Self-Schema, Attachment Style, and Treatment Outcome of Patients in an Opiate Maintenance Treatment Unit.

The aim of this study was to explore self-schemas and attachment style among patients in a methadone or buprenorphine maintenance treatment program of opiate dependence, in relation to treatment outcome (relapse in substance use). The study included 84 patients (21 women and 63 men) in a psychiatric clinic in Malmö, Sweden, providing maintenance treatment of opiate dependence. Three self-report instruments were employed, Young Schema Questionnaire Short version (YSQ-S) and Young Parenting Inventory (YPI) for studying self-schemas and Experiences in Close Relationships-Relationship Structures questionnaire (ECR-RS) for studying attachment style. Demographical data and relapse in substance abuse were registered. The study demonstrated, unsurprisingly, that an insecure attachment style was more common in the group of patients compared to available general population reference data. Significant correlations were found between attachment style and core beliefs about the self (self-schemas). Memories of parenting experiences from childhood (YPI) showed correlations with ongoing self-schemas (YSQ-S). Treatment outcome, defined as relapses in substance abuse, was associated to a minor degree with self-schemas but showed no correlation with attachment style. Patients who did not work or study had more maladaptive self-schemas and insecure attachment style, and a higher incidence of relapse in abuse than patients who were working or studying.

Comparison of Different Small Clinical Hematology Laboratory Configurations With Focus on Remote Smear Imaging.

CONTEXT.­: Stand-alone clinical sites (eg, infusion centers) are becoming increasingly common. These sites require timely hematology analysis. Here we compare performance and costs of currently available analysis configurations with special focus on a proposed alternative using a minimal hematology analyzer plus a digital imaging device, allowing for remote oversight and interpretation. OBJECTIVES.­: To determine whether low-volume laboratories might realize savings while gaining function by substituting commonly used configurations with a proposed alternative. DESIGN.­: To evaluate the performance of the proposed alternative configuration, blood counts with automated differentials produced by a Sysmex XE5000 (complete blood count reference method) were compared with cell counts from the Sysmex pocH-100i, CellaVision DM96 preclassified differentials, and DM96 reclassified differentials (differential reference method) by using standard regression analyses, 95% CIs, and truth tables. Financial cost modeling used staffing practices, test volumes, and smear production rates observed at remote clinics performing on-site hematology analysis within the University of California at San Diego Health system. RESULTS.­: Differential blood count parameters showed excellent correlation between the XE5000 and preclassification DM96 with R2 > 0.95. For blasts/abnormal cells, immature granulocytes, and nucleated red blood cells, the DM96 showed higher sensitivity and similar specificity to the XE5000. Cost modeling revealed that decreased personnel costs through remote monitoring of results facilitated by the DM96 would lead to lower operational costs relative to more conventional analysis configurations. CONCLUSIONS.­: A digital imaging instrument with an inexpensive hematology analyzer provides similar information to a complex hematology analyzer and allows remote review of the blood smear findings by experts, leading to significant cost savings.

The importance of wildlife in the ecology and epidemiology of the TBE virus in Sweden: incidence of human TBE correlates with abundance of deer and hares.

