bluuebunny/crossref_metadata_2025 huggingface dataset:
IT Governance in Romania: A Case Study
Authors: Gheorghe Mirela , Nastase Pavel , Boldeanu Dana , Ofelia Aleca
Published: March 2009

Relatively new in Romania, IT governance is defined as procedures and policies established in order to assure that the IT system of an organization sustains its goals and strategies. This bundle of policies and procedures, following the best practices in the area, intends to guide and control the IT function in order to add value to the organization and to minimize IT risks.

The purpose of the research is to identify the measure in which the IT governance practices are implemented to the level of the financial institutions in Romania. The goal of this paper is a comparative analysis for implementing IT governance using data offered by the IT Governance Institute. This institute makes every year a study (IT Governance Global Status Report – 2006) to determine a sense of priorities and to develop actions for implementing IT governance, using data which acknowledges once more the need for all organizations to have tools and services to assure an efficient IT governance. In this way, the research will analyze, in the field of Romanian financial institutions, the most serious IT problems pointed out by the respondents from the last year, the most efficient measures considered by top management for resolving problems pointed out, the best used practices in IT governance and the most used frameworks for implementing IT governance practices.
Moving Toward the Next G-20 Summit
Authors: Rao P. K.
Published: March 2009

This brief paper a) focuses on important elements of the November Summit of G-20 Countries that resulted in the Washington Declaration; b) highlights problems with credit rating agencies and financial regulation; c) argues that the IMF is a laggard in being able to coordinate any major efforts to prevent, mitigate, or coordinate global issues; and d) identifies a number of important issues that deserve attention at the next G-20 Summit to be held in London on April 2nd.
Comment on Luigi Zingales: Why not Consider Maximum Reserve Ratios?
Authors: Dasgupta Swapan
Published: March 2009

Why not set a maximum on bank reserves, wonders Swapan Dasgupta?
The inside outside intersection problem for hexagon triple systems
Authors: Lindner C. , Meszka M. , Pettis C.
Published: March 2009

We give a complete solution of the following two problems:
(1)For which (n, x) does there exist a pair of hexagon triple systems of order n having x inside triples in common?(2)For which (n, x) does there exist a pair of hexagon triple systems having x outside triples in common?
The number of edges of radius-invariant graphs
Authors: Vacek Ondrej
Published: March 2009

The eccentricity e(υ) of vertex υ is defined as a distance to a farthest vertex from υ. The radius of a graph G is defined as r(G) = $$
\mathop {\min }\limits_{u \in V(G)}
$$ {e(u)}. We consider properties of unchanging the radius of a graph under two different situations: deleting an arbitrary edge and deleting an arbitrary vertex. This paper gives the upper bounds for the number of edges in such graphs.
On a relative uniform completion of an archimedean lattice ordered group
Authors: Černák Štefan , Lihová Judita
Published: March 2009

The notion of a relatively uniform convergence (ru-convergence) has been used first in vector lattices and then in Archimedean lattice ordered groups.

Let G be an Archimedean lattice ordered group. In the present paper, a relative uniform completion (ru-completion) $$
G_{\omega _1 }
$$ of G is dealt with. It is known that $$
G_{\omega _1 }
$$ exists and it is uniquely determined up to isomorphisms over G. The ru-completion of a finite direct product and of a completely subdirect product are established. We examine also whether certain properties of G remain valid in $$
G_{\omega _1 }
$$. Finally, we are interested in the existence of a greatest convex l-subgroup of G, which is complete with respect to ru-convergence.
Diminishing the Divisions Among Us: Reading and Writing Across Difference in Theory and Method in the Sociology of Education
Authors: Weis Lois , Jenkins Heather , Stich Amy
Published: March 2009

Evidenced in several now classic reviews of the field, much has been made of theoretical and methodological “difference” with regard to research in the sociology of education. Although such renditions often constitute important intellectual contributions, the authors suggest that it is increasingly important to read across theoretical and methodological divisions that are now widely understood to characterize the field. The authors fear, in fact, that the seemingly taken-for-granted assumption of staked-out theoretical and methodological “camps” (with which scholars and doctoral students are inevitably allied) implies a misunderstanding or misreading of how scholars came to be where they are today while simultaneously stunting scholarship related to the production of social inequalities both in and outside of schools. The authors intentionally traverse select taken-for-granted boundaries as they work toward productive scholarly “trespassing” that encourages the kind of theoretical and methodological struggle, debate, and difference that characterized an earlier period.
Effective Programs in Middle and High School Mathematics: A Best-Evidence Synthesis
Authors: Slavin Robert E. , Lake Cynthia , Groff Cynthia
Published: March 2009

