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Ethical guidance from the British Medical Association (BMA) about treating doctor-patients is compared and contrasted with evidence from a qualitative study of general practitioners (GPs) who have been patients. Semistructured interviews were conducted with 17 GPs who had experienced a significant illness. Their experiences were discussed and issues about both being and treating doctor-patients were revealed. Interpretative phenomenological analysis was used to evaluate the data. In this article data extracts are used to illustrate and discuss three key points that summarise the BMA ethical guidance, in order to develop a picture of how far experiences map onto guidance. The data illustrate and extend the complexities of the issues outlined by the BMA document. In particular, differences between experienced GPs and those who have recently completed their training are identified. This analysis will be useful for medical professionals both when they themselves are unwell and when they treat doctor-patients. It will also inform recommendations for professionals who educate medical students or trainees. [ABSTRACT FROM AUTHOR]

Work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient. However qualitative evidence about their experiences of illness and patienthood is sparse. Our study offers an interpretative perspective on GPs' experiences of illness and the influence that this has had on their practice. Seventeen GPs who had experienced significant illness took part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis (IPA). The findings highlight the relationship between empathy and empowerment and explore the role of self-disclosure of GP status by GPs in consultations. We make suggestions as to how empathy in doctor-patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. Future research should focus on more specific ways to integrate these ideas into medical training. [ABSTRACT FROM AUTHOR]

One of the goals of the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing is to increase the efficiency of equitable organ allocation in the United States. Recognizing the ever-growing need for organ donors and transplants, leaders at the Organ Center increased its commitment to quality improvement initiatives through the development of a quality management team in 2001. The Organ Center began to focus on ways to capture data on processes and pinpoint areas for improvement. As the collection and analysis of data evolved, the Organ Center embraced formal quality standards, such as improvement cycles. Using these cycles, the Organ Center has seen significant improvement. One initiative involving lifesaving heart, lung, and liver placement showed success by doubling the Organ Center's organ placement rate. Another project involving the validation of donor information demonstrated that the accuracy of organ allocation can be improved by 5% on a consistent basis. As stewards for the gift of life and leaders in organ allocation, the Organ Center uses continuous quality improvement to achieve the goal of increasing the efficiency of equitable organ allocation. [ABSTRACT FROM AUTHOR]

The use of power screwdrivers and drills for tapping and screw insertion in surgery is becoming more common. It has been established from clinical observations that the use of a small air drill for inserting self-tapping screws provides improved coaxial alignment and precision, and that the drill should be stopped before the screw head is completely seated on the plate, presumably to reduce the risk of over-tightening. The risk of overrun and over-tightening during tapping and screw insertion is increased with the use of power tools. Prevention of over-tightening is dependent upon when the surgeon detects the onset of tightening, both visually and from the feel of the rapid increase in torque. If detection is too late, then over-tightening or stripping can occur. This study is concerned with using a mechatronic screwdriver to control the tapping depth and to prevent the over-tightening of screws. The effects of various parameters upon the torque profile during tapping and screw insertion have been investigated in synthetic bone and sheep tibia. An automated system is proposed for preventing over-tightening of pre-tapped and self-tapping screws when attaching a surgical plate to a sheep tibia in vitro. The system was used to attach a plate to a sheep tibia using self-tapping screws. The mean torque of the screws inserted using the automated system was 35 per cent of the stripping torque. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to evaluate whether preoperative alexithymia might play a role in the persistence of gastrointestinal symptoms after laparoscopic cholecystectomy. METHODS: A sample of 52 consecutive patients with gallstone disease and symptoms of dyspepsia were assessed with validated scales for alexithymia (20-item Toronto Alexithymia Scale), and psychological (90-item Symptom Checklist) and gastrointestinal (GI) (Gastrointestinal Symptom Rating Scale) symptoms before surgery. GI symptoms were evaluated also one year after surgery. Change from preoperative to postoperative GI symptoms and level of GI symptoms after surgery were used to form groups of improved (n = 31) and unimproved (n = 21) patients. RESULTS: Unimproved patients had significantly higher preoperative alexithymia, psychological distress, and gastrointestinal symptom scores than patients who had improved. Regression analyses showed that alexithymia predicted the persistence of gastrointestinal symptoms more strongly than did psychological distress, even after controlling for preoperative gastrointestinal symptoms. CONCLUSION: Alexithymia played a substantial and predictive role in the persistence of GI symptoms in gallstone patients after surgery. Treatment planning and outcome of gallstone disease might be improved by preoperative assessment of alexithymia. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of George Engel's psychoanalytic approach and con tributions to psychosomatic medicine. Methods: Engel's publications were reviewed to identify his use of psychoanalytic methods and concepts to explore and conceptualize the interrelationships among mind, body and environment in health and disease. Results: Engel's contributions include an interviewing method for accessing psychological data; insights into the psychobiology of anaclitic depression; a psychosomatic theory concerning the influence of relationships and loss on susceptibility to disease; an elucidation of psychodynamic factors in the pathogenesis of chronic pain; and a longitudinal self-analytic study of anniversary reactions. Conclusions: Engel successfully bridged the disciplines of medicine, psychiatry, and psychoanalysis, and broadened the scope of psychosomatic research and clinical practice by identifying the role of interpersonal relationships throughout life in regulating mental and bodily processes. [ABSTRACT FROM AUTHOR]

