New roles for community pharmacists in modern health care systems: a challenge for pharmacy education and research.

The academic activities led by the Unit of Community Pharmacy can be classified as translational. Our group is interested in person-centered pharmaceutical services aimed at a more responsible use of drugs (effectiveness, safety, efficiency) in collaboration with physicians and other health care professionals in a primary care setting. The following domains of education and research are high priorities for our group: medication therapy management, medication adherence, integrated care, individualization of therapies, care management for the elderly and e-health.

Early clarification processes in clients presenting with borderline personality disorder: Relations with symptom level and change

Clarification-Oriented Psychotherapy (COP), an integrative treatment form with a basis in process-experiential psychotherapy, is particularly relevant for clients with Personality Disorders (PDs). We argue here that two related core therapeutic COP principles, "dual action regulation" and "interactional games" have consequences for symptom severity and therapeutic outcome for clients with PDs. A high quality COP clarification process requires that client's interactional games may be quickly assessed and treated in all (preferably early) therapy sessions. These processes can be observed and measured using the observer-rated Bochum Process and Relationship Rating Scales (BPRRS) which measure both clients' and therapists' contributions to the quality of the clarification processes engaged in therapy. This measure has been successfully applied to COP-therapies, but not, as yet, to therapies other than experiential, nor to specific client populations such as borderline personality disorder. The present study is a first attempt to evaluate the application of COP processes to other therapies and populations. We measured action regulation and interactional games using the BPRRS during intake sessions of a 10-session psychodynamic treatment of borderline personality disorder for a total of N = 30 clients and N = 8 therapists. Significant relationships were found between the client's degree of interactional games and both pretherapy symptom level and symptom change across therapy. These results are discussed in the context of Clarification-Oriented Psychotherapy, and more generally Person-Centered and Process-Experiential Psychotherapies. The potential relevance of the findings for psychodynamic psychotherapists are explored as well as the potential usefulness of taking into account a detailed analysis of interactional games for the training of psychotherapists working with any model of therapy working with clients presenting with BPD.

The normative dimension of social life from a second-person perspective

This thesis argues that insofar as we want to account for the normative dimension of social life, we must be careful to avoid construing that normative dimension in such a way as to exclude that which the second-person perspective reveals is important to social life and our ability to participate in it.¦The second-person perspective reveals that social life ought to be understood as a mix or balance of the regular and the irregular, where, in addition, those one interacts with are always to some extent experienced as other in a way that is neither immediately, nor perhaps ultimately, understandable. For persons to be able to participate in social life, conceived of in this way, they must have abilities that allow them to be, to some extent, hesitant and tentative in their relations with others, and thus tolerant of ambiguity, uncertainty and unpredictability, and responsive to and capable of learning from the otherness of others in the course of interacting with them.¦Incorporating the second-person perspective means we have to make some changes to the way we think about the normative in general, and the normative dimension of social life in particular. It does not mean giving up on the distinction between the normative and the regular - that continues to be fundamentally important but it does mean not excluding, as part of social life and as worthy of explanation, all that which is irregular. A radical way of putting it would be to say that there must be a sense in which the irregular is part of the normative. A less radical way, and the way adopted by this thesis, is to say that any account of the normative dimension of social life must not be such as to exclude the importance of irregularity from social life. This will mean 1) not characterising conventions, norms and rules as determinants of appropriateness and inappropriateness; 2) not thinking of them as necessary; 3) not thinking of them as necessarily governing minds; and 4) not thinking of them as necessarily shared.¦-¦L'argument principal de la thèse est que, pour rendre compte de la dimension normative de la vie sociale, il faut veiller à ne pas exclure la perspective de la deuxième personne - une perspective importante pour comprendre la vie sociale et la capacité requise pour y participer.¦Cette perspective nous permet d'imaginer la vie sociale comme un mélange ou un équilibre entre le régulier et l'irrégulier, l'interaction entre des individus pouvant être appréhendée comme l'expérience de chaque personne avec «l'autre» d'une manière qui n'est pas immédiatement compréhensible, et qui ne peut pas, peut-être, être ultimement comprise. Pour participer à la vie sociale, l'on doit avoir la capacité de rester hésitant et «réactif» dans ses relations avec les autres, de rester ouvert à leur altérité et de tolérer l'ambiguïté, l'incertitude et l'imprévisibilité des interactions sociales.¦Adopter une perspective «à la deuxième personne» conduit à une autre manière de penser la normativité en général, et la dimension normative de la vie sociale en particulier. Cela ne veut pas dire qu'il faut abandonner la distinction entre le normatif et le régulier - une distinction qui garde une importance fondamentale - mais qu'il faut reconnaître l'irrégulier comme faisant partie de la vie sociale et comme étant digne, en tant que tel, d'être expliqué. Une conception radicale pourrait même concevoir l'irrégulier comme faisant partie intégrante de la normativité. Une approche moins radicale, qui est celle adoptée dans cette thèse, est de dire que tout compte-rendu de la dimension normative de la vie sociale doit prendre en considération l'importance de l'irrégularité dans la vie sociale. Une telle approche implique que les conventions, normes et règles (1) ne déterminent pas ce qui est approprié ou inapproprié; (2) ne sont pas toujours nécessaires ; (3) ne gouvernent pas le fonctionnement de l'esprit ; et (4) ne sont pas nécessairement partagées.