This article reviews research on the achievement outcomes of mathematics programs for middle and high schools. Study inclusion requirements include use of a randomized or matched control group, a study duration of at least 12 weeks, and equality at pretest. There were 100 qualifying studies, 26 of which used random assignment to treatments. Effect sizes were very small for mathematics curricula and for computer-assisted instruction. Positive effects were found for two cooperative learning programs. Outcomes were similar for disadvantaged and nondisadvantaged students and for students of different ethnicities. Consistent with an earlier review of elementary programs, this article concludes that programs that affect daily teaching practices and student interactions have more promise than those emphasizing textbooks or technology alone.
Should Graduate Students Publish?
Authors: PASCO ALLAN H.
Published: March 2009

Most graduate students in the humanities have the intelligence and insight required to publish outstanding studies, though, of course, they may lack the knowledge and persistence required of successful professionals. Whether or not they should publish remains an open question, with a number of issues that must be evaluated. Publication should be entertained only if neither graduate students' own classes nor those they teach would suffer. They should, moreover, make the attempt only if the potential article makes a significant contribution to the field. Nonetheless, students who wish to be competitive would be wise to have something accepted for publication when they look for a job. A faculty mentor is helpful, both to ensure that the manuscript is sufficiently expert, well written, and organized and to put negative, sometimes hurtful reviews in context. While the process of turning papers into first-rate publications can be a wonderfully useful experience, it can also take more time than students can afford and be undeservedly damaging to their self-confidence.
A Review of Mental Health Issues as a Result of Hurricane Katrina
Authors: Potash Mordecai N. , Winstead Daniel K.
Published: March 2009

Hurricane Katrina was an unprecedented disaster in the United States, whose effects and consequences are ongoing. What is well known to those of us practicing psychiatry in this region is that Hurricane Katrina created diverse and serious mental health issues that have been among the greatest personal and professional challenges of our lives. This article is intended to review and explore these issues since Katrina’s landfall on August 29, 2005. We hope that our experiences can inform mental health professionals planning for or facing regional or national emergencies.
 ABOUT THE AUTHORS
Mordecai N. Potash, MD, is Associate Professor of Clinical Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine. Daniel K. Winstead, MD, is Heath Professor and Chairman, Department of Psychiatry and Neurology, Tulane University School of Medicine.

Address correspondence to: Mordecai N. Potash, MD, Tulane SOM Dept. of Psychiatry and Neurology, TB 48, 1440 Canal Street, 10th Floor, New Orleans, LA 70112-2715; or e-mail mpotash@tulane.edu.

Dr. Potash and Dr. Winstead have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Review issues in mental health care arising in New Orleans since Hurricane Katrina’s landfall and how these issues can help mental health professionals plan for future regional or national emergencies.

Discuss psychological stressors affecting first-responders during the first weeks and months after Hurricane Katrina and review findings of researchers studying mental health consequences in affected residents in New Orleans.

Explain the consequences of the loss of mental health practitioners and facilities on the returning population of New Orleans and discuss responses of government officials to the loss of mental health services in New Orleans since Hurricane Katrina.
Computational Modeling: A Tool for New Psychiatric Medication Development
Authors: Li Guoshi , Nair Jyotsna , Quirk Gregory J. , Nair Satish S.
Published: March 2009

Computational models are being used in a variety of medical applications, including drug discovery research, where genomic and proteomic software tools facilitate modeling complex intracellular pathways. Increasing understanding of brain functioning due to advances in basic neuroscience techniques and imaging modalities has led to the emergence of computational modeling as an important tool for studying brain mechanisms and circuits. Recent advances in the areas of cellular neurophysiology and synaptic plasticity permit the development of biophysically realistic models that more closely approximate learning, both at the network and membrane levels. Such models have the potential to enhance a psychiatrist’s understanding of brain circuits with applicability to a range of phenomena from the mechanism of action of drugs to the neural basis of mental illness. An example case is provided in the fear circuit to illustrate the ability of a model to provide insights into possible sites for the storage of auditory fear and extinction memories. Since disruption of the fear circuit is thought to underlie the pathology of posttraumatic stress disorder (PTSD) and other anxiety disorders, such a model could potentially provide ideas and approaches for the development of new medications.

ABOUT THE AUTHORS

Guoshi Li, PhD candidate, and Satish S. Nair, PhD, are with the Department of Electrical and Computer Engineering, University of Missouri-Columbia. Jyotsna Nair, MD, is with the Department of Psychiatry, University of Missouri-Columbia. Gregory J. Quirk, PhD, is with the Department of Psychiatry, University of Puerto Rico School of Medicine, San Juan.

Address correspondence to: Satish S. Nair, PhD, nairs@missouri.edu.

Mr. Li, Dr. Satish Nair, Dr. Jyotsna Nair, and Dr. Quirk have disclosed no relevant financial information.
Pharmacogenetics of Major Depressive Disorder
Authors: Lohoff Falk W.
Published: March 2009

Major depressive disorder (MDD) is a common psychiatric illness with high levels of morbidity and mortality. It is estimated that 10% to 15% of the general population will experience clinical depression during their lifetime, and 5% of men and 9% of women will experience a depressive disorder in a given year.1 Although there are a variety of pharmacological treatments available, response and tolerability to medication are highly variable with some patients responding to one treatment but not another. In general, only one-third of treated MDD patients respond to pharmacological treatment and reach remission of symptoms. There are several potential explanations for these poor drug response rates, including clinical heterogeneity and diagnostic uncertainty, environmental and social factors, and genetics factors. This article will focus on the recent developments in the field of pharmacogenetics in MDD.
 ABOUT THE AUTHOR
Falk W. Lohoff, MD, is Assistant Professor of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, and the Center for Neurobiology and Behavior, Translational Research Laboratories, Philadelphia.