Socially responsible nurse educators articulate the need to explore opportunities for nursing students to participate in experiences that promote caring and respect for diversity. This research illuminates the experiences of 10 African-American nursing students who participated in caring groups while enrolled in a predominantly White nursing education program. Although the meanings embedded in the African-American students' stories revealed commonalities with those of European-American and international students, there were also some differences. The authors maintained a critical social consciousness to analyze and describe these commonalities and differences. This article discusses the constitutive patterns and themes that emerged from the data and addresses implications for nursing education and practice. Copyright © 2001 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement., Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity., Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies., Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model., Competing Interests: Competing interests: None., (© 2024 Giovanni Fioriti Editore s.r.l.)

Evidence accumulation models (EAMs) have become the dominant theoretical framework for rapid decision-making, and while many theoretically distinct variants exist, comparisons have proved challenging due to strong mimicry in their predictions about choice response time data. One solution to reduce mimicry is constraining these models with double responses, which are a second response that is made after the initial response. However, instructing participants that they are allowed to change their mind could influence their strategy for initial responding, meaning that explicit double responding paradigms may not generalise to standard paradigms. Here, we provide a validation of explicit double responding paradigms, by assessing whether participants' initial decisions - as measured by diffusion model parameters - differ based on whether or not they were instructed that they could change their response after their initial response. Across three experiments, our results consistently indicate that allowing for changes of mind does not influence initial responses, with Bayesian analyses providing at least moderate evidence in favour of the null in all cases. Our findings suggest that explicit double responding paradigms should generalise to standard paradigms, validating the use of explicit double responding in future rapid decision-making studies., (© 2023. The Psychonomic Society, Inc.)

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing alexithymia, with more than 25 years of research supporting its reliability and validity. The items that compose this scale were written to operationalize the components of the construct that are based on clinical observations of patients and thought to reflect deficits in the cognitive processing of emotions. The Perth Alexithymia Questionnaire (PAQ) is a recently introduced measure and is based on a theoretical attention-appraisal model of alexithymia. An important step with any newly developed measure is to evaluate whether it demonstrates incremental validity over existing measures. In this study using a community sample ( N  = 759), a series of hierarchical regression analyses were conducted that included an array of measures assessing constructs closely associated with alexithymia. Overall, the TAS-20 showed strong associations with these various constructs to which the PAQ was unable to add any meaningful increase in prediction relative to the TAS-20. We conclude that until future studies with clinical samples using several different criterion variables demonstrate incremental validity of the PAQ, the TAS-20 should remain the self-report measure of choice for clinicians and researchers assessing alexithymia, albeit as part of a multi-method approach.

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The concept of pensée opératoire (operational thinking) was introduced by French psychoanalysts in 1963 and a decade later was included as an essential component of the alexithymia construct as formulated by the U.S. analysts John Nemiah and Peter Sifneos. Despite a large body of research on alexithymia, the pensée opératoire component is not well understood, especially among clinicians and researchers who are not familiar with French psychoanalytic literature. In this article we clarify the definition and metapsychological conceptualization of the concept, review findings from some relevant empirical studies, and critique a recent proposal for redefining the alexithymia construct that departs from the original understanding of pensée opératoire. We also discuss some clinical implications of the concept and some strategies that psychotherapists can employ in the treatment of patients with this mode of thinking.

