Experimental induction of psychotherapeutically relevant emotional states

Background: Emotion research in neuroscience targets brain structures and processes involved in discrete emotion categories (e.g. anger, fear, sadness) or dimensions (e.g. valence, arousal, approach-avoidance), and usually relies on carefully controlled experimental paradigms with standardized and often simple emotion-eliciting stimuli like e.g. unpleasant pictures. Emotion research in clinical psychology and psychotherapy is often interested in very subtle differences between emotional states, e.g. differences within emotion categories (e.g. assertive, self-protecting vs. rejecting, protesting anger or specific grief vs. global sadness), and/or the biographical, social, situational, or motivational contexts of the emotional experience, which are desired to be minimized in experimental neuroscientific research. Objective: In order to facilitate the experimental and neurophysiological investigation of psychotherapeutically relevant emotional experiences, the present study aims at developing a priming procedure to induce specific, therapeutically and biographically relevant emotional states under controlled experimental conditions. Methodology: N = 50 participants who reported negative feelings towards another close person were randomly assigned to 2 different conditions. They fulfilled 2 different sentence completion tasks that were supposed to prime either ‘therapeutically productive’ or ‘therapeutically unproductive’ emotional states and completed an expressive writing task and several self-report measures of specific emotion-related constructs. The sentence completion task consisted in max. 22 sentence stems drawn from psychotherapy patients’ statements that have been shown to be typical for productive or unproductive therapy sessions. The subjects of the present study completed these sentence stems with regard to their own negative feelings towards the close person. Results: There were a substantial inter-individual variability concerning the number of completed sentences, and significant correlations between number of completed sentences and problem activation in both conditions. No differences were observed in general mood or problem activation between both groups after priming. Descriptively, there were differences between groups concerning emotion regulation aspects. Significant differences between groups in resolution of negative feelings towards the other person were found. Discussion: The results point in the expected direction, however the small sample sizes (after exclusion of several subjects) and low power hinder the detection of convincing significant effects. More data is needed in order to evaluate the efficacy of this emotional priming procedure.

Antiretrovirale Therapie

Antiretroviral therapy to treat HIV, as we know it today, is nothing less than a huge success story in modern medical history. What used to be an almost certain death-sentence was transformed into a very manageable chronic disease by means of highly efficient und mostly well tolerated drugs. Today, HIV-infected patients treated according to international recommendations have a very good chance to outgo the negative effects of HIV-1 and are therefore able to reach an almost normal life expectancy. Furthermore, patients successfully treated with antiretroviral drugs are no longer infectious, which is an essential aspect of global strategies to overcome the pandemic. Nevertheless, due to the complexity of HIV, physicians treating patients with antiretroviral therapy require profound knowledge of aspects such as viral resistance mechanisms and immune reconstitution, as well as drug-toxicity und drug-drug-interactions. Many other aspects such as long-term side-effects of antiretroviral drugs are still unknown. Strict adherence to treatment is of utmost importance.

Quality Control for SP Performance Regarding Patient Portrayal in a High-Stakes OSCE

Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SP’s performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument after being inspired by others [5] and used it in our high-stakes exam. Methods SP trainers from all five Swiss medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised with the partners twice, based on experiences during OSCEs. The final instrument contains 14 criteria for acting (i.e. adequate verbal and non-verbal expression) and standardization (i.e. verbatim delivery of the first sentence). All partners used the instrument during a high-stakes OSCE. Both, SPs and trainers were introduced to the instrument. The tool was used in training (more than 100 observations) and during the exam (more than 250 observations). FAIR_OSCE The list of items to assess the quality of the simulation by SPs was primarily developed and used to provide formative feedback to the SPs in order to help them to improve their performance. It was therefore named “Feedbackstruckture for the Assessment of Interactive Role play in Objective Structured Clinical Exams (FAIR_OSCE). It was also used to assess the quality of patient portrayal during the exam. The results were calculated for each of the five faculties individually. Formative evaluation was given to the five faculties with individual feedback without revealing results of other faculties other than overall results. Results High quality of patient portrayal during the exam was documented. More than 90% of SP performances were rated to be completely correct or sufficient. An increase in quality of performance between training and exam was noted. In example the rate of completely correct reaction in medical tests increased from 88% to 95%. 95% completely correct reactions together with 4% sufficient reactions add up to 99% of the reactions meeting the requirements of the exam. SP educators using the instrument reported an augmentation of SPs performance induced by the use of the instrument. Disadvantages mentioned were high concentration needed to explicitly observe all criteria and cumbersome handling of the paper-based forms. Conclusion We were able to document a very high quality of SP performance in our exam. The data also indicate that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed augmentation of performance. The development of an iPad based application for the form is planned to address the cumbersome handling of the paper.

