Construct validity for the verbal associated pairs screen

The present study introduces the Verbal Associated Pairs Screen (VAPS) as a new measure for assessing performance validity in pediatric populations. This study presents initial data on psychometric properties and establishes construct validity for the VAPS in a sample of 30 adolescent healthy controls and 206 youths with traumatic brain injury (TBI: moderate/severe, N = 30; mild, N = 176). The control group’s age (M = 14.93, SD = 1.8) was significantly higher than the moderate/severe TBI (M = 13.9, SD = 2.8), t(68.508) = ?3.038, p = .003, and mild TBI (mTBI) groups (M = 14, SD = 2.8), t(54.147) = 2.038, p = .046. The TBI groups were administered the VAPS in accord with other established performance validity tests (PVTs) and well-established memory tests as part of routine clinical evaluations. The healthy control group was administered the VAPS only. VAPS score distributions for the control group were negatively skewed and highly kurtotic. VAPS scores from the moderate/severe TBI and control groups were indistinguishable for Trial 2 (U = 274, p < .01) and the Delay (U = 396, p = .218). In the mTBI group, convergent and divergent validity was established with other well-validated PVTs and memory tests, respectively. ROC curve analyses identified optimal cutoff scores for the VAPS Total Score, with acceptable sensitivity (55%) and excellent specificity (100%), as well as strong detectability (AUC = .829, 95% CI: 0.731 – 0.928, p < .001). Clinical applications, limitations, and directions for future research with the VAPS are discussed.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

The hippocampus facilitates integration within a symbolic field

This paper attempts to elaborate a fundamental brain mechanism involved in the creation and maintenance of symbolic fields of thought. It will integrate theories of psychic spaces as explored by Donald Winnicott and Wilfred Bion with the neuroscientific examinations of those with bilateral hippocampal injury to show how evidence from both disciplines sheds important light on this aspect of mind. Possibly originating as a way of maintaining an oriented, first person psychic map, this capacity allows individuals a dynamic narrative access to a realm of layered elements and their connections. If the proposed hypothesis is correct, the hippocampus facilitates the integration of this symbolic field of mind, where narrative forms of thinking, creativity, memory, and dreaming are intertwined. Without the hippocampus, there is an inability to engage many typical forms of thought itself. Also, noting the ways these individuals are not impaired supports theories about other faculties of mind, providing insight into their possible roles within human thought. The evidence of different systems working in conjunction with the symbolic field provides tantalizing clues about these fundamental mechanisms of brain and mind that are normally seamlessly integrated, and hints at future areas of clinical and laboratory research, both within neuroscience and psychoanalysis.     

Subtle Motor Findings During Recovery from Pediatric Traumatic Brain Injury: A Preliminary Report

Pediatric traumatic brain injury (TBI) is a heterogeneous condition, varying in both severity and sequelae. The long-term motor deficits following severe TBI requiring inpatient rehabilitation are better established than those following milder forms of TBI. The authors examined motor performance 2 and 12 months postinjury in children without overt motor impairment using standard measures of upper limb function and the Physical and Neurological Examination for Subtle Signs (PANESS). The PANESS was sensitive to differences between children with TBI and uninjured children as well as to changes in children with TBI over time. These data suggest that subtle motor deficits are present after milder forms of TBI and, particularly those related to balance and gait, may persist even 12 months postinjury.     

Gender Symmetry and Asymmetry in Violent Relationships: Patterns of Mutuality Among Racially Diverse Women

Three patterns of mutual intimate partner violence (IPV) are proposed, based on frequency and severity: Male primary perpetrator (MPP), female primary perpetrator (FPP), and symmetrical (SYM). Patterns and effects of ethnicity were examined with 445 African American, Euro-American, and Mexican American low-income women experiencing mutual IPV. More relationships were classified as MPP (54%) than SYM (35%) or FPP (11%). Comparing women's and men's perpetration of several types of IPV (e.g., threats, severe physical) indicated MPP-pattern women experienced all IPV types more often and were more likely to sustain injury than their male partners. Fewer gender differences were found in the FPP pattern. Racial/ethnic groups were more similar than different; previously reported differences may be explained by variation in socioeconomic status. The larger part of the study was funded by grant R49/CCR610508 from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention, awarded to the third author. This article was also made possible by grant 2001-WT-BX-0504 from the National Institute of Justice awarded to the first and third authors. These agencies are not responsible for the results. Portions of this paper were presented by the first and third authors at the International Family Violence Conference in Portsmouth, NH, July, 2003.     

新的人身损害赔偿司法解释对医疗行业的影响及医疗行业的对策

新的人身损害赔偿司法解释将于2004年5月1日正式施行.预计将引起医疗纠纷诉讼大量增加,且多以医疗侵权为诉因,医疗机构的赔偿费用也会大幅上升.医疗行业应从减少医疗过失,改善医患关系,完善医疗事故鉴定等方面加以应对.     

Using Cognitive Mapping to Understand Problems Experienced by Family Caregivers of Persons with Severe Physical Disabilities

Individuals who provide ongoing care for family members who have a chronic disease or disability are likely to encounter a wide array of problems that can compromise their own health and their ability to function effectively in a caregiving role. Structured focus group meetings were conducted to elicit a comprehensive list of the problems that caregivers experienced during their first year of providing care to a person with a severe physical disability. A separate group of caregivers (N = 60) individually sorted problems into piles based on their similarity and assigned relative importance to each problem. The aggregated data were analyzed with multidimensional scaling and hierarchical cluster analysis. Results indicated that caregivers cognitively organize problems along three dimensions: I. Centeredness–caregiver versus patient-oriented; II. Relationship Demands–physical versus emotional; and III. Caregiver Burden–time versus emotional. Additionally, 6 clusters of substantively similar problems were identified and prioritized in terms of personal relevance: Basic Needs (lowest); Perceived Constraints; Caregiver Challenges; Patient Resentment; Patient Withdrawal; and Patient Intrapsychic Adjustment (highest). Further examination of the organization of problems identified by caregivers should provide important insights about the experience of caregivers and how more targeted interventions can be developed to address their specific needs.     

原发性甲亢合并严重肝损伤患者的循证治疗

为原发性甲亢合并严重肝损伤患者制定循证治疗方案。根据PICO原则,提出临床问题并转换成便于检索的形式,检索美国国家指南交换中心（NGC）、Cochrane图书馆（2010年第3期）、PubMed（1995-2010．11）和维普数据库（CHKD,1995～2010．11）。根据检索结果,制定治疗方法,2月后患者肝功能、...     

体外循环所致炎性肺损伤机制及保护进展

肺损伤是体外循环心内直视手术的主要并发症之一。肺损伤的机制十分复杂,主要是全身炎性反应和缺血/再灌注损伤所致。肺保护的方法多种多样,其目的是降低全身炎性反应,减轻或避免缺血/再灌注损伤。本文探讨体外循环肺损伤的机制和保护进展。