Managing the therapeutic relationship in online cognitive behavioural therapy for depression: Therapists' treatment of clients' contributions

This article examines how therapists and clients manage the therapeutic relationship in online psychotherapy. Our study focuses on early sessions of therapy involving 22 therapist-client pairs participating in online Cognitive Behavioural Therapy (CBT) for depression. Using Conversation Analysis (CA), we examine how therapists can orient to clients’ contributions, while also retaining control of the therapeutic trajectory. We report two practices that therapists can use, at their discretion, following clients’ responses to requests for information. The first, thanking, accepts clients’ responses, orienting to the neutral affective valence of those responses. The second, commiseration, orients to the negative affective valence of clients’ responses. We argue that both practices are a means by which therapists can simultaneously manage developing rapport, while also retaining control of the therapeutic process.

How collaborative technology supports cognitive processes in collaborative process modeling : a capabilities-gains-outcome model

We examine which capabilities technologies provide to support collaborative process modeling. We develop a model that explains how technology capabilities impact cognitive group processes, and how they lead to improved modeling outcomes and positive technology beliefs. We test this model through a free simulation experiment of collaborative process modelers structured around a set of modeling tasks. With our study, we provide an understanding of the process of collaborative process modeling, and detail implications for research and guidelines for the practical design of collaborative process modeling.

The relationship between children's emotional and cognitive self-regulation at 2 to 3 years and prosocial behavior in the early years of school

This study used data from Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) to investigate how parent report of children’s emotional and cognitive regulation at age 2-3 years was associated with teacher ratings of children’s prosocial behaviors in the early years of school. A sample of 2,392 children was drawn from the LSAC Birth Cohort for the analyses. The analyses used structural equation modeling to estimate parameters of the relationships between key variables. Within the model, estimates of mother-reported emotional and cognitive regulation at age 2 to 3 years were significantly associated with teacher-reported prosocial behavior at 6 to 7 years. Emotional regulation was a slightly stronger indicator of prosocial behavior than cognitive regulation. Being female and from a family with a higher socioeconomic position were also associated with higher levels of prosocial behavior. Results are discussed in relation to the role of early childhood teachers in fostering children’s self-regulatory behaviors and in providing environments in which empathic and prosocial behaviors are modeled, guided, and scaffolded so that foundations are laid for caring behaviors to be understood and internalized by children.

The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

Serine protease inhibition and mitochondrial dysfunction associated with cisplatin resistance in human tumor cell lines: targets for therapy

Indicators of mitochondrial function were studied in two different cell culture models of cis-diamminedichloroplatinum-II (CDDP) resistance: the intrinsically resistant human ovarian cancer cell line CI-80-13S, and resistant clones (HeLa-S1a and HeLa-S1b) generated by stable expression of the serine protease inhibitor—plasminogen activator inhibitor type-2 (PAI-2), in the human cervical cancer cell line HeLa. In both models, CDDP resistance was associated with sensitivity to killing by adriamycin, etoposide, auranofin, bis[1,2-bis(diphenylphosphino)ethane]gold(I) chloride {[Au(DPPE)2]Cl}, CdCl2 and the mitochondrial inhibitors rhodamine-123 (Rhl23), dequalinium chloride (DeCH), tetraphenylphosphonium (TPP), and ethidium bromide (EtBr) and with lower constitutive levels of ATP. Unlike the HeLa clones, CI-80-13S cells were additionally sensitive to chloramphenicol, 1-methyl-4-phenylpyridinium ion (MPP+), rotenone, thenoyltrifluoroacetone (TTFA), and antimycin A, and showed poor reduction of 1-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT), suggesting a deficiency in NADH dehydrogenase and/or succinate dehydrogenase activities. Total platinum uptake and DNA-bound platinum were slightly lower in CI-80-13S than in sensitive cells. The HeLa-S1a and HeLa-S1b clones, on the other hand, showed poor reduction of triphenyltetrazolium chloride (TTC), indicative of low cytochrome c oxidase activity. Total platinum uptake by HeLa-S1a was similar to HeLa, but DNA-bound platinum was much lower than for the parent cell line. The mitochondria of CI-80-13S and HeLa-S1a showed altered morphology and were fewer in number than those of JAM and HeLa. In both models, CDDP resistance was associated with less platinum accumulation and with mitochondrial and membrane defects, brought about one case with expression of a protease inhibitor which is implicated in tumor progression. Such markers may identify tumors suitable for treatment with gold phosphine complexes or other mitochondrial inhibitors.

