Clinical psychology service users' experiences of confidentiality and informed consent: a qualitative analysis

OBJECTIVES

To explore and describe the experience of clinical psychology service users in relation to the processes associated with confidentiality and the generation of informed consent in individual therapy.

DESIGN

A qualitative interview-based study employing interpretative phenomenological analysis was conducted with service users. User researchers were active collaborators in the study.

METHODS

A focus group of four users was convened to explore issues related to confidentiality and consent, which then informed the development of the semi-structured interview schedule. Twelve users of community mental health clinical psychology services were interviewed by user researchers. A user researcher and a clinical psychologist undertook joint analysis of the data. A second clinical psychologist facilitated reflexivity and wider consideration of validity issues.

RESULTS

Four main themes were identified from the data: being referred; the participant's feelings, mental health difficulties, and their impact; relationships with workers and carers; and autonomy.

CONCLUSIONS

The meaningfulness of processes of discussing confidentiality, and generating informed consent, can be improved by psychologists placing a greater emphasis on choice, control, autonomy, individual preferences, and actively involving the user in dialogue on repeated occasions.

An investigation into the prevalence of Renibacterium salmoninarum in farmed rainbow trout, Oncorhynchus mykiss (Walbaum), and wild fish populations in selected river catchments in England and Wales between 1998 and 2000

A cross-sectional survey of Renibacterium salmoninarum infection in farmed rainbow trout (RBT) and wild fish populations was carried out in 10 farms and six river catchments, respectively, in England and Wales. The majority of the wild fish were sampled in 1998 and the farmed fish in 2000. Grayling, Thymallus thymallus, and brown trout, Salmo trutta, were the main wild species sampled. Two fish, one grayling and one salmon, Salmo salar, were R. salmoninarum culture-positive, compared with 40 confirmed polymerase chain reaction-positive wild fish. The highest prevalence of R. salmoninarum infection was found in grayling in rivers with RBT farms with a history of R. salmoninarum infection. One hundred and fifty fish were sampled from each RBT farm, but none of the fish was found to be R. salmoninarum-positive. Evidence was found, for the first time, for the presence of R. salmoninarum in an eel, Anguilla anguilla.

Flavor characterization of top-blade, top-sirloin, and tenderloin steaks as affected by pH, maturity, and marbling

Little information is available in the literature on the interrelationships and interactions among pH, aging time, marbling, and maturity on the flavor profile of some beef muscles commonly used for steaks. To investigate these effects on beef flavor, the infraspinatus (top-blade steak) from the chuck clod, the gluteus medius (top-sirloin steak) from the sirloin, and the psoas major (tenderloin steak) from the loin were obtained from A- (n = 80) and B-maturity (n = 60) carcasses with either Slight (n = 68) or Small (n = 72) marbling, and with either normal (< or = 5.7; n = 80) or high (> or = 6.0; n = 60) pH. Muscles were selected from two commercial processing plants at six different sampling times to evaluate factors that affect the flavor profile of cooked beef steaks. Muscles were vacuum-aged for 7, 14, 21, or 35 d, and a highly trained, flavor-profile sensory panel evaluated charbroiled steaks from these muscles. Numerous statistical interactions (P < 0.05) were detected for flavor attributes of the different muscles. In general, muscles from high pH (dark cutting) carcasses had less typical beef flavor identity and less brown-roasted flavor than those from carcasses with normal pH. Aging longer than 21 d generally decreased beef flavor identity. Top-blade steaks generally had less intense beef flavor identity and more intense bloody/serumy flavor than did top-sirloin and tenderloin steaks. Tenderloin and top-sirloin steaks of normal pH generally had the most brown-roasted flavor, especially when aged 21 d or less. Small degree of marbling generally resulted in a more rancid flavor compared with Slight marbling, but marbling had no other appreciable effects on the flavor profile. Aging steaks for 35 d increased (P < 0.05) the metallic flavor compared with aging for only 7 or 14 d. Top-sirloin steaks had a more intense (P < 0.05) sour flavor than did top-blade steaks, and steaks from carcasses with a high pH were more rancid (P < 0.05) than steaks from carcasses with normal pH. Vacuum-aging top-blade, top-sirloin, and tenderloin steaks to 21 or 35 d postmortem generally increased metallic and rancid flavors and increased sour flavor in top-sirloin steaks that were high in pH.

Four years of monitoring for viral haemorrhagic septicaemia virus in marine waters around the United Kingdom

Between 1995 and 1998, marine fish from around the coast of the UK were collected and samples analysed for viral haemorrhagic septicaemia virus (VHSV) using cell culture isolation methods. In 1997 and 1998 the samples were also analysed for VHSV by reverse transcription PCR (RT-PCR). A total of 1867 fish of 11 species were tested, but VHSV was isolated on only 1 occasion, from herring Clupea harengus, in 1996. However, despite VHSV not being isolated in 1997 and 1998, in both years samples of herring from the west and south coasts of England produced positive signals in the RT-PCR, and in 1997 cod from the east coast of England also produced positive signals in the RT-PCR. These results are believed to be true indications of the presence of VHSV nucleic acid in the fish. In 1997, birnaviruses from Serogroup B1 were isolated from herring (a previously unrecorded host for the virus) and cod Gadus morhua, and a birnavirus from Serogroup A2 was also isolated from cod. In 1998, an aquareovirus was isolated from haddock Melanogrammus aeglefinus, a previously unrecorded host for the virus.