Address correspondence to: Falk W. Lohoff, MD, 125 South 31st Street, Room 2213, Philadelphia, PA 19104; fax 215-573-2041; lohoff@mail.med.upenn.edu.

Dr. Lohoff has disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Demonstrate that genetic differences can influence drug absorption, distribution, metabolism, and excretion (pharmacokinetics), as well as mechanism of action (pharmacodynamics).

Explain that the nature of genetic variation in drug metabolism for antidepressants involves multiple P450 enzymes, each of which may vary in DNA sequence, with resultant alteration in enzyme activity.

Discuss that no specific genetic variation has a large effect on antidepressant response to make that variation clinically meaningful.
 
Expression of Depressive Symptoms, Regional Variations: A Comparison of Three Cities in Pakistan
Authors: Gadit Dr. Amin A. Muhammad , Mugford Dr. Gerry J.
Published: March 2009

Rates of depression are alarming, and depression appears to be a global issue. Regional depression is attributable to a number of factors, including economic problems, political upheavals, violence, upsurge of physical illnesses, and disruption of the general social fabric. In any given 1-year period, 9.5% of the U.S. population, or about 20.9 million American adults, suffer from a depressive illness. An estimate from developing countries indicates 50.8 million people suffer from major depression. A study conducted by the World Health Organization in 14 countries showed 24% of primary care attendees worldwide received an International Classification of Diseases-10 (IDC) psychiatric diagnosis, the most common of which was current depressive episode.
 ABOUT THE AUTHORS
Dr. Amin A. Muhammad Gadit is with the Discipline of Psychiatry; and Dr. Gerry J. Mugford is with the Departments of Pharmacy, Medicine, and Psychiatry, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada.

Address correspondence to: Dr. Amin A. Muhammad Gadit, Memorial University of Newfoundland, St. John’s, Newfoundland, NL A1B 3V6 Canada; or e-mail amin.muhammad@med.mun.ca.

Dr. Gadit and Dr. Mugford have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Identify the regional differences in expression of depressive symptoms.

Compare the findings in a cross-cultural perspective.

Discuss the need for prospective studies in this area of research.
 
Treatment Delay in the Early Course of Schizophrenia and the Duration of Untreated Psychosis
Authors: Compton Michael T. , Goulding Sandra M. , Broussard Beth , Trotman Hanan
Published: March 2009

Treatment Delay in the Early Course of Schizophrenia and the Duration of Untreated Psychosis

Michael T. Compton, MD, MPH; Sandra M. Goulding, MPH; Beth Broussard, MPH, CHES; and Hanan Trotman, MA

In recent decades, treatment delay in the early course of schizophrenia has evolved as an issue of great interest to schizophrenia researchers, especially early psychosis researchers. This interest is partly derived from accumulating research evidence that delaying treatment of new-onset psychosis, like delaying treatment of any emerging medical condition, is associated with poorer symptomatic and functional outcomes. Additionally, the interest also stems from the clinical observation of countless mental health practitioners — that the period of untreated psychosis is detrimental, confusing, emotionally painful, and even disabling for patients and their families. Thus, in addition to a potential accumulation of biological morbidity (ie, an “active morbid process” or neurotoxicity effect) that may lead to poorer future outcomes, the immediate “psychosocial toxicity” of untreated psychosis is a critical outcome in itself. Because age and level of social development at onset influence the later social course of the disorder, an extended duration of untreated psychosis (DUP) is likely to adversely affect the course of illness through significant social losses that occur during DUP. Early intervention for psychotic disorders, like secondary prevention efforts for any health condition, has the potential to decrease prevalence, enhance outcomes, reduce morbidity, and ameliorate present distress.
 ABOUT THE AUTHORS
Michael T. Compton, MD, MPH; Sandra M. Goulding, MPH; and Beth Broussard, MPH, CHES, are with the Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences. Hanan Trotman, MA, is with the Emory University Graduate School of Arts and Sciences, Department of Psychology.

Direct correspondence to: Michael T. Compton, MD, MPH, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 49 Jesse Hill Jr. Drive, SE, Room #333, Atlanta, GA 30303; fax 404-616-3241 or e-mail Michael.Compton@emory.edu.

Dr. Compton, Ms. Goulding, Ms. Broussard and Ms. Trotman have disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
Explain the importance of early intervention efforts aimed at reducing the duration of untreated psychosis.

Describe the relationship between duration of untreated psychosis and early-course outcomes.