BACKGROUND: Tick-borne encephalitis (TBE) is one tick-transmitted disease where the human incidence has increased in some European regions during the last two decades. We aim to find the most important factors causing the increasing incidence of human TBE in Sweden. Based on a review of published data we presume that certain temperature-related variables and the population densities of transmission hosts, i.e. small mammals, and of primary tick maintenance hosts, i.e. cervids and lagomorphs, of the TBE virus vector Ixodes ricinus, are among the potentially most important factors affecting the TBE incidence. Therefore, we compare hunting data of the major tick maintenance hosts and two of their important predators, and four climatic variables with the annual numbers of human cases of neuroinvasive TBE. Data for six Swedish regions where human TBE incidence is high or has recently increased are examined by a time-series analysis. Results from the six regions are combined using a meta-analytical method. RESULTS: With a one-year time lag, the roe deer (Capreolus capreolus), red deer (Cervus elaphus), mountain hare (Lepus timidus) and European hare (Lepus europaeus) showed positive covariance; the Eurasian elk (moose, Alces alces) and fallow deer (Dama dama) negative covariance; whereas the wild boar (Sus scrofa), lynx (Lynx lynx), red fox (Vulpes vulpes) and the four climate parameters showed no significant covariance with TBE incidence. All game species combined showed positive covariance. CONCLUSIONS: The epidemiology of TBE varies with time and geography and depends on numerous factors, i.a. climate, virus genotypes, and densities of vectors, tick maintenance hosts and transmission hosts. This study suggests that the increased availability of deer to I. ricinus over large areas of potential tick habitats in southern Sweden increased the density and range of I. ricinus and created new TBEV foci, which resulted in increased incidence of human TBE. New foci may be established by TBE virus-infected birds, or by birds or migrating mammals infested with TBEV-infected ticks. Generally, persistence of TBE virus foci appears to require presence of transmission-competent small mammals, especially mice (Apodemus spp.) or bank voles (Myodes glareolus).

"I feel like I do not exist:" A study of dissociative experiences among war-traumatized refugee youth.

OBJECTIVE: War-traumatized refugee children and adolescents have been overlooked in research on trauma-related dissociation, and whatever research has been conducted has relied almost exclusively on questionnaires. The present study was an exploration of dissociative experiences in multitraumatized war-refugee youth. METHOD: In this study, we used a mixed-method approach by grouping participants according to a Western-based dissociation measure (the Adolescent Dissociative Experiences Scale; Armstrong, Putnam, Carlson, Libero, & Smith, 1997), and conducting qualitative and quantitative analyses of their verbal descriptions of mental experiences related to dissociation in the aftermath of war and resettlement. The sample included 40 refugee youth, ages 13 to 21, 19 girls and 21 boys resettled in Sweden because of war and persecution. RESULTS: Severe trauma-related dissociation was a problem for a considerable subgroup of the sample. Some dissociative experiences were present in all the sample; others were restricted to the most dissociative group. The correlates of severe dissociation included high frequency and severity of emotional dysregulation and intensity, negative self- and body-perception, depressive mood, and experiences of detachment. CONCLUSION: Clinicians are urged to be aware of and assess trauma-related dissociation in war-refugee youth, and consider not only dissociative phenomena, but also other important processes such as emotional dysregulation. (PsycINFO Database Record

A psychometric evaluation of the Temperament in Middle Childhood Questionnaire (TMCQ) in a Swedish sample.

Personality is generally considered to be biologically founded in temperament, and temperamental qualities have proven to be relatively stable across childhood and into adulthood (Caspi, Roberts & Shiner, ). Temperament predicts important developmental outcomes such as academic performance (Muris, ), and social functioning (Eisenberg, Fabes, Guthrie & Reiser, ), and it has also been found to be strongly related to the etiology and maintenance of internalizing and externalizing psychopathology in children (Muris, Meesters & Blijlevens, ; Nigg, ). To allow for the possibility of making early interventions, identification of potential risk factors (such as temperamental dispositions) is of great importance (Rettew & McKee, ). As temperament is multidimensional and has many different manifestations, parents and teachers are valuable sources in providing information about children's temperament (Rothbart & Bates, ; Tackett, Slobodskaya, Mar et al., ), and caregiver questionnaires are frequently used in child personality research. However, such questionnaires are only useful if their reliability and validity have been established. The aim of the present study was to examine the psychometric properties of the Temperament in Middle Childhood Questionnaire (TMCQ; Simonds, Kieras, Rueda & Rothbart, ), which focuses specifically on the ages between 7 and 11 years. The TMCQ is the least validated of the Rothbart measures, and although reliability data have been presented, together with some validity data, for a computerized self-report version of the questionnaire (Simonds & Rothbart, ), information about the reliability and validity for the caregiver version is scant. In the present paper, we report such data for a Swedish sample.