A possible role for mitochondrial dysfunction in migraine

Migraine is a common neurological disorder characterised by debilitating head pain and an assortment of additional symptoms which can include nausea, emesis, photophobia, phonophobia and occasionally visual sensory disturbances. Migraine is a complex disease caused by an interplay between predisposing genetic variants and environmental factors. It affects approximately 12 % of studied Caucasian populations with affected individuals being predominantly female. Genes involved in neurological, vascular or hormonal pathways have all been implicated in predisposition towards developing migraine. All of these are nuclear encoded genes, but given the role of mitochondria in a number of neurological disorders and in energy production it is possible that mitochondrial variants may play a role in the pathogenesis of this disease. Mitochondrial DNA has been a useful tool for studying population genetics and human genetic diseases due to the clear inheritance shown through successive generations. Given the clear gender bias found in migraine patients it may be important to investigate X-linked inheritance and mitochondrial-related variants in this disorder. This paper explores the possibility that mitochondrial DNA changes may play a role in migraine. Few variants in the mitochondrial genome have so far been investigated in migraine and new studies should be aimed towards investigating the role of mitochondrial DNA in this common disorder.

Sexual desire, erectile dysfunction and the biomedicalization of sex in older heterosexual men

Aim To examine sexual desire in older age and the use of pharmaceuticals for sexual enhancement in the context of erectile dysfunction. Background The ability of the older person to fulfil sexual desire has not been well supported in Western society. Design The paper draws on themes that emerged during a phenomenological study of sexual desire in older age. Method Narratives were collected between 2008–2010 from in-depth interviews with six men and two women aged 65–84 years who were part of a larger Australian study of sexual desire in older age. Findings Emergent themes reveal that for some older people, the biomedicalization of sex can be a disappointing experience. Conclusion The findings illuminate the need for nurses who are at the front line of health care, health policy makers and educators, to consider sexual desire experienced in older age in the context of sexual health and healthy ageing. This study will contribute to a growing body of knowledge about sexual desire in older age

Performance of a cognitive, but not visual, secondary task interacts with alcohol-induced balance impairment in novice and experienced motorcycle riders

The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders’ focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders’ performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future ‘drink riding’ policy considerations are discussed.

Complex cognitive interactions in a badly designed world : Investigating the underlying causes of collisions between distinct road users

Collisions between distinct road users (e.g. drivers and riders, drivers and cyclists) make a substantial contribution to the road trauma burden. Although evidence suggests different road users interpret the same road situations contrarily, it is not clear how their situation awareness differs, nor is it clear which differences might lead to conflicts. This article presents the findings from an on-road study which was conducted to examine driver, cyclist and motorcyclist situation awareness in different road environments. The findings suggest that drivers, motorcyclists, and cyclists develop markedly different situational understandings even when operating in the same road environments. Examination of these differences indicate that they are likely to be compatible along arterial roads, shopping strips and at roundabouts, but that they may create conflicts between the different road users at intersections. The key role of road design in supporting compatible situation awareness and behaviour across different road users is discussed.

Motivation during videogame play : analysing player experience in terms of cognitive action

This paper describes a method for analysing videogames based on game activities. It examines the impact of these activities on the player experience. The research approach applies heuristic checklists that deconstruct games in terms of cognitive processes that players engage in during gameplay (e.g., addressing goals, interpreting feedback). For this study we examined three puzzle games, Portal 2, I-Fluid and Braid. The Player Experience of Need Satisfaction (PENS) survey is used to measure player experience following gameplay. Cognitive action provided within games is examined in light of reported player experiences to determine the extent to which these activities influence players’ feelings of competence, autonomy, intuitive control and presence. Findings indicate that the positive experiences are directly influenced by game activity design. Our study also demonstrates the value of expert review in deconstructing gameplay activity as a means of providing direction for game design that enhances the player experience.