Discuss potential predictive variables of treatment delay in first-episode psychosis.
The Promise of Early Recognition and Treatment
Authors: Fawcett Jan
Published: March 2009

This issue of Psychiatric Annals features a series of articles on Early Intervention of Psychotic Disorders, guest edited by Michael T. Compton, MD, MPH. This series, with articles from Norway, Australia, Canada, and the United States, is one of the most progressive and optimistic series of articles pertaining to schizophrenia that I have seen. This series makes a case for early recognition and treatment of high-risk youth as a method for early case finding of people with prodromal or at-risk symptoms for psychosis in order to increase the rate of social recovery and to increase functional outcomes.
Insomnia and Sleep-related Disorders
Authors: Roth Thomas
Published: March 2009

Research on insomnia and its treatment throughout the past 25 years has significantly changed the medical view of insomnia. These changes are most clearly explicated in the National Institute of Mental Health (NIMH) State of the Science Conference on the nature of insomnia and insomnia therapeutics.

ABOUT THE GUEST EDITOR

Thomas Roth, PhD, is Director of the Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan.

Dr. Roth’s research primarily focuses on sleep processes. His work includes research on sleep loss, sleep fragmentation, and deviation from sleep processes, including pharmacologic effects and sleep pathologies.

Dr. Roth has held numerous leadership positions within his field. He is Past Chairman of the National Center on Sleep Disorders Research Advisory Board of the National Institutes of Health and is Past President of the U.S. Sleep Research Society, the American Sleep Disorders Association, and the National Sleep Foundation. He also served as past Editor-in-Chief of the journal Sleep.

In addition to his position at Henry Ford, he is a Clinical Professor of Psychiatry at the University of Michigan School of Medicine in Ann Arbor.

He has published more than 325 manuscripts, 13 edited volumes, 170 chapters, and 491 abstracts.

Dr. Roth received his doctorate from the University of Cincinnati in 1970.
Pharmacologic Treatment of Insomnia
Authors: Mendelson Wallace B.
Published: March 2009

Insomnia is a common but undertreated condition, which places a significant burden on the patient’s daytime life. There are a number of pharmacologic agents available for treating insomnia, and the choice of a specific agent hinges on desired therapeutic target, side effect profile, and liability for misuse. A growing body of data suggests that treatment of insomnia may not only improve sleep but also aid in the management of coexisting medical or psychiatric disorders. There are also data indicating that pharmacologic treatment may produce a relative decline in healthcare costs compared with untreated insomniacs, and that pharmacologic or nonpharmacologic therapy may reverse deficits in perceived health and quality of life.
 ABOUT THE AUTHORS
Wallace B. Mendelson, MD, is Professor of Psychiatry and Clinical Pharmacology at the University of Chicago.

Address correspondence to: Wallace B. Mendelson, MD, via e-mail at drmendelson@yahoo.com.

Dr. Mendelson has disclosed the following relevant financial relationships: Takeda Pharmaceutical Company Limited; Sanofi-Aventis; Sepracor Inc.; and VivoMetrics: Speakers Bureau/Consultant.
 EDUCATIONAL OBJECTIVES
Describe the evolution of sedative/hypnotics, from the barbiturates to the new nonbenzodiazepine hypnotics.

Discuss the clinical characteristics of currently available hypnotics.

Explain the risk/benefit ratio of administering hypnotics.
 
Insomnia and Psychiatric Disorders
Authors: Peterson Michael J. , Rumble Meredith E. , Benca Ruth M.
Published: March 2009

Insomnia and psychiatric disorders frequently occur together. Epidemiological studies have revealed that individuals with insomnia are more likely to have clinically significant psychological symptoms in comparison with individuals without insomnia. For example, a recent population survey indicated that adults with insomnia were up to nine times more likely to have clinically significant depressive symptoms and were up to 17 times more likely to have clinically significant anxiety symptoms than those without insomnia. Epidemiological studies also have demonstrated that approximately 25% to 50% of individuals with clinically significant insomnia meet criteria for insomnia that is comorbid with a psychiatric disorder, including mood and anxiety disorders and have an increased lifetime prevalence of major depressive and anxiety disorders. Furthermore, in samples of patients from sleep clinics, this rate was even higher — more than 75% of patients with insomnia also met criteria for a psychiatric disorder. In general, sleep disruption is one of the most common and consistent symptoms of psychiatric disorders, and is included in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, (DSM-IV-TR) diagnostic criteria for depression, mania and hypomania, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD).
 ABOUT THE AUTHORS
Michael J. Peterson, MD, PhD, is Assistant Professor, Department of Psychiatry, University of Wisconsin-Madison. Meredith E. Rumble, PhD, is Research Associate, Department of Psychiatry, University of Wisconsin-Madison. Ruth M. Benca, MD, PhD, is Professor, Department of Psychiatry, University of Wisconsin-Madison, and Director, University of Wisconsin Sleep Program.

Address correspondence to: Michael J. Peterson, MD, PhD, Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd., Madison, WI 53719; fax (608) 263-0265; or e-mail mpeterson2@wisc.edu.