Impact of Integrating Rumke Statistics to Assist with Choosing Between Automated Hematology Analyzer Differentials vs Manual Differentials.

BACKGROUND: To optimize precision of nucleated blood cell counting, the clinical laboratory scientist should post the automated differential rather than the manual differential if the former is within the 95% CI of the latter, as determined by the "Rumke statistic." The objective of this study was to determine the potential impact of real-time, computer-assisted use of Rumke statistics for more judicious use of the automated vs digitally imaged, manual differential. METHODS: Complete blood counts with automated differentials produced by a XE5000™ hematology analyzer (Sysmex) were compared with both the DM96 (CellaVision™ AB) preclassification differentials and the posted reclassified manual differentials, using the Rumke 95% CIs as calculated using the Clopper-Pearson method. RESULTS: A total of 44.7% of manual differentials had no statistical or clinical justification over the automated differential. In addition, 31.1% of manual differentials had statistical discrepancies between the instrument absolute neutrophil count (IANC) and manual absolute neutrophil count (ANC). Nineteen of these IANC/manual ANC discrepant samples had ANCs below 1500/µL, a decision level for cancer treatment. Holding the IANC when it is less than 2000/µL until after manual smear review would have prevented the posting of any IANC vs manual ANC discrepant results at the 1500/µL ANC decision threshold. CONCLUSIONS: A real-time operator alert concerning the statistical identity of imaging device differentials vs automated differentials could have reduced manual differentials by nearly 45%. Not posting unnecessary manual differentials for the cases with IANC/manual ANC discrepancies would have likely reduced clinical error/confusion.

The relation of dissociation and mind wandering to unresolved/disorganized attachment: an experience sampling study.

Individuals with unresolved/disorganized representations of childhood trauma (U/d attachment) report more psychological distress than others, but little is known about their everyday mentation. In the present study adults with childhood trauma (N = 45) completed the Berkeley-Leiden Adult Attachment Questionnaire-Unresolved (BLAAQ-U) and the Adult Attachment Interview (AAI), and reported everyday mentation during 5 days of experience sampling. The BLAAQ-U and the AAI showed a medium association with each other, but only the former significantly predicted negative affect, dissociation, and low control/awareness of mentation. Contrary to our predictions, U/d attachment did not significantly predict mind wandering, but the BLAAQ-U predicted endorsements of a negative mind wandering style. U/d attachment, as assessed by both instruments, was associated with the Poor attentional control style and beliefs in anomalous mental phenomena. Experience sampling is a valuable way to investigate everyday experiences in individuals with U/d attachment.

Types of trauma in adolescence and their relation to dissociation: A mixed-methods study.

OBJECTIVE: To study adolescent traumatization and the impact of various types of trauma on dissociative experiences in a sample of 239 Swedish youngsters, 13 to 20 years of age, with diverse socioeconomic and migration backgrounds. We also evaluated whether the type of worst lifetime trauma was associated with higher rates of dissociation. METHOD: Quantitative and qualitative data on posttraumatic stress, dissociative experiences, and potentially traumatic events (PTEs), including participants' written descriptions of their worst lifetime trauma. RESULTS: Most (92%) of the participants had been exposed to at least 1 PTE and 51% to 4 or more, during their life. Number of PTEs correlated with symptoms of posttraumatic stress and dissociation. There were higher rates of dissociation among economically vulnerable and second-generation war refugee participants. Emotional abuse by others (mostly peers) was the only significant predictor of dissociation when controlling for gender, age, total PTEs, posttraumatic stress, and poverty. Moderation analyses showed that lifetime worst traumas categorized as primarily emotional moderated and amplified the relation between total PTEs and dissociation, but only among girls. CONCLUSIONS: Our findings indicate that traumatization is very common among adolescents, with greater prevalence of dissociation among vulnerable groups, and that emotional traumas are linked to higher rates of dissociation, especially among girls. Researchers, clinicians, and school personnel need to focus more on immigrant status and low SES as vulnerability factors, and address the consequences of emotional abuse, including bullying, among adolescents. (PsycINFO Database Record

Performance evaluation of the automated morphological analysis of erythrocytes by CellaVision DM96.