Towards modelling web search behaviour : integrating users’ cognitive styles

With the rapid growth of information on the Web, the study of information searching has let to an increased interest. Information behaviour (IB) researchers and information systems (IS) developers are continuously exploring user - Web search interactions to understand and to help users to provide assistance with their information searching. In attempting to develop models of IB, several studies have identified various factors that govern user's information searching and information retrieval (IR), such as age, gender, prior knowledge and task complexity. However, how users' contextual factors, such as cognitive styles, affect Web search interactions has not been clearly explained by the current models of Web Searching and IR. This study explores the influence of users' cognitive styles on their Web search behaviour. The main goal of the study is to enhance Web search models with a better understanding of how these cognitive styles affect Web searching. Modelling Web search behaviour with a greater understanding of user's cognitive styles can help information science researchers and IS designers to bridge the semantic gap between the user and the IS. To achieve the aims of the study, a user study with 50 participants was conducted. The study adopted a mixed method approach incorporating several data collection strategies to gather a range of qualitative and quantitative data. The study utilised pre-search and post-search questionnaires to collect the participants' demographic information and their level of satisfaction about the search interactions. Riding's (1991) Cognitive Style Analysis (CSA) test was used to assess the participants' cognitive styles. Participants completed three predesigned search tasks and the whole user - web search interactions, including thinkaloud, were captured using a monitoring program. Data analysis involved several qualitative and quantitative techniques: the quantitative data gave raise to detailed findings about users' Web searching and cognitive styles, the qualitative data enriched the findings with illustrative examples. The study results provide valuable insights into Web searching behaviour among different cognitive style users. The findings of the study extend our understanding of Web search behaviour and how users search information on the Web. Three key study findings emerged: • Users' Web search behaviour was demonstrated through information searching strategies, Web navigation styles, query reformulation behaviour and information processing approaches while performing Web searches. The manner in which these Web search patterns were demonstrated varied among the users with different cognitive style groups. • Users' cognitive styles influenced their information searching strategies, query reformulation behaviour, Web navigational styles and information processing approaches. Users with particular cognitive styles followed certain Web search patterns. • Fundamental relationships were evident between users' cognitive styles and their Web search behaviours; and these relationships can be illustrated through modelling Web search behaviour. Two models that depict the associations between Web search interactions, user characteristics and users' cognitive styles were developed. These models provide a greater understanding of Web search behaviour from the user perspective, particularly how users' cognitive styles influence their Web search behaviour. The significance of this research is twofold: it will provide insights for information science researchers, information system designers, academics, educators, trainers and librarians who want to better understand how users with different cognitive styles perform information searching on the Web; at the same time, it will provide assistance and support to the users. The major outcomes of this study are 1) a comprehensive analysis of how users search the Web; 2) extensive discussion on the implications of the models developed in this study for future work; and 3) a theoretical framework to bridge high-level search models and cognitive models.

The impact of a social-cognitive teaching strategy on students with learning difficulties

This study examined the impact of a social-cognitive teaching strategy, the community of inquiry, on the functioning of six Year 4 students with learning difficulties. Results indicated that the students became more self-regulated in their learning and developed greater academic self-efficacy and stronger reading comprehension skills. Although the degree of development varied across the group, the results indicated that all six students (in addition to their class peers) benefited from actively engaging in scaffolded opportunities for intellectual and social exchange in a whole class setting. Accordingly, the findings of this study have implications for approaches to supporting the development and learning of students with learning difficulties.

