<p>Syftet med studien var att undersöka hur dialyspatienter hanterar information i stressfyllda</p><p>situationer och i vilken utsträckning resultaten överensstämmer från mätningar med</p><p>mätinstrumenten The Miller Behavioral Style Scale (MBSS) och Threatening Medical</p><p>Situations Inventory (TMSI). Studien hade en beskrivande och jämförande design och</p><p>urvalet var ett bekvämlighetsurval. Undersökningsgruppen bestod av 30 dialyspatienter från</p><p>två olika dialysmottagningar. Mätinstrument som använts är MBSS som bestod av två</p><p>frågor i stressfyllda situationer där deltagarna fick kryssa för ett eller flera alternativ. TMSI</p><p>bestod av fyra frågor om olika medicinska stressfyllda situationer, där deltagarna fick svara</p><p>på sex olika påståenden med hjälp av en fem gradig skala. Resultatet visade på att</p><p>dialyspatienters sätt att hantera information i stressfyllda situationer var jämt fördelat</p><p>mellan ”monitoring” (informations sökande) och ”blunting” (informations undvikande) i</p><p>TMSI. Medan i MBSS var fördelningen fler ”monitoring” än ”blunting”. Ingen</p><p>överensstämmelse mellan de båda instrumenten visades i resultatet. På grund av att</p><p>sjuksköterskans arbete består till stor del av förebyggande arbete inom sjukvården är det av</p><p>stor vikt för sjuksköterskan att veta hur information skall ges till patienter som har</p><p>”monitoring” respektive ”blunting” som copingstil.</p> / <p>The aim of the study was focused on dialysis patients and how information is handled in</p><p>stressful situations and to what extent the results from the measuring instruments The</p><p>Miller Behavioral Style Scale (MBSS) and Threatening Medical Situations Inventory</p><p>(TMSI) conformed. The study had a descriptive and comparing design and was</p><p>convenience sampled. The survey consists of 30 dialysis patients from two different</p><p>dialysis centers. MBSS measuring instruments consists of two different questions in</p><p>stressful situations where the participants had several options on each question. TMSI</p><p>consists of four questions related to medical stressful scenarios where each participant</p><p>answered on a five level scale relating to six different statements. The result showed that</p><p>dialysis patient’s ways to handle information in stressful situations was evenly distributed</p><p>in TMSI. The majority of the dialysis patient’s in MBSS was found to be more</p><p>“monitoring” (information seekers) than “blunting” (information avoidance). No</p><p>conformity of the two instruments was found. Because of the work that nurse`s do consists</p><p>of preventing healthcare and therefore it is of value that the nurse know how to give</p><p>information to patients that have” monitoring” respective” blunting” as a coping style.</p>

Syftet med studien var att undersöka hur dialyspatienter hanterar information i stressfyllda situationer och i vilken utsträckning resultaten överensstämmer från mätningar med mätinstrumenten The Miller Behavioral Style Scale (MBSS) och Threatening Medical Situations Inventory (TMSI). Studien hade en beskrivande och jämförande design och urvalet var ett bekvämlighetsurval. Undersökningsgruppen bestod av 30 dialyspatienter från två olika dialysmottagningar. Mätinstrument som använts är MBSS som bestod av två frågor i stressfyllda situationer där deltagarna fick kryssa för ett eller flera alternativ. TMSI bestod av fyra frågor om olika medicinska stressfyllda situationer, där deltagarna fick svara på sex olika påståenden med hjälp av en fem gradig skala. Resultatet visade på att dialyspatienters sätt att hantera information i stressfyllda situationer var jämt fördelat mellan ”monitoring” (informations sökande) och ”blunting” (informations undvikande) i TMSI. Medan i MBSS var fördelningen fler ”monitoring” än ”blunting”. Ingen överensstämmelse mellan de båda instrumenten visades i resultatet. På grund av att sjuksköterskans arbete består till stor del av förebyggande arbete inom sjukvården är det av stor vikt för sjuksköterskan att veta hur information skall ges till patienter som har ”monitoring” respektive ”blunting” som copingstil. / The aim of the study was focused on dialysis patients and how information is handled in stressful situations and to what extent the results from the measuring instruments The Miller Behavioral Style Scale (MBSS) and Threatening Medical Situations Inventory (TMSI) conformed. The study had a descriptive and comparing design and was convenience sampled. The survey consists of 30 dialysis patients from two different dialysis centers. MBSS measuring instruments consists of two different questions in stressful situations where the participants had several options on each question. TMSI consists of four questions related to medical stressful scenarios where each participant answered on a five level scale relating to six different statements. The result showed that dialysis patient’s ways to handle information in stressful situations was evenly distributed in TMSI. The majority of the dialysis patient’s in MBSS was found to be more “monitoring” (information seekers) than “blunting” (information avoidance). No conformity of the two instruments was found. Because of the work that nurse`s do consists of preventing healthcare and therefore it is of value that the nurse know how to give information to patients that have” monitoring” respective” blunting” as a coping style.