The lateral eyes of the horseshoe crab, Limulus polyphemus, are the largest compound eyes within recent Arthropoda. The cornea of these eyes contains hundreds of inward projecting elongated cuticular cones and concentrate light onto proximal photoreceptor cells. Although this visual system has been extensively studied before, the precise mechanism allowing vision has remained controversial. Correlating high-resolution quantitative refractive index (RI) mapping and structural analysis, it is demonstrated how gradients of RI in the cornea stem from structural and compositional gradients in the cornea. In particular, these RI variations result from the chitin-protein fibers architecture, heterogeneity in protein composition, and bromine doping, as well as spatial variation in water content resulting from matrix cross-linking on the one hand and cuticle porosity on the other hand. Combining the realistic cornea structure and measured RI gradients with full-wave optical modeling and ray tracing, it is revealed that the light collection mechanism switches from refraction-based graded index (GRIN) optics at normal light incidence to combined GRIN and total internal reflection mechanism at high incident angles. The optical properties of the cornea are governed by different mechanisms at different hierarchical levels, demonstrating the remarkable versatility of arthropod cuticle., (© 2022 The Authors. Advanced Science published by Wiley-VCH GmbH.)

Wheat ( Triticum aestivum L.) is one of the major staple crops in the world and is used to prepare a range of foods. The development of new varieties with wider variation in grain composition could broaden their use. We characterized grains and flours from oil-accumulating transgenic wheat expressing the oat ( Avena sativa L.) endosperm WRINKLED1 ( AsWRI1 ) grown under field conditions. Lipid and starch accumulation was determined in developing caryopses of AsWRI1 -wheat and X-ray microtomography was used to study grain morphology. The developing caryopses of AsWRI1 -wheat grains had increased triacylglycerol content and decreased starch content compared to the control. Mature AsWRI1 -wheat grains also had reduced weight, were wrinkled and had a shrunken endosperm and X-ray tomography revealed that the proportion of endosperm was decreased while that of the aleurone was increased. Grains were milled to produce two white flours and one bran fraction. Mineral and lipid analyses showed that the flour fractions from the AsWRI1- wheat were contaminated with bran, due to the effects of the changed morphology on milling. This study gives a detailed analysis of grains from field grown transgenic wheat that expresses a gene that plays a central regulatory role in carbon allocation and significantly affects grain composition.