FAIR_OSCE – Feedback structure for assessment of interactive roleplay in Objective Structured Clinical Exams

Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SPs’ performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument after being inspired by others [5] and used it in our high-stakes exam. Project description SP trainers from five medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised twice, based on experiences during OSCEs. The final instrument contains 14 criteria for acting (i.e. adequate verbal and non-verbal expression) and standardization (i.e. verbatim delivery of the first sentence). All partners used the instrument during a high-stakes OSCE. SPs and trainers were introduced to the instrument. The tool was used in training (more than 100 observations) and during the exam (more than 250 observations). Outcome High quality of SPs’ patient portrayal during the exam was documented. More than 90% of SP performances were rated to be completely correct or sufficient. An increase in quality of performance between training and exam was noted. For example, the rate of completely correct reaction in medical tests increased from 88% to 95%. Together with 4% of sufficient performances these 95% add up to 99% of the reactions in medical tests meeting the standards of the exam. SP educators using the instrument reported an augmentation of SPs’ performance induced by the use of the instrument. Disadvantages mentioned were the high concentration needed to observe all criteria and the cumbersome handling of the paper-based forms. Discussion We were able to document a very high quality of SP performance in our exam. The data also indicates that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed enhancement of performance. The development of an iPad-based application for the form is planned to address the cumbersome handling of the paper.

Speech Intelligibility in Noise With a Single-Unit Cochlear Implant Audio Processor.

INTRODUCTION The Rondo is a single-unit cochlear implant (CI) audio processor comprising the identical components as its behind-the-ear predecessor, the Opus 2. An interchange of the Opus 2 with the Rondo leads to a shift of the microphone position toward the back of the head. This study aimed to investigate the influence of the Rondo wearing position on speech intelligibility in noise. METHODS Speech intelligibility in noise was measured in 4 spatial configurations with 12 experienced CI users using the German adaptive Oldenburg sentence test. A physical model and a numerical model were used to enable a comparison of the observations. RESULTS No statistically significant differences of the speech intelligibility were found in the situations in which the signal came from the front and the noise came from the frontal, ipsilateral, or contralateral side. The signal-to-noise ratio (SNR) was significantly better with the Opus 2 in the case with the noise presented from the back (4.4 dB, p < 0.001). The differences in the SNR were significantly worse with the Rondo processors placed further behind the ear than closer to the ear. CONCLUSION The study indicates that CI users with the receiver/stimulator implanted in positions further behind the ear are expected to have higher difficulties in noisy situations when wearing the single-unit audio processor.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

Deterrence, Incapacitation, and Repeat Offenders

This paper develops an economic model of criminal enforcement that combines the goals of deterrence and incapacitation. Potential offenders commit an initial criminal act if the present value of net private gains is positive. A fraction of these offenders become habitual and commit further crimes immediately upon release from their initial prison term (if any). The optimal punishment scheme in this setting generally involves a finite prison term for first-time offenders (based on the goal of deterrence), and an infinite (life) sentence for repeat offenders (based on the goal of incapacitation).

Algunos epigramas de Goethe y de Schiller

Este trabajo ofrece algunos epigramas de Goethe y de Schiller en una versión que puede llamarse rítmica porque ha procurado hacer justicia tanto a la sentencia como a la forma de los mismos. Pero precisamente por ser ésta una versión rítmica, no se ha de encontrar, en todos los casos, una correspondencia literal con los originales. La meta ha sido salvar siempre la idea y el ritmo de cada epigrama, a sabiendas de que ello obligaría a sacrificar, acá y allá, más de una palabra. Los epigramas que pertenecen a dos grupos. El primero, vinculado con el nombre de Goethe, está integrado por doce de ellos, que se dan a conocer aquí por primera vez. El segundo grupo abarca, por su parte, dieciséis de treinta epigramas ya publicados, aunque ahora renovados, con la figura rítmica regular de la que carecían.

Creación y libertad : la cuestión tras la discusión entre Pegis y Lovejoy

A fines de los años 40’, el filósofo norteamericano Arthur Lovejoy y el en ese momento Presidente del Pontifical Institute of Mediaeval Studies, Anton Pegis, sostuvieron una interesante discusión sobre la existencia de libertad o necesidad eficiente en el acto divino de crear conforme a la filosofía de Tomás de Aquino. Lovejoy denunciaba una supuesta incoherencia fundamental en las enseñanzas de Tomás al respecto. Según él, en el concepto tomásico de creación se encuentran implicados al mismo tiempo los conceptos de necesidad agente y libre albedrío aplicados al Creador. Esta supuesta contradicción era para Pegis no sólo falsa sino imposible. Aquí repensaremos dos puntos centrales de dicha discusión: en primer lugar, si, como piensa Lovejoy, para Santo Tomás efectivamente existe una contraposición entre la autosuficiencia de Dios y su capacidad para amar otras cosas distintas de Él. Luego, el significado de la frase: “condice a la bondad divina que también otras cosas participen de la misma". (S.th., I, q.19, a.2).