Dr. Peterson has disclosed no relevant financial relationships. Dr. Rumble has disclosed no relevant financial relationships. Dr. Benca has disclosed the following relevant financial relationships: Actekion, Sanofi-Aventis, Sepracor, and Takeda: Consultant.

This study was supported by a National Institutes of Health (NIH) Roadmap Interdisciplinary Award T32 MH75880 (MJP) and a National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator Award (MJP).
 EDUCATIONAL OBJECTIVES
Discuss the biological mechanisms shard by sleep and mood disorders.

Summarize the nature of sleep abnormalities in different psychiatric disorders.

Describe the relation of insomnia and psychiatric disorders
 
Sleep Disturbance in Bereavement
Authors: Monk Timothy H. , Germain Anne , Reynolds Charles F.
Published: March 2009

Bereavement is a ubiquitous part of the human condition. Almost no person makes it through his or her life without having to cope with the loss of a loved one several different times. The loss of a parent, child, or grandparent can be very distressing. For many, the most devastating loss is that of their spouse or partner, which usually occurs during later life. More than 800,000 older Americans are widowed every year. Apart from the severe emotional strain of the loss of a loved one, there are profound changes in lifestyle and status, often accompanied by reductions in financial security, perceived personal safety, and freedom of action. Thus, late-life spousal bereavement (LLSB) comprises one of the major impacts of bereavement on society.

ABOUT THE AUTHORS

Timothy H. Monk, PhD, DSc, is Professor of Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Anne Germain, PhD, is Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine. Charles F. Reynolds III, MD, is the Professor of Geriatric Psychiatry and Professor of Neurology and Neuroscience, University of Pittsburgh Medical Center.

Address correspondence to Timothy H. Monk, DSc, Western Psychiatric Institute and Clinic, Room E1123, 3811 O’Hara Street, Pittsburgh PA 15213; fax 412-246-5300; or e-mail monkth@upmc.edu.

Dr. Monk, Dr. Germain, and Dr. Reynolds have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

Recognize the importance of sleep disruption in bereavement.

Explain the possible role of insomnia treatment for bereaved individuals.

Discuss the etiology of sleep disorders in bereavement.
Traumatic Bereavement in War Veterans
Authors: Papa Anthony , Neria Yuval , Litz Brett
Published: March 2009

Anthony Papa, PhD; Yuval Neria, PhD; and Brett Litz, PhD

More than a million men and women have been deployed to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) since the beginning of these conflicts. Recent studies show that loss of fellow service members to death or debilitating injuries is a major hazard. Hoge and colleagues reported that 68% of service members saw dead or seriously injured Americans, and 86% knew someone who was seriously injured or killed. The majority of these service members will not develop lasting mental health problems as a result of the dual burden of loss and exposure to potentially traumatic events, but a salient minority will develop persistent problems.

ABOUT THE AUTHOR

Anthony Papa, PhD, is with the University of Nevada, Reno. Yuval Neria, PhD, is with the N.Y. State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York. Brett Litz, PhD, is with the National Center for Post-Traumatic Stress Disorder, Boston University School of Medicine, Boston, Massachusetts.

Address correspondence to: Anthony Papa, PhD, University of Nevada, Reno, Department of Psychology/298, Reno, NV 89557; or e-mail apapa@unr.edu.

Dr. Papa, Dr. Neria, and Dr. Litz have disclosed no relevant financial relationships.
Complicated Grief
Authors: Shear M. Katherine , Mulhare Elizabeth
Published: March 2009

M. Katherine Shear, MD; and Elizabeth Mulhare, MSW

The death of a loved one can be one of the most painful experiences of a lifetime. The grief response that follows such a loss is often intense and debilitating. Nevertheless, studies document that, difficult though it may be, most people come to terms with the death of a loved one and regain their interest and engagement in ongoing life. Adjustment occurs during a period of acute grief, during which confrontation with the painful reality oscillates with defensive exclusion, in the form of numbing, focus on positive memories, imagined reunion, and other forms of respite in which attention is directed toward neutral or positive thoughts. Although there is a general progression from numbing and disbelief to painful acknowledgment and ultimate integration of loss and grief, discrete stages cannot be discerned. Clinicians should be cautious about suggesting that a bereaved person can expect to follow a predictable pathway. In the words of C.S. Lewis:

 ABOUT THE AUTHORS

M. Katherine Shear, MD, is with the Columbia University School of Social Work, and Columbia University College of Physicians and Surgeons, New York, NY. Elizabeth Mulhare, MSW, is with the Department of Psychiatry, Weill Cornell Medical College, New York, NY.

Address correspondence to: M. Katherine Shear, MD, 1255 Amsterdam Ave., New York, NY 10027; or e-mail ks2394@columbia.edu.

Dr. Shear and Ms. Mulhare have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES
Describe an attachment-based model of acute, integrated, and complicated grief (CG).

Describe the clinical syndrome of CG and its differential diagnosis.

Explain the goals, strategies, and techniques used in psychotherapy for CG.