No description available.

No description available.

Operant acquisition, operant expression, and decision-making differentially rely on brain areas that are differentially affected by antipsychotic and other dopaminergic drugs. The purpose of this thesis was to test if the known differential pharmacological and location of action of antipsychotic and other dopaminergic drugs predict the drug effects on operant acquisition, operant expression, and decision-making. Clozapine and to a lesser extent, risperidone but not metoclopramide or haloperidol affect the prefrontal cortex (PFC); haloperidol, metoclopramide, and to a lesser extent, risperidone affect the dorsolateral striatum (DLS). We used amphetamine as a broadly-acting indirect dopamine (DA), serotonin (5-HT), and norepinephrine agonist. We found that all antagonists altered operant acquisition and expression, but in different ways. The DA D2-like receptor antagonists blunted reinforcement impact during operant acquisition and induced an extinction-like decline in expression whereas the atypical antipsychotics with high PFC 5-HT-2A affinity maintained inactive lever presses during acquisition, but produced tolerance in expression. Curiously, risperidone and metoclopramide, but not clozapine or haloperidol, more potently suppressed lever pressing in acquisition than expression. In contrast, amphetamine suppressed operant expression, but not acquisition, at a dose range that increased locomotion and induced conditioned place preference. Amphetamine decreased sensitivity to reward presentation and inactive lever pressing during operant acquisition, but had the opposite effects during expression. A very different pattern was found in the rodent gambling task (rGT), a model of the 4- choice (deck) Iowa Gambling Task used in humans. The rGT puts small, immediate rewards that are advantageous in the long-term due to generally fewer and shorter associated penalties in conflict with large, immediate rewards that are disadvantageous in the long-term due to generally more and longer associated penalties. Two antipsychotics (risperidone, haloperidol) but not the anti-emetic (metoclopramide) enhanced performance by shifting preferences towards advantageous options, but the antipsychotic that induces PFC Fos (clozapine) impaired performance. Amphetamine decreased discrimination among different decks in the rGT. These data demonstrate the differential effects of clinically relevant drugs on decision-making and different stages of operant learning. The differential effects on operant responding and decision-making of different antipsychotic drugs provide important information regarding their therapeutic and side-effect profiles. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-03-14 16:12:57.629