The 20-Item Toronto Alexithymia Scale (TAS-20) is the most widely used measure to assess the personality construct of alexithymia and is composed of three-factor analytically derived subscales. These subscales measure and represent three critical, theoretically based facets of alexithymia. The subscales are distinct, yet highly interrelated and only as a collective body do they reflect adequately the alexithymia construct. Although different studies using both university student and community samples suggest that TAS-20 total scores are largely reflective of variation on a single construct, and that subscale scores do not provide unique and reliable information beyond total scores, many users of the scale frequently continue to employ and even rely more heavily on subscale scores rather than total scale scores when interpreting research study outcomes. Our goal in this study is to provide clinicians and researchers with replicable psychometric information for the TAS-20 estimated from bifactor modeling in an attempt to provide further support for using total rather than subscale scores. In general, our findings were consistent with previous studies indicating that TAS-20 total scores can be considered indicative of a single construct. The replication of these earlier results from previous investigations provides additional support for the use of a total TAS-20 score and questions the utility of using TAS-20 subscale scores. Based on these results, we recommend that researchers and clinicians use a single total TAS-20 score and not subscale scores. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Four subtypes of the alexithymia construct have been proposed based on different response patterns to the Cognitive and Affective dimensions of the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Previous studies investigating whether alexithymia subtypes can be statistically estimated have not found complete support for these specific subtypes. These previous studies, however, contained several methodological limitations such as relatively small sample sizes, and considerations of only a limited number of proposed subtypes. In the current investigation, we examined whether the four proposed subtypes could be statistically detected in a large sample of undergraduate students (N = 612) who completed the BVAQ, using latent profile analysis (LPA). Based on observed responses to the five BVAQ subscales, consistent with previous studies, our results did not find support for the four proposed alexithymia subtypes. Rather, our results suggested LPA solutions that correspond to individuals with various degrees of alexithymia 'severity'. Although further studies are needed, especially with clinical samples, these results question the idea of four alexithymia subtypes and suggest that the implementation of these subtypes into various research studies may be a premature endeavour., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The alexithymia personality construct encompasses difficulties identifying and describing feelings, restricted imaginal processes, and an externally oriented cognitive style. The construct was derived initially from observations of patients with classic psychosomatic diseases. The self-report 20-item Toronto Alexithymia Scale (TAS-20) is the most frequently used measure to assess alexithymia. A concern associated with the TAS-20 is whether individuals can accurately self-report difficulties identifying and describing feelings if they are deficient in those abilities. To address this issue, we sought to develop and validate an informant form (version) of the TAS-20, the 20-item Toronto Alexithymia Scale - Informant Form (TAS-20-IF)., Method: We employed a three-phase methodological strategy. In the first phase, items from the TAS-20 were re-written into a third person version by a team of experts. In the second phase, the "traditional" three-factor structure was tested in the TAS-20-IF using confirmatory factor analysis in a large sample of young adults (N = 857). The third phase was conducted with another sample (N = 430) composed of "informants" (n = 215), who completed the TAS-20-IF, and "targets" (n = 215), who completed the TAS-20 (informants were nominated by the targets)., Results: The psychometric properties (items and scales) of both versions were adequate and the three-factor structure of the TAS-20-IF was supported; the correlation between the two versions was statistically significant and the factor structures were similar., Conclusion: Although further research is needed to replicate these findings, especially in clinical samples, the results support the reliability and validity of the TAS-20-IF., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Macromolecular crowding is known to modulate chemical equilibria, reaction rates, and molecular binding events, both in aqueous solutions and at lipid bilayer membranes, natural barriers that enclose the crowded environments of cells and their subcellular compartments. Previous studies on the effects of macromolecular crowding in aqueous compartments on conduction through membranes have focused on single-channel ionic conduction through previously formed pores at thermodynamic equilibrium. Here, the effects of macromolecular crowding on the mechanism of pore formation itself were studied using the droplet interface bilayer (DIB) technique with the voltage-dependent pore-forming peptide alamethicin (alm). Macromolecular crowding was varied using 8 kDa molecular weight polyethylene glycol (PEG8k) or 500 kDa dextran (DEX500k) in two aqueous droplets on both sides of the bilayer membrane. In general, voltage thresholds for pore formation in the presence of crowders in the droplets decreased compared to their values in the absence of crowders, due to excluded volume effects, water binding by PEG, and changes in the ordering of water molecules and hydrogen-bonding interactions involving the polar lipid headgroups. In addition, asymmetric crowder loading (e.g., PEG8k-DEX500k on either side of the membrane) resulted in transmembrane osmotic pressure gradients that either enhanced or degraded the ionic conduction through the pores.

Animal eyes typically possess specialized regions for guiding different behavioural tasks within their specific visual habitat. These specializations, and evolutionary changes to them, can be crucial for understanding an animal's ecology. Here, we explore how the visual systems of some of the smallest flying insects, fungus gnats, have adapted to different types of forest habitat over time (approx. 30 Myr to today). Unravelling how behavioural, environmental and phylogenetic factors influence the evolution of visual specializations is difficult, however, because standard quantitative techniques often require fresh tissue and/or provide data in eye-centric coordinates that prevent reliable comparisons between species with different eye morphologies. Here, we quantify the visual world of three gnats from different time periods and habitats using X-ray microtomography to create high-resolution three-dimensional models of the compound eyes of specimens in different preservation states-fossilized in amber, dried or stored in ethanol. We present a method for analysing the geometric details of individual corneal facets and for estimating and comparing the sensitivity, spatial resolution and field of view of species across geographical space and evolutionary time. Our results indicate that, despite their miniature size, fungus gnats do have variations in visual properties across their eyes. We also find some indication that these visual specializations vary across species and may represent adaptations to their different forest habitats. Overall, the findings demonstrate how such investigations can be used to study the evolution of visual specializations-and sensory ecology in general-across a range of insect taxa from different geographical locations and across time.