 
Statistics — What Can You Believe? If You Care About DSM-V, Read This
Authors: Fawcett Jan
Published: March 2009

First, let me say how proud I am that this last issue of Psychiatric Annals for 2008 is featuring a series of articles on behavioral statistics, guest edited by Robert Gibbons, PhD, a national resource. Dr. Gibbons has enlisted some of the best statistical minds in this country to write about modern issues in behavioral statistics. The material is well worth digesting. For research investigators, this issue should be a collector’s item. For clinicians who have been bombarded by conclusions in textbooks in their development, and are currently flooded with “new findings” from many sources, it is a key to informed skepticism — a much better position than no-nothing nihilism. Was that result you claim obtained from a last observation carried forward (LOCF) analysis? How did your handling of missing data affect your result? Much is not what it seems, and this series is a partial guide for the rabbit hole. My thanks to the authors for the informative challenge they have brought us.
Intent-to-treat vs. Non-intent-to-treat Analyses under Treatment Non-adherence in Mental Health Randomized Trials
Authors: Ten Have Thomas R. , Normand Sharon-Lise T. , Marcus Sue M. , Brown C. Hendricks , Lavori Philip , Duan Naihua
Published: March 2009

The intent-to-treat (ITT) principle has long been mandated by the Food and Drug Administration (FDA) as the primary design and analysis strategy for industry clinical trials. The ITT principle also has been adopted widely in government-funded randomized clinical trials. Intent-to-treat analysis aims to estimate the effect of treatment as offered or as assigned. This analysis entails comparisons of randomized groups and includes outcome data for all randomized participants regardless of their status regarding non-adherence to assigned treatment protocols and missed assessment encounters. Petkova and Teresi attributed the term “intent-to-treat” to Hill with a common refrain “once randomized, always analyzed.” FDA regulations emphasize this point in more formal language: “The intention-to-treat principle implies that the primary analysis should include all randomized subjects. Compliance with this principle would necessitate complete follow-up of all randomized subjects for study outcomes.”

ABOUT THE AUTHORS

Thomas R. Ten Have, PhD, is with the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia. Sharon-Lise T. Normand, PhD, is with the Department of Health Care Policy, Harvard Medical School; and the Department of Biostatistics, Harvard School of Public Health, Boston. Sue M. Marcus, PhD, is with the Department of Psychiatry, Mount Sinai School of Medicine, New York. C. Hendricks Brown, PhD, is with the Prevention Science and Methodology Group, Departments of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa. Philip Lavori, PhD, is Professor of Biostatistics and Chair, Department of Health Research and Policy, Stanford University School of Medicine. Naihua Duan, PhD, is Professor of Biostatistics in Psychiatry, Departments of Biostatistics and Psychiatry, Columbia University; and Director, Division of Biostatistics, N.Y. State Psychiatric Institute, New York, N.Y.

Address correspondence to: Thomas R. Ten Have, PhD, 607 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; fax 215-573-5315; or e-mail ttenhave@upenn.edu.

Dr. Ten Have, Dr. Normand, Dr. Marcus, Dr. Brown, Dr. Lavori, and Dr. Duan have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

Describe the advantages and limitations of intent to treat (ITT) analyses.

Discuss advantages and limitations of as-treated (AT) analyses.

Summarize valid alternatives to ITT.
Applying the Principles of Significant Learning in the e-Learning Environment
Authors: Magnussen Lois
Published: March 2009

E-learning technologies in education use adult learning theories that view the educator as a facilitator of learning and an assessor of outcomes. The change to this technology requires a shift in the focus of a course from the educator to the subject. The experience of one faculty member involved in an implementation of an online program is used to demonstrate the application of Fink's principles of significant learning in the virtual environment. Fink urged faculty to create learning-centered courses, as opposed to content-centered courses. The taxonomy of six course components he proposed as necessary to significant learning are foundational knowledge, application, integration, human dimension, caring, and learning how to learn. Fink's taxonomy of significant learning can be used as a framework to focus course planning and assessment of student outcomes as courses are adapted to a Web-based environment.
Challenging Stereotyping and Bias: A Voice Simulation Study
Authors: Dearing Karen S. , Steadman Sheryl
Published: March 2009

Stigma is a barrier to mental health care access for patients with schizophrenia and can interfere with developing therapeutic relationships. This study demonstrates success of a voice simulation experience during orientation in changing the biases of nursing students and the effect on the development of the nurse-patient relationship. Ninety-four individuals participated; 52 received a voice simulation experience during orientation, and 42 received orientation with no voice simulation experience. The Medical Condition Regard Scale was administered before and after orientation. Posttest paired
t
test results show significant differences in attitudes toward patients with voice hearing experiences between the two groups. The themes of personal growth from the focus groups postorientation include Affective Experience, Physical Experience, and Empathy. Findings demonstrate that the orientation process should include methods to challenge stereotyping and bias to decrease stigma, improve service access, and enhance the ability to develop therapeutic relationships.
Dimensions of Caring: A Qualitative Analysis of Nurses' Stories
Authors: Hudacek Sharon S.
Published: March 2009