This research program represents the first systematic exploration of the subjective experience of alogia, anhedonia, attention problems, avolition, and emotional blunting, and its relation to other objective and subjective factors in schizophrenia. Using a combined rational-empirical approach, a vulnerability-stress-coping model of adjustment to the 5 negative symptoms was developed and tested. Three aspects of appraisal were examined, the primary appraisals of symptom severity and distress, and the secondary appraisal of control. The dimensions of coping with individual symptoms were initially examined using a rational approach, and then empirically using exploratory factor analyses. The Appraisal and Coping with Negative Symptoms Interview Schedule (ACNSIS) was developed for use in Study 1. Both qualitative and quantitative appraisal and coping data were examined for 20 people with negative symptoms. Responses to the ACNSIS demonstrated that appraisals and coping responses varied across participants and individual negative symptoms. Previously employed categorisations of coping behaviour were used to examine and quantify coping. Negative symptom-specific differences were found in awareness of negative symptom presence, degree of agreement with objective ratings, appraisals, reliance on different types of coping, and relations with participant characteristics. Participant coping responses from Study 1 were used to construct the self-report measure used in subsequent studies. Study 2 involved the development, administration, and evaluation of the self-report Appraisal and Coping with Negative Symptoms Questionnaire (ACNSQ). Both an electronic and paper version of the ACNSQ were developed. The ACNSQ was administered to 120 people with schizophrenia or schizoaffective disorder. Participants were required to make severity, distress and control appraisals for each negative symptom they believed they were suffering from. Following symptom appraisals, a number of symptom-specific and general coping items were presented for each negative symptom. In Study 2A, the multidimensionality of coping responses and the nature of empirically derived subscales were explored individually for each negative symptom. Factor analyses of data from 119 participants resulted in 3 underlying coping dimensions for each symptom. These dimensions, which formed the basis of the ACNSQ coping subscales, were labelled as active, emotional, or avoidant forms of coping. Coping subscales were found to be moderately similar across symptoms. The subscales were shown to be internally consistent and largely independent within symptoms. It was found that the degree of reliance on particular coping subscales was negative symptom-specific, although participant coping was related across symptoms. In Study 2B, the nature of negative symptom appraisals and the psychometric properties of the ACNSQ were examined. There was evidence that the nature of appraisals varied according to negative symptom. Retest reliability analyses indicated that overall, ACNSQ appraisals had a low to moderate degree of reliability while coping subscales demonstrated a moderate to high degree of reliability. Differential associations between appraisal and coping and a range of theoretically related variables provided evidence of the construct validity of the ACNSQ. Study 3 used exploratory techniques to conduct cross-sectional tests of a vulnerability-stress-coping model of adjustment to individual negative symptoms based on the data of the 119 participants. Associations between the objective indicator of negative symptom stressor level, and the subjective experience variables of insight, appraisal and coping were examined in relation to adjustment using a multidimensional approach. Two models of the relations between negative symptom predictors and 3 separate domains of adjustment were investigated. Study 3A provided moderate support for a direct effects model for each of the 5 negative symptoms. Objective negative symptom level, insight, primary appraisals and coping subscales all had significant direct effects on one or more domains of adjustment. In general, higher objective negative symptom levels, higher severity and distress appraisals, and greater reliance on avoidant forms of coping were associated with poorer adjustment. The direct effects of active and emotional forms of coping were less consistent and varied across symptoms and adjustment domains. Study 3B extended these findings by providing a limited amount of support for a mediated effects model. Appraisal and coping were found to act as mediators in some of the relations between objective indicators and subjective experience variables for alogia, attention problems and avolition. There was evidence that the impact of insight on coping was partly mediated by control appraisals. Coping partly mediated the relation between stress and adjustment, and appraisal and adjustment. Overall, this series of exploratory studies make a unique contribution to understanding the subjective experience of the negative symptoms of schizophrenia. The proposed vulnerability-stress-coping model demonstrated utility in identifying variables important in the prediction of adjustment to individual negative symptoms, and in delineating the nature of associations between variables. Further research is required to improve the psychometric properties of the ACNSQ. However, it offers promise as an instrument with which to assess negative symptom appraisals and coping responses, in both clinical and research settings. The present findings have important theoretical and clinical implications concerning the role of subjective and objective factors involved in adjustment to the negative symptoms of schizophrenia. This research program provides a valuable foundation for future research to test the vulnerability-stress-coping model in its entirety.

Le mode de propagation complexe des fissures courtes observé dans les métaux ductiles sous chargement cyclique est généralement attribué à différents mécanismes de stabilisation intervenant à l’échelle de la microstructure, l’échelle mésoscopique. Parmi ces mécanismes, l’interaction de la fissure avec la microstructure de dislocation semble jouer un rôle majeur. La dynamique des dislocations contrôle la déformation plastique et le transfert de chaleur qui lui est associé et réduit ainsi la quantité d’énergie élastique stockée dans le matériau. De plus, la microstructure de dislocations peut « écranter » le champ élastique induit par la fissure par son propre champ de contraintes et modifier la géométrie de la fissure par l’émoussement des surfaces en pointe. Pour la première fois, ces mécanismes sont étudiés avec des simulations 3D de Dynamique des Dislocation avec le modèle Discrete-Continu. Trois orientations de fissure sont testées sous un chargement monotone en traction, promouvant une ouverture en fond de fissure en mode I. De manière surprenante, les simulations montrent que les effets d’écrantage et d’émoussement n’ont pas un rôle clé dans la stabilisation des fissures testées en mode I. Le mécanisme principal se trouve être la capacité du matériau à se déformer plastiquement sans mettre en oeuvre un durcissement important par le mécanisme de la forêt. Des recherches supplémentaires sur deux effets de taille confirment ces résultats et montrent également la contribution mineure d’une densité de dislocations polarisées et du durcissement cinématique associé à la stabilisation des fissures. / The erratic behaviour of short cracks propagation under low cyclic loading in ductile metals is commonly attributed to a complex interplay between stabilisation mechanisms that occur at the mescopic scale. Among these mechanisms, the interaction with the existing dislocation microstructure play a major role. The dislocation microstructure is source of plastic deformation and heat transfer that reduce the specimen stored elastic energy, screen the crack field due to its self generated stress field or change the crack geometry through blunting mechanisms. For the first time, these mechanisms are investigated with 3D-DD simulations using the Discrete- Continuous Model, modelling three different crack orientations under monotonic traction loading promoting mode I crack opening.Surprisingly, screening and blunting effects do not seem to have a key role on mode I crack stabilisation. Rather, the capability of the specimen to deform plastically without strong forest hardening is found to be the leading mechanism. Additional investigations of two different size effects confirm those results and show the minor contribution of a polarised dislocations density and the associated kinematic hardening on crack stabilisation.