Former eating disorder impairs 3rd person but not 1st person perspective taking. Does dance training help?

The mental ability to take the perspective of another person may depend on one's own bodily awareness and experience. In the present study, the former was defined as having a history of an eating disorder, and the latter variable was defined as formal experience with dance. The study used a 2 × 2 × 2 factorial design in which reaction times in two mental perspective taking tasks were compared between female dancers and non-dancers with and without a former eating disorder. Participants were asked to imagine two perspectives: i) the position of front-facing and back-facing figures (3rd person perspective taking task) and ii) that these same figures are a self reflection in a mirror (1st person perspective taking task). In both tasks, a particular hand was indicated in the presented figures, and the participants had to decide whether the hand represented their own left or right hand. Overall, responses were slower for front-facing than back-facing figures in the 3rd person perspective taking task, and for back-facing than front-facing figures in the 1st person perspective taking task. Importantly, having a former history of an eating disorder related to a decreased performance in the 3rd person perspective taking task, but only in participants without dance experience. Results from an additional control group (a history of exercise but no dance experience) indicated that dance is particularly beneficial for mental bodily perspective taking. Dance experience, more so than exercise in general, can benefit 3rd person or extrapersonal perspective taking, supporting the favourable impact this exercise has on own body processing

Multisensory mechanisms in temporo-parietal cortex support self-location and first-person perspective.

Self-consciousness has mostly been approached by philosophical enquiry and not by empirical neuroscientific study, leading to an overabundance of diverging theories and an absence of data-driven theories. Using robotic technology, we achieved specific bodily conflicts and induced predictable changes in a fundamental aspect of self-consciousness by altering where healthy subjects experienced themselves to be (self-location). Functional magnetic resonance imaging revealed that temporo-parietal junction (TPJ) activity reflected experimental changes in self-location that also depended on the first-person perspective due to visuo-tactile and visuo-vestibular conflicts. Moreover, in a large lesion analysis study of neurological patients with a well-defined state of abnormal self-location, brain damage was also localized at TPJ, providing causal evidence that TPJ encodes self-location. Our findings reveal that multisensory integration at the TPJ reflects one of the most fundamental subjective feelings of humans: the feeling of being an entity localized at a position in space and perceiving the world from this position and perspective.

One person with two DNA profiles: a(nother) case of mosaicism or chimerism.

Nuclear DNA markers, such as short tandem repeats (STR), are widely used for crime investigation and paternity testing. STR were used to determine whether a piece of tissue regurgitated by a dog was part of the penis of a dead, emasculated, man. Unexpectedly, when analyzing the recovered material and a blood sample from the deceased, five out of the 18 loci differed. According to the results, one could have concluded that these samples originated from two different persons. However, taking into account contextual information and data from complementary genetic analyses, the most likely hypothesis was that the deceased was a genetic mosaic or a chimera. Within a forensic genetic context, such genetic peculiarities may prevent associating the perpetrator of an offense with a stain left at a crime scene or lead to false paternity exclusions. Fast recognition of mosaics or chimeras, adapted sampling scheme, as well as careful interpretation of the data should allow avoiding such pitfalls.

Temporo-Parietal Junction encodes the Embodied Self: Neuro-Robotics, fMRI, and Lesion mapping.