The purpose of this qualitative, phenomenological study is to describe dimensions of caring as they relate to and clarify the practice of professional nursing. Nurses are unique caregivers, and their work at the bedside and in the community matters. What nurses do as they care for patients is multi-dimensional, complex, and essential. Two hundred stories written by nurses were analyzed using Giorgi's methodology for existential phenomenology. Their stories indicate that nursing goes far beyond technical skills. Seven dimensions of caring that define professional nursing practice were found: caring, compassion, spirituality, community outreach, providing comfort, crisis intervention, and going the extra distance. The nurses' stories demonstrate that the dimensions of caring that define professional nursing practice are universal. Documentation of nurse's stories facilitates reflective and thoughtful practice, while clarifying the essential components of nursing.
Nursing Student Caring Behaviors During Blood Pressure Measurement
Authors:   Minnesota Baccalaureate Psychomotor Skills Faculty Group
Published: March 2009

The purpose of this multisite, nonexperimental study was to examine, using a repeated measures design, the effects of a teaching intervention designed to promote caring behaviors as students learn the psychomotor skill of blood pressure measurement. Watson's theory of human caring and a combination of cognitive and connectionist learning theories were used as the organizing construct. Baccalaureate nursing student participants were videotaped and evaluated at two points in time while performing the psychomotor skill of blood pressure measurement on a role-player. Role-players rated the students' caring behaviors using the Role Player Survey of Caring Behaviors During Blood Pressure Measurement instrument. Between these data collection points, students learned about caring behaviors through analysis of a videotaped role-play and required readings. An evaluator randomly selected 10 student videotapes from each of the 6 baccalaureate nursing program study sites and noted the presence or absence of caring behaviors on the Caring Behaviors During Blood Pressure Measurement instrument. Pretest and posttest scores on both subjective and objective research instruments were compared using descriptive statistics and repeated measures analysis of variance (ANOVA). Students demonstrated a significant improvement in objective and subjective caring behaviors between the two performance examinations. The findings support further investigation of teaching interventions to promote the development of caring behaviors during nursing psychomotor skill development.
Students' Opinions About and Expectations of Effective Nursing Clinical Mentors
Authors: Elcigil Ayfer , Sari Hatice Yildirim
Published: March 2009

Nursing practice is an integral part of nursing education in which clinical mentors play an important role. Mentors' attitudes, experience, and knowledge influence nursing students and help them to complete their nursing practice with success. The purpose of this qualitative study was to determine nursing students' opinions about and expectations of effective nursing clinical mentors. Focus group interviews were used to obtain data from 24 students after completion of their third year of nursing school. The students, who had nursing practice experience in internal diseases, surgery, gynecology, pediatrics, psychiatry, and public health, were divided into three groups of 8 students. The students noted that effective clinical mentors should be able to communicate without prejudice, give positive feedback, have empathy, require students to do their own research, and offer the students information.
Comparing the Academic Performance of Students in Traditional and Second-Degree Baccalaureate Programs
Authors: Korvick Lynda M. , Wisener Linda K. , Loftis Lea Ann , Williamson Marvel L.
Published: March 2009

Programs offering accelerated baccalaureate (BSN) curricula to students with bachelor's degrees in other fields are growing in popularity. Such students' academic ability may differ from that of students pursuing the BSN as their first degree, due to academic maturity, greater confidence, and polished study skills. This study directly compared accelerated second-degree BSN and traditional BSN students under controlled conditions matched for identical instruction and performance measures. Outcomes analyzed included class test scores, nationally standardized examination scores, skills laboratory performance, and final course grades. Age, as a possible factor of any such differences, was also analyzed. The accelerated students performed significantly higher on every measure than did the students in the traditional program. Age was not found to be predictive of success in either group. Recommendations include modification of teaching strategies to accommodate accelerated students capable of higher performance.
Development of a Visual Analogue Scale to Measure Curriculum Outcomes
Authors: Foley Diana K.
Published: March 2009

All facets of nursing education are more often being held accountable for outcomes, yet measures that accurately capture those outcomes may not be available. This article describes the development of instruments to measure the two outcomes of communication and critical thinking for the culminating assignment in master's programs. Visual analogue scales are adaptable instruments that capture subjective phenomena, permit quantification of those phenomena, and produce at least interval-level data. These instruments have been used for several years to help evaluate outcomes in master's programs and have consistently produced evidence of reliability and validity.
Early Identification of At-Risk Nursing Students: A Student Support Model
Authors: Hopkins T. Hampton
Published: March 2009

Due to the shortage of nurses in the health care industry, colleges offering associate-degree nursing programs are beginning to pay more attention to attrition and the factors contributing to success. A logistic regression model was used to explain the cognitive and noncognitive variables that contribute to success in a nursing fundamentals course. Although much work is necessary to fully understand first-semester nursing students' retention and success, an early identification model is explored to better support students as they enter associate-degree nursing programs.
Learning About Aboriginal Contexts: The Reading Circle Approach
Authors: Begoray Deborah L. , Banister Elizabeth
Published: March 2009