Einführung: Im Sommersemester 2011 wurde an der Universität Göttingen das interdisziplinäre Kursprojekt „Tod und Sterben – eine Reflexion im Anatomiekurs“ eingeführt. Dieses Gemeinschaftsprojekt der Abteilungen Palliativmedizin, Medizinische Psychologie und Soziologie sowie Anatomie dient als Reflexionsimpuls der Vorbereitung auf den anatomischen Präparierkurs und beinhaltet Aspekte wie Würde und Distanz im Umgang mit dem menschlichen Leichnam im Präpariersaal sowie deren Bezüge zum späteren ärztlichen Handeln. Die Implementierung des aus einem Vorlesungsbeitrag und einem Seminar bestehenden Pilotprojektes wurde wissenschaftlich begleitet und evaluiert. Neben der formalen Kursevaluation wurden Vorerfahrungen der Göttinger Medizinstudierenden mit dem Thema Tod und Sterben, ihre Einstellung zu Beginn des Präparierkurses sowie die Verknüpfung des Anatomiekurses mit emotionaler Belastung, Somatisierungsstörungen und emotionaler Abstumpfung exploriert. Methoden: Mittels eigens konzipierter Fragebögen wurden die Studierenden vor Beginn des Präparierkurses (Tag1), im Anschluss an das reflexive Seminar (Tag 3) und abschließend am letzten Präparierkurstag (Tag 88) befragt. Die Daten wurden mit Hilfe der Programme EvaSys, STATISTICA, SPSS und Excel bearbeitet und es wurden Signifikanztests, Varianz- und Reliabilitätsanalysen durchgeführt. Die Auswertung der offenen Fragen erfolgte in Anlehnung an die Qualitative Inhaltsanalyse nach Mayring. Ergebnisse: Bei einer Rücklaufquote von im Mittel 64,2% entsprach die durchschnittliche Geschlechtsverteilung aller 3 Fragebögen 37,3% männlich und 62,7% weiblich bei einem Durchschnittsalter von 21,9 Jahren. Bei den Medizinstudierenden der Universität Göttingen besteht bereits zu Beginn des Präparierkurses eine große Spannbreite an Vorerfahrungen mit dem Thema Tod und Sterben: Nahezu die gesamte Studierendenschaft hat bereits Todesfälle im familiären Umfeld erlebt. Die meisten Studierenden waren im Vorfeld gegenüber dem Anatomiekurs eher positiv eingestellt, Angst spielte nur für 1/5 der Befragten eine Rolle. Der Präparierkurs ist mit einer emotionalen Belastung verbunden, wenn auch die tatsächlich erlebte psychische Belastung weitaus geringer war als initial von den Studierenden befürchtet; allerdings empfanden rückblickend immerhin noch 61,7% den Präparationskurs in verschiedener Intensität psychisch belastend. 39% der Probanden litten während des Kurses in unterschiedlichem Ausmaß unter Somatisierungstörungen. Die Mehrzahl der Befragten (81,4%) stimmte in unterschiedlichem Maße der Aussage zu, dass der Präparierkurs zu einer gewissen emotionalen Abstumpfung beigetragen hat. Obwohl mehr als die Hälfte der Studierenden sich bereits selbst in irgendeiner Form auf den Umgang mit Verstorbenen vorbereitet hat, erachteten alle Befragten eine angeleitete Vorbereitung auf den Umgang mit Verstorbenen als sinnvoll. Die Kursevaluation bestätigte, dass der interdisziplinäre Kursteil einen Impuls zur Selbstreflexion gegeben hat. So wurden die Studierenden nicht nur angeregt, über die Thematik Tod und Sterben nachzudenken, sondern ein Großteil der Studierenden fühlte sich auch durch die im Seminar erarbeiteten Aspekte zu Empathie, Würde und Distanz besser auf den Umgang mit Verstorbenen vorbereitet. Schlussfolgerung: Der eingeführte Kurs „Tod und Sterben – eine Reflexion im Anatomiekurs“ stellt eine sinnvolle und notwendige Vorbereitung auf den Umgang mit Verstorbenen im Präparationskurs dar. Auch wenn viele Medizinstudierenden bereits außerhalb des Anatomiekurses Erfahrungen mit Tod und Sterben gesammelt haben, sind emotionale Belastungsreaktionen unumstritten und bedürfen somit einer Vorbeugung oder Intervention.