Introduction: Neuroimaging of the self focused on high-level mechanisms such as language, memory or imagery of the self. Recent evidence suggests that low-level mechanisms of multisensory and sensorimotor integration may play a fundamental role in encoding self-location and the first-person perspective (Blanke and Metzinger, 2009). Neurological patients with out-of body experiences (OBE) suffer from abnormal self-location and the first-person perspective due to a damage in the temporo-parietal junction (Blanke et al., 2004). Although self-location and the first-person perspective can be studied experimentally (Lenggenhager et al., 2009), the neural underpinnings of self-location have yet to be investigated. To investigate the brain network involved in self-location and first-person perspective we used visuo-tactile multisensory conflict, magnetic resonance (MR)-compatible robotics, and fMRI in study 1, and lesion analysis in a sample of 9 patients with OBE due to focal brain damage in study 2. Methods: Twenty-two participants saw a video showing either a person's back or an empty room being stroked (visual stimuli) while the MR-compatible robotic device stroked their back (tactile stimulation). Direction and speed of the seen stroking could either correspond (synchronous) or not (asynchronous) to those of the seen stroking. Each run comprised the four conditions according to a 2x2 factorial design with Object (Body, No-Body) and Synchrony (Synchronous, Asynchronous) as main factors. Self-location was estimated using the mental ball dropping (MBD; Lenggenhager et al., 2009). After the fMRI session participants completed a 6-item adapted from the original questionnaire created by Botvinick and Cohen (1998) and based on questions and data obtained by Lenggenhager et al. (2007, 2009). They were also asked to complete a questionnaire to disclose the perspective they adopted during the illusion. Response times (RTs) for the MBD and fMRI data were analyzed with a 3-way mixed model ANOVA with the in-between factor Perspective (up, down) and the two with-in factors Object (body, no-body) and Stroking (synchronous, asynchronous). Quantitative lesion analysis was performed using MRIcron (Rorden et al., 2007). We compared the distributions of brain lesions confirmed by multimodality imaging (Knowlton, 2004) in patients with OBE with those showing complex visual hallucinations involving people or faces, but without any disturbance of self-location and first person perspective. Nine patients with OBE were investigated. The control group comprised 8 patients. Structural imaging data were available for normalization and co-registration in all the patients. Normalization of each patient's lesion into the common MNI (Montreal Neurological Institute) reference space permitted simple, voxel-wise, algebraic comparisons to be made. Results: Even if in the scanner all participants were lying on their back and were facing upwards, analysis of perspective showed that half of the participants had the impression to be looking down at the virtual human body below them, despite any cues about their body position (Down-group). The other participants had the impression to be looking up at the virtual body above them (Up-group). Analysis of Q3 ("How strong was the feeling that the body you saw was you?") indicated stronger self-identification with the virtual body during the synchronous stroking. RTs in the MBD task confirmed these subjective data (significant 3-way interaction between perspective, object and stroking). fMRI results showed eight cortical regions where the BOLD signal was significantly different during at least one of the conditions resulting from the combination of Object and Stroking, relative to baseline: right and left temporo-parietal junction, right EBA, left middle occipito-temporal gyrus, left postcentral gyrus, right medial parietal lobe, bilateral medial occipital lobe (Fig 1). The activation patterns in right and left temporo-parietal junction and right EBA reflected changes in self-location and perspective as revealed by statistical analysis that was performed on the percentage of BOLD change with respect to the baseline. Statistical lesion overlap comparison (using nonparametric voxel based lesion symptom mapping) with respect to the control group revealed the right temporo-parietal junction, centered at the angular gyrus (Talairach coordinates x = 54, y =-52, z = 26; p>0.05, FDR corrected). Conclusions: The present questionnaire and behavioural results show that - despite the noisy and constraining MR environment) our participants had predictable changes in self-location, self-identification, and first-person perspective when robotic tactile stroking was applied synchronously with the robotic visual stroking. fMRI data in healthy participants and lesion data in patients with abnormal self-location and first-person perspective jointly revealed that the temporo-parietal cortex especially in the right hemisphere encodes these conscious experiences. We argue that temporo-parietal activity reflects the experience of the conscious "I" as embodied and localized within bodily space.

Prise en charge des jeunes patients avec endocrinopathies pediatriques chroniques: les défis d'une transition souvent difficile [Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition].

The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.

When Preference Is Not Satisfied but the Individual Is: How Power Distance Affects Person-Job Fit

One aspect of person-job fit reflects congruence between personal preferences and job design; as congruence increases so should satisfaction. We hypothesized that power distance would moderate whether fit is related to satisfaction with degree of job formalization. We obtained measures of job-formalization, fit and satisfaction, as well as organizational commitment from employees (n = 772) in a multinational firm with subsidiaries in six countries. Confirming previous findings, individuals from low power-distance cultures were most satisfied with increasing fit. However, the extent to which individuals from high power-distance cultures were satisfied did not necessarily depend on increasing fit, but mostly on whether the degree of formalization received was congruent to cultural norms. Irrespective of culture, satisfaction with formalization predicted a broad measure of organizational commitment. Apart from our novel extension of fit theory, we show how moderation can be tested in the context of polynomial response surface regression and how specific hypotheses can be tested regarding different points on the response surface.

Spare non-occupational HIV post-exposure prophylaxis by active contacting and testing of the source person.

OBJECTIVE: HIV-1 post-exposure prophylaxis (PEP) is frequently prescribed after exposure to source persons with an undetermined HIV serostatus. To reduce unnecessary use of PEP, we implemented a policy including active contacting of source persons and the availability of free, anonymous HIV testing ('PEP policy'). METHODS: All consultations for potential non-occupational HIV exposures i.e. outside the medical environment) were prospectively recorded. The impact of the PEP policy on PEP prescription and costs was analysed and modelled. RESULTS: Among 146 putative exposures, 47 involved a source person already known to be HIV positive and 23 had no indication for PEP. The remaining 76 exposures involved a source person of unknown HIV serostatus. Of 33 (43.4%) exposures for which the source person could be contacted and tested, PEP was avoided in 24 (72.7%), initiated and discontinued in seven (21.2%), and prescribed and completed in two (6.1%). In contrast, of 43 (56.6%) exposures for which the source person could not be tested, PEP was prescribed in 35 (81.4%), P < 0.001. Upon modelling, the PEP policy allowed a 31% reduction of cost for management of exposures to source persons of unknown HIV serostatus. The policy was cost-saving for HIV prevalence of up to 70% in the source population. The availability of all the source persons for testing would have reduced cost by 64%. CONCLUSION: In the management of non-occupational HIV exposures, active contacting and free, anonymous testing of source persons proved feasible. This policy resulted in a decrease in prescription of PEP, proved to be cost-saving, and presumably helped to avoid unnecessary toxicity and psychological stress.