As more opportunities arise for nursing students to obtain experience in community sites, they will be called on to practice in culturally appropriate ways more often. Although nurses remain challenged by the range of populations needing differentiated approaches, Aboriginal cultural contexts deserve special attention. Nurse educators must help students increase their understanding of Aboriginal life and ways of knowing. One way to facilitate this understanding is through a learning approach called
reading circles
. Reading circles offer a structure in the classroom for students to interact about ideas or readings. The reading circle process is congruent with Aboriginal ways of learning, which emphasize working
in circle
, with each member having a role and an equal chance to be heard. Aboriginal students in the class may be particularly comfortable with this learning method. This article describes specific steps for incorporating the reading circle approach into the nurse education classroom.
Training Nursing Students in Evidence-Based Techniques for Cognitive-Behavioral Pediatric Pain Management
Authors: MacLaren Jill E. , Cohen Lindsey L. , Larkin Kevin T. , Shelton Elisabeth N.
Published: March 2009

This study evaluates the effects of a didactic training program for nursing students involving developmentally appropriate strategies for cognitive-behavioral pain management in children. Junior-level nursing students were assigned to one of two groups: training or control. Pretraining and posttraining knowledge and attitudes toward pain management were assessed. Implementation of cognitivebehavioral strategies was assessed via clinical role-play. Training participants had significantly more knowledge of cognitive-behavioral strategies after the training program versus before it, and they had more knowledge after the training program than did control participants. The training had no effect on attitude. In the role-play, training participants used a higher ratio of cognitive-behavioral strategies and implemented them in a higher quality manner than did control participants. These results suggest that a brief training program in cognitive-behavioral pain management can improve nursing students' knowledge of cognitive-behavioral pain management strategies and ability to implement them.
Faculty and Student Assessment of and Experience with Incivility in Nursing Education
Authors: Clark Cynthia M.
Published: March 2009

Academic incivility is a significant problem and reports of discord on college campuses underscore the need for addressing uncivil behaviors in a forthright manner. In this study, 504 respondents from 41 states—194 nursing faculty, 306 nursing students, and 4 who did not specify their status—completed the Incivility in Nursing Education survey. The most frequently cited uncivil student behaviors included holding distracting conversations, using computers unrelated to class, and demanding make-up examinations and grade changes. The uncivil student behaviors occurring most frequently were arriving late for class, holding distracting conversations, and being unprepared. The uncivil faculty behaviors most frequently cited included making condescending remarks, making rude gestures or comments, and exerting superiority over others. The uncivil faculty behaviors occurring most frequently included ineffective teaching methods, arriving late for scheduled activities, and deviating from the syllabus and changing class assignments. Student and faculty uncivil behaviors were viewed similarly by both groups.
Simulator Effects on Cognitive Skills and Confidence Levels
Authors: Brannan Jane D. , White Anne , Bezanson Judy L.
Published: March 2009

Use of a human patient simulator (HPS) as a tool for experiential learning provides a mechanism by which students can participate in clinical decision making, practice skills, and observe outcomes from clinical decisions. The purpose of this study was to compare the effectiveness of two instructional methods to teach specific nursing education content, acute myocardial infarction, on junior-level nursing students' cognitive skills and confidence. The instructional methods included an interactive approach using the HPS method, compared with traditional classroom lecture. Results of this study suggest that use of a teaching strategy involving the HPS method made a positive difference in the nursing students' ability to answer questions on a test of cognitive skills. Confidence levels were not found to be significantly enhanced by use of the HPS method.
Development of Human Patient Simulation Programs: Achieving Big Results with a Small Budget
Authors: Curtin Michelle M. , Dupuis Michelle Denise
Published: March 2009

The benefits of simulation in nursing education are well documented. Nursing students learn in a safe environment that enhances critical thinking and collaboration. Barriers to simulation include cost, resources, and fear of technology. This article describes how to design and implement a quality simulation program for less than $20,000.
Standardized Patients: A Creative Teaching Strategy for Psychiatric-Mental Health Nurse Practitioner Students
Authors: Shawler Celeste
Published: March 2009

In this article, a learning strategy for psychiatric nurse practitioner students in a research-intensive university is described. The strategy actively involved students in experiences with standardized patients. The course content included review of the causes, manifestations, assessment, and diagnoses of psychopathology across the lifespan. The goal was for students to build diagnostic reasoning skills so they could conceptualize case formulations and examine differential diagnoses related to mental disorders. Faculty simulated complex mental health disorders in a controlled environment where students practiced assessment and diagnostic skills with feedback from faculty, peers, and the standardized patients. On completion of the course with six different standardized patient situations and a final standardized patient scenario that involved assessment, diagnosis, and creation of a formal paper about the case, the students demonstrated excellent interviewing skills, confident assessment abilities, appropriate use of screening and diagnostic tools, and accurate diagnosis of the standardized patients.