Evidence for the safety and quality issues associated with the care of patients with cognitive impairment in acute care settings : a rapid review

The Australian Commission on Safety and Quality in Health Care commissioned this rapid review to identify recent evidence in relation to three key questions: 1. What is the current evidence of quality and safety issues regarding the hospital experience of people with cognitive impairment (dementia/delirium)? 2. What are the existing evidence-based pathways, best practice or guidelines for cognitive impairment in hospitals? 3. What are the key components of an ideal patient journey for a person with dementia and/or delirium? The purpose of this review is to identify best practice in caring for patients with cognitive impairment (CI) in acute hospital settings. CI refers to patients with dementia and delirium but can include other conditions. For the purposes of this report, ‘Hospitals’ is defined as acute care settings and includes care provided by acute care institutions in other settings (e.g. Multipurpose Services and Hospital in the Home). It does not include residential aged care settings nor palliative care services that are not part of a service provided by an acute care institution. Method Both peer-reviewed publications and the grey literature were comprehensively searched for recent (primarily post 2010) publications, reports and guidelines that addressed the three key questions. The literature was evaluated and graded according to the National Health and Medical Research Council (NHMRC) levels of criteria (see Evidence Summary – Appendix B). Results Thirty-one recent publications were retrieved in relation to quality and safety issues faced by people with CI in acute hospitals. The results indicate that CI is a common problem in hospitals (upwards of 30% - the rate increases with increasing patient age), although this is likely to be an underestimate, in part, due to numbers of patients without a formal dementia diagnosis. There is a large body of evidence showing that patients with CI have worse outcomes than patients without CI following hospitalisation including increased mortality, more complications, longer hospital stays, increased system costs as well as functional and cognitive decline. 4 To improve the care of patients with CI in hospital, best practice guidelines have been developed, of which sixteen recent guidelines/position statements/standards were identified in this review (Table 2). Four guidelines described standards or quality indicators for providing optimal care for the older person with CI in hospital, in general, while three focused on delirium diagnosis, prevention and management. The remaining guidelines/statements focused on specific issues in relation to the care of patients with CI in acute hospitals including hydration, nutrition, wandering and care in the Emergency Department (ED). A key message in several of the guidelines was that older patients should be assessed for CI at admission and this is particularly important in the case of delirium, which can indicate an emergency, in order to implement treatment. A second clear mess...

Validation of the interRAI Cognitive Performance Scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients

Objective To compare the diagnostic accuracy of the interRAI Acute Care (AC) Cognitive Performance Scale (CPS2) and the Mini-Mental State Examination (MMSE), against independent clinical diagnosis for detecting dementia in older hospitalized patients. Design, Setting, and Participants The study was part of a prospective observational cohort study of patients aged ≥70 years admitted to four acute hospitals in Queensland, Australia, between 2008 and 2010. Recruitment was consecutive and patients expected to remain in hospital for ≥48 hours were eligible to participate. Data for 462 patients were available for this study. Measurements Trained research nurses completed comprehensive geriatric assessments and administered the interRAI AC and MMSE to patients. Two physicians independently reviewed patients’ medical records and assessments to establish the diagnosis of dementia. Indicators of diagnostic accuracy included sensitivity, specificity, predictive values, likelihood ratios and areas under receiver (AUC) operating characteristic curves. Results 85 patients (18.4%) were considered to have dementia according to independent clinical diagnosis. The sensitivity of the CPS2 [0.68 (95%CI: 0.58–0.77)] was not statistically different to the MMSE [0.75 (0.64–0.83)] in predicting physician diagnosed dementia. The AUCs for the 2 instruments were also not statistically different: CPS2 AUC = 0.83 (95%CI: 0.78–0.89) and MMSE AUC = 0.87 (95%CI: 0.83–0.91), while the CPS2 demonstrated higher specificity [0.92 95%CI: 0.89–0.95)] than the MMSE [0.82 (0.77–0.85)]. Agreement between the CPS2 and clinical diagnosis was substantial (87.4%; κ=0.61). Conclusion The CPS2 appears to be a reliable screening tool for assessing cognitive impairment in acutely unwell older hospitalized patients. These findings add to the growing body of evidence supporting the utility of the interRAI AC, within which the CPS2 is embedded. The interRAI AC offers the advantage of being able to accurately screen for both dementia and delirium without the need to use additional assessments, thus increasing assessment efficiency.