Métrica y orden de palabras en griego antiguo : la cuestión del segundo argumento

A pesar de la ausencia de hablantes nativos, el griego cuenta con fuentes secundarias que permiten estudiar su estructura prosódica. En este artículo combino el estudio del orden de palabras y de la métrica de los trímetros yámbicos con el objetivo de ver cuál es la relación entre el verbo y el segundo argumento en términos de posición en la oración y de prosodia. Se mostrará que hay una tendencia a que el segundo argumento aparezca junto al verbo y a que formen parte de una única unidad prosódica. La tendencia es mayor con pronombres personales que con sintagmas nominales, que pueden aparecer separados si son complejos y extensos.

Fases en la derivación e interpretación semántico pragmática

En trabajos anteriores (Romero, 2008a y b, Alabart Lago, L., P. Díaz y G. Herrera, 2012, Alabart Lago, L. y Herrera, G., 2013) se intentó mostrar que el mecanismo interpretativo que propone la TR podría resultar adecuado como uno de los sistemas externos (también interpretativos) postulados por la GG, más precisamente, el sistema llamado CI. La relación que intentamos establecer tendrá en cuenta lo siguiente como marco teórico: a) En TR se afirma que la interpretación de un enunciado se deriva de las estructuras sintácticas, y esta derivación se realiza "en paralelo" con la derivación de estructuras llevada a cabo por las operaciones del componente sintáctico. b) En las últimas propuestas de la GG, extensiones y revisiones del PM propuesto en Chomsky (1995) no solo se dejan de lado los niveles de representación internos SP y ES sino también se considera prescindible la interfaz FL (Chomsky, 2005). Las estructuras generadas se transfieren a los sistemas externos en cuanto rasgos formales de las Categorías Funcionales son valorados. Mantendremos la noción de que el sistema computacional es relativamente irrestricto y que sus operaciones son condicionadas solo por Atracción y las llamadas "condiciones de legibilidad" impuestas por los sistemas externos, fundamentalmente el Principio de Interpretación Completa (PIC). c) Tendremos en cuenta la propuesta de Leonetti y Escandell Vidal (2004), que sostiene que las CCFF de la GG pueden considerarse equivalentes a las Categoría Procedimentales propuestas por la TR. En este sentido consideraremos válida la afirmación de Chomsky (1998) acerca de que las CCFF centrales (C, T, v y D) tienen propiedades semánticas. d) Otro factor que tendremos en cuenta es la noción de fase en la derivación, considerándola correcta en los términos expuestos en Chomsky (2001 y 2005) y Gallego (2007 y 2009), con ciertas modificaciones. Nuestra hipótesis puede resumirse en lo siguiente: Las operaciones de extracción de inferencias propuestas por TR se aplican durante la derivación sintáctica independientemente de que se haya transferido o no una fase. Es más, esperamos poder demostrar que algunos mecanismos inferenciales imponen ciertas condiciones que afectan a la valoración de los rasgos de las CCFF. Pretendemos también intentar mostrar que además de los núcleos de fase reconocidos, C y v, debe considerarse fase a SD, porque contiene rasgos específicos de cuyo cotejo y valoración se desprende el valor que recibirán otros rasgos en el curso de la derivación. Con estos fundamentos esperamos poder elaborar una descripción de cómo interactúan ambos sistemas en la derivación de una oración y la asignación (casi simultánea) de significado

As téchnai da cidade e a competência do filósofo

El propósito de esta comunicación es examinar la competencia del filósofo en el texto que hoy conocemos como Primer Alcibíades o Alcibíades Mayor. El trabajo propone la lectura del diálogo como un texto de filosofía política. La hipótesis sostenida es que el diálogo fue escrito con la intención de explicar la filosofía como una forma de intervenir políticamente basada en la exégesis filosófica de la sentencia apolínea "Conócete a ti mismo". Se argumenta que la perspectiva del texto se fundamenta en el principio de que la frase lleva consigo una exhortación a ejercer la política de manera recta. El diálogo, pues, no sólo contiene un análisis filosófico sobre la competencia adecuada para el ejercicio del poder, sino que también analiza cómo esta competencia se relaciona con la política, lo que pone a la filosofía en conflicto con las téchnai practicadas en la ciudad