of GH on hepatocytes and does not involve changed expression of SREBP-1c or LXRα mRNA but is associated with decreased insulin sensitivity.
Difference in skeletal muscle function in males vs. females: role of estrogen receptor-β
Authors: Glenmark Birgitta , Nilsson Maria , Gao Hui , Gustafsson Jan-Åke , Dahlman-Wright Karin , Westerblad Håkan
Published: July 2004

Male skeletal muscles are generally faster and have higher maximum power output than female muscles. Conversely, during repeated contractions, female muscles are generally more fatigue resistant and recover faster. We studied the role of estrogen receptor-β (ERβ) in this gender difference by comparing contractile function of soleus (mainly slow-twitch) and extensor digitorum longus (fast-twitch) muscles isolated from ERβ-deficient (ERβ−/−) and wild-type mice of both sexes. Results showed generally shorter contraction and relaxation times in male compared with female muscles, and ERβ deficiency had no effect on this. Fatigue (induced by repeated tetanic contractions) and recovery of female muscles were not affected by ERβ deficiency. However, male ERβ−/− muscles were slightly more fatigue resistant and produced higher forces during the recovery period than wild-type male muscles. In fact, female muscles and male ERβ−/− muscles displayed markedly better recovery than male wild-type muscles. Gene screening of male soleus muscles showed 25 genes that were differently expressed in ERβ−/− and wild-type mice. Five of these genes were selected for further analysis: muscle ankyrin repeat protein-2, muscle LIM protein, calsequestrin, parvalbumin, and aquaporin-1. Expression of these genes showed a similar general pattern: increased expression in male and decreased expression in female ERβ−/− muscles. In conclusion, ERβ deficiency results in increased performance during fatigue and recovery of male muscles, whereas female muscles are not affected. Improved contractile performance of male ERβ−/− mouse muscles was associated with increased expression of mRNAs encoding important muscle proteins.