BACKGROUND: Automated digital morphology systems are utilized for blood cell morphological examination. The aim of this study is to evaluate the accuracy and efficacy of RBC morphological anomaly screening using the CellaVision DM96 (DM96) automated image analysis system. METHODS: The automated analysis of RBC shape, size, and chromasia abnormalities was conducted on the DM96 using 478 blood samples. A manual microscopic review was independently performed. RESULTS: The DM96 preclassified samples as poikilocytosis-positive for 98% of cases with schistocytosis or echinocytosis, 97% of elliptocytosis, and 92% or 65% of cases that were positive for teardrop cells or for target cells, respectively. The accuracy of the DM96 in the detection of RBC size and chromasia abnormalities of iron deficiency anemia cases was higher than direct microscopic observation. CONCLUSIONS: Automated morphological analysis with the DM96 has potential utility in the morphological screening of RBC anomalies that are associated with disease.

The use of CellaVision competency software for external quality assessment and continuing professional development.

AIMS: Quality assessment of blood cell morphological testing, such as white blood cell (WBC) differential and its interpretation, is one of the most important and difficult assignments in haematology laboratories. A monthly survey was performed to assess the possible role of the proficiency testing program produced by CellaVision competency software (CCS) in external quality assessment (EQA) of the clinical laboratories of affiliated university hospitals and the effective utilisation of this program in continuing professional development (CPD). METHODS: Four monthly proficiency surveys were conducted in collaboration with four clinical laboratories affiliated with the teaching hospitals of Juntendo University of Medicine in Japan. RESULTS: EQA results by the CCS proficiency testing program revealed a difference of performance levels of WBC differential and morphological interpretation and a discrepancy in the WBC differential criteria among laboratories. With regard to the utilisation of this proficiency program as a tool for CPD, this program successfully improved the performance of the low-scoring laboratories and less experienced individuals. CONCLUSIONS: The CCS proficiency testing program was useful for the quality assessment of laboratory performance, for education, and for the storage and distribution of cell images to be utilised for further standardisation and education.

Mothers' representations of caregiving and their adult children's representations of attachment: intergenerational concordance and relations to beliefs about mothering.

Mothers (N= 35) and their adult children completed questionnaires and were interviewed in order to examine relationships between mothers' caregiving representations and their adult children's attachment representations, and relationships between attachment/caregiving representations and beliefs about mothering. Mothers' and their children's accounts of and present thinking about their past relationship were highly similar, indicating that the two parts develop concordant states of mind regarding their relationship. In contrast, there was no relationship between mothers' and their adult children's beliefs about mothering, suggesting that such beliefs are not simply passed on from generation to generation within families. Attachment/caregiving classification interacted with generation in influencing a belief that biological facts determine maternal behavior, young adults with preoccupied attachment being particularly prone to reject this idea. Attachment/caregiving classification also had a significant effect on participants' tendency to adhere to an idealized conception of mothering, this tendency being associated with a dismissive attachment/caregiving representation.

Young children's representations of peers' distress: associations to children's social functioning and acceptance of distressed peers.

Children's mental representations of situations involving another child's distress were examined in two studies. Study 1 examined 3- to 7-year-old children's (n= 44) ideas about what victims and bystanders would think, feel and do in hypothetical situations. In Study 2, 7- to 8-year-olds (n= 40) described their own cognitive response to situations in which they were confronted with another's distress. In both studies, representational bias was examined in relation to children's display of prosocial and aggressive behavior and in relation to their acceptance of distressed peers. Although not entirely consistent, findings indicate that three types of representational biases are associated with low levels of considerate behavior and with relatively low acceptance of distressed peers: (a) mentally representing the victim's problem without giving thought to its implications for the victim, (b) significantly reducing the emotional significance of the problem and (c) exaggerating negative aspects of the problem.

