Investigations of positronium formation and destruction using 3gamma/2gammaannihilation-ratio measurements.

Positronium (Ps) produced by 4 to 40 eV positrons colliding with Ne, Ar, Kr, CO2, and O2 is investigated by measuring the ratio of signals of two gamma rays in coincidence resulting from (a) three gamma annihilation of ortho-Ps and (b) two annihilation gamma rays due to para-Ps decay and destruction of ortho-Ps at an aluminum scattering cell surface. These ratios provide evidence that relates to the kinetic energy dependence of ortho-Ps interactions with an aluminum surface, the Ps formation potential at this surface, and the fact that Ps is being formed with inner orbital electrons for CO2 and O2.

Inaccuracies in physicians' perceptions of their patients.

OBJECTIVE: The objective was to assess primary care physicians' awareness of their patients' rated emotions, satisfaction, and opinion of the quality of their communication. DESIGN: Diabetic patients (n = 261) and their primary care physicians (n = 44) each filled in a questionnaire following a routine medical visit. Patients were asked about the quality of communication with their physician, their satisfaction, and their experience of six emotions. Physicians were asked to estimate the patients' views on each of these questions. Physicians' awareness was measured by (1) correlating the physician and patient ratings, and (2) comparing mean ratings between physicians and patients. RESULTS: Correlations between patients' and physicians' views of patients' emotions and satisfaction were weak to moderate in magnitude; for patients' opinion of communication quality, there was no correlation. All ratings showed a substantial discrepancy between physicians and patients, such that physicians thought patients' responses were more negative than they actually were. CONCLUSIONS: Although the causes of physicians' weak awareness of their patients' responses are not known, the results suggest that the patients' affective responses may be an especially neglected aspect of communication in the medical visit.

Thriving in a busy practice: physician-patient communication training.

BACKGROUND: Despite growing concern about the potential impact of managed care on the physician-patient relationship, efforts to enhance the quality of communication between practicing clinicians and their patients have been limited. OBJECTIVE: To determine the effectiveness of a 1-day educational workshop. DESIGN: Clinician self-assessment of interviewing skills measured immediately before and 3 months after the workshop. SETTING: The Kaiser Permanente Medical Care Program. PARTICIPANTS: Practicing clinicians (n = 1384) in 22 workshops during a 5-year period. Nine hundred eleven participants (66% response rate) completed self-assessment questionnaires 3 months after the workshop. RESULTS: Self-assessed interviewing skills improved in all items 3 months after the workshop (P < 0.05). Clinicians also reported a decline in the proportion of visits that they characterized as frustrating. CONCLUSION: A 1-day educational intervention for large groups of practicing clinicians can improve confidence in medical interviewing skills and the ability to handle difficult encounters.

Deconstructing sexual orientation: understanding the phenomena of sexual orientation.

The very terms of a debate about whether or not sexual orientation is primarily a biological phenomenon fail to consider the complex origins of the phenomenon. Deconstruction of the term "homosexuality" shows that it refers to multiple factors which cannot be studied as or subsumed under a unitary concept. Adequate understanding of sexual orientation must consider the developmental, interpersonal, experiential, and cultural dimensions of sexuality, as well as any biological contributions to sexual attraction, behavior, and identity.

A curriculum for learning in psychiatric residencies about homosexuality, gay men, and lesbians.

Homosexuality was redefined by the American Psychiatric Association in 1973 as a variation in sexual orientation rather than a mental illness, and recent research has greatly expanded knowledge about homosexuality, gay men, and lesbians. However, generally speaking, neither a non pathological perspective nor this new information has been integrated into psychiatric residency curricula. This absence compromises the ability of residency programs to train residents to be broadly competent in dealing with issues related to these topics. Learning about homosexuality, gay men, and lesbians should be integrated into all psychiatric residencies, and a curriculum to serve as a basic model for this necessary professional training is proposed.

Men's changing social roles in the 1990s: emerging issues in the psychiatric treatment of men.

In the last two decades, men's social roles have changed to incorporate the increasing time they spend with their families, their greater concern about adult children's leaving or returning home, and alternative sexual preferences and life-styles. One related development is the increased amounts of psychiatric distress reported by men in recent years. Mental health professionals should be familiar with these and other complex issues specific to men and with how such issues might manifest themselves in psychotherapy.

Theoretical considerations in psychotherapy with gay men and lesbians.

This paper examines certain issues relevant to psychotherapy with gay men and lesbians. The roles of general factors in psychotherapy in relation to homosexuality, including the theoretical orientation of the therapist, the nature of the presenting problem, the mode of therapy, and the personal characteristics of the therapist, are discussed. Special issues of concern to gay men and lesbians, specifically the question of pathology, the amount of information the therapist has about homosexuality, the sexual orientation of the therapist, and the unique problems of gay men and lesbians, are reviewed. Finally, an overview of the role of homophobia in psychotherapy is presented, and the importance of further exploration in this area is discussed.