Pulsatile blood flow, shear force, energy dissipation and Murray's Law.

BACKGROUND: Murray's Law states that, when a parent blood vessel branches into daughter vessels, the cube of the radius of the parent vessel is equal to the sum of the cubes of the radii of daughter blood vessels. Murray derived this law by defining a cost function that is the sum of the energy cost of the blood in a vessel and the energy cost of pumping blood through the vessel. The cost is minimized when vessel radii are consistent with Murray's Law. This law has also been derived from the hypothesis that the shear force of moving blood on the inner walls of vessels is constant throughout the vascular system. However, this derivation, like Murray's earlier derivation, is based on the assumption of constant blood flow. METHODS: To determine the implications of the constant shear force hypothesis and to extend Murray's energy cost minimization to the pulsatile arterial system, a model of pulsatile flow in an elastic tube is analyzed. A new and exact solution for flow velocity, blood flow rate and shear force is derived. RESULTS: For medium and small arteries with pulsatile flow, Murray's energy minimization leads to Murray's Law. Furthermore, the hypothesis that the maximum shear force during the cycle of pulsatile flow is constant throughout the arterial system implies that Murray's Law is approximately true. The approximation is good for all but the largest vessels (aorta and its major branches) of the arterial system. CONCLUSION: A cellular mechanism that senses shear force at the inner wall of a blood vessel and triggers remodeling that increases the circumference of the wall when a shear force threshold is exceeded would result in the observed scaling of vessel radii described by Murray's Law.

Performance evaluation of the CellaVision DM96 system: WBC differentials by automated digital image analysis supported by an artificial neural network.

We evaluated the CellaVision DM96 (CellaVision AB, Lund, Sweden), an automated digital cell morphology and informatics system for peripheral blood smears. Technologists agreed with 82% of the instrument's preclassifications. Correlation coefficients between final results released from the CellaVision and results obtained by direct microscopy were 0.96 (all neutrophils), 0.94 (lymphocytes), 0.88 (segmented neutrophils), 0.73 (eosinophils), 0.69 (bands), and 0.67 (monocytes). After correction for statistically and clinically insignificant variations, the CellaVision DM96 had 95% sensitivity and 88% specificity for immature myeloid cells. It was 100% sensitive and 94% specific for blasts, and 100% sensitive and 97% specific for unusual WBCs and nucleated RBCs. Advantages of the CellaVision DM96 over direct microscopy include the ability to review slides from a remote location, consultation and quality control on a cell-by-cell basis, and potential labor savings.

Developmental aspects of children's behavior and safety while cycling.

OBJECTIVE: To examine children's competence while cycling, as demonstrated in mistakes in performance and failure to comply with safety rules. METHODS: Children in three age groups (8, 10, and 12 years) participated in a realistic yet simulated traffic environment. RESULTS: The boys' cycling speed increased steadily with age, while that of the girls increased from 8 to 10 but decreased at age 12. Most children had adequate motor control by age 10, and the youngest compensated for their less developed skills by cycling slowly and braking early at junctions. Serious mistakes, often related to the children's age and gender, consisted of the children failing to stop at signals or stopping too late, especially at short stopping range. CONCLUSIONS: There are considerable individual differences in children's cycling competence that are related to biological factors, such as age and gender, and psychological factors, such as rule compliance and choice of cycling speed.

A simple model for the arterial system.

We present a simple model for the arterial part of the cardiovascular system, based on Poiseuille flow constrained by the power dissipated into the cells lining the vessels. This, together with the assumption of a volume-filling network, leads to correct predictions for the evolution of vessel radii, vessel lengths and blood pressure in the human arterial system. The model can also be used to find exponents for allometric scaling, and gives good agreement with data on mammals.