Perceptual ratings for pureed and molded peaches for individuals with and without impaired swallowing

Food molds have been created to alter the appearance of pureed foods by making the pureed consistencies look more like typically prepared foods. This study examined the perceptions of 15 adults with impaired swallowing and 15 adults with nonimpaired swallowing for three different types of pureed peach: a typically prepared pureed peach, a pureed peach with a thickening agent added, and a pureed peach with a thickening agent added and molded to look like peach slices. Results are presented for the attribute ratings of overall liking: liking of taste, texture, and appearance; and ease of chewing and swallowing. The results showed that the adults with impaired swallowing rated the attributes of chewing and swallowing significantly lower (i.e.. more difficult) for each type of puree. Significant differences within samples also were found for the attributes of overall liking and liking of taste. Overall, the pureed peach molds were not perceived favorably for any of the examined attributes. In addition, the molded peach was rated lower (more difficult) in its ease of chewing. The implications of these findings and ideas for further research are discussed.

In vitro complement activation favoring soluble C5b-9 complex formation alters myocellular sodium homeostasis

BACKGROUND

Deranged Na(+) homeostasis in skeletal muscle is closely associated with excessive complement activation that is encountered during sepsis. Recent evidence suggests that soluble C5b-9 complexes (SC5b-9), which are readily detected in plasma during sepsis and have long been considered irrelevant nonmembrane binding end products of complement activation, may have numerous biologic effects. The purpose of this study, therefore, was to determine the effects of SC5b-9 on myocellular ion homeostasis and its mechanism(s) of action.

METHODS

Hindlimb fast-twitch extensor digitorum longus (EDL) was freshly isolated from rats weighing 50 to 70 g and then incubated at 30 degrees C for 60 minutes in normal Krebs-Henseleit buffer (KHB, pH 7.4) containing 10% zymosan-activated rat serum (10 mg/mL at 37 degrees C for 60 minutes) as a source of SC5b-9. Zymosan particles were removed by centrifugation after activation to exclude any noncomplement direct effects. Heat-inactivated rat serum (56 degrees C for 30 minutes) was used as control. EDL muscle was also incubated with pertussis toxin (1 microg/mL), in Ca(2+)-free KHB, with thapsigargin (0.3 or 3 micromol/L), or with ouabain (0.01, 0.1 or 1 micromol/L) before and/or during incubation with 10% zymosan-activated or heat-inactivated rat serum. Intracellular Na(+) and K(+) contents ([Na(+)](i) or [K(+)](i)) of EDL muscle were determined by using flame photometry after washing in ice-cold Na(+)-free Tris-sucrose buffer. SC5b-9 in zymosan-activated human serum was determined by SC5b-9 enzyme-linked immunoassay.

RESULTS

SC5b-9 in zymosan-activated human serum significantly increased by 400% as compared with nonactivated, normal human serum. Zymosan-activated rat serum markedly increased [Na+]i without affecting [K(+)](i) in fast-twitch EDL muscle, which was completely inhibited by pertussis toxin, removal of extracellular Ca(2+) or depletion of intracellular Ca(2+) with thapsigargin. The addition of ouabain (at micromolar concentrations) increased myocellular [Na(+)](i) and decreased myocellular [K(+)](i) in both the zymosan-activated and the heat-inactivated rat serum groups. The effects of ouabain on myocellular [Na(+)](i) and [K(+)](i) were equivalent in these 2 groups. Zymosan-activated and heat-inactivated rat serum had similar effects on myocellular [K(+)](i) in the presence or absence of pertussis toxin, removal of extracellular Ca(2+) or depletion of intracellular Ca(2+).

CONCLUSIONS

Zymosan-activated rat serum (presumed SC5b-9 enriched) selectively alters Na(+) homeostasis in isolated fast-twitch skeletal muscle. The mechanisms for such effects may be linked to G-proteins, Ca(2+) flux and Na(+),K(+)-adenosine triphosphatase pump binding site blockade.

Cognitive strategies for reporting portion sizes using dietary recall procedures

OBJECTIVES

To examine recall strategies used by interview respondents when making judgments about portion size and to better understand how respondents use various portion-size aids.

DESIGN

Study participants were separated into groups, each using a different set of portion-size estimation aids: (a) 2-dimensional paper aids presented in stacks, (b) 2-dimensional aids, cut out and presented on rings, (c) household-type aids, and (d) a combination of 2- and 3-dimensional aids, many of which are used in national government surveys. Respondents gave a "quick list" of foods consumed the previous day and practiced cognitive thinking skills. Then the interviewer selected at least 2 solid, 2 liquid, and 2 amorphous foods for probing. Respondents were asked to think aloud as they reported how much they ate of each food. Types and frequencies of cognitive strategies used for portion-size estimation were determined.

SUBJECTS

Interviews of 1 to 1 1/2 hours were conducted with 76 adults aged 18 to 65 years. Participants were recruited to obtain a mix of races, ages, educational levels, and genders.

RESULTS

The most frequently used strategy was visualization and comparison to aids. Others strategies were known amounts, estimations based on known amounts, visualization of volume or a container, and actions such as pouring or moving hands to the mouth. Respondents preferred aids that were similar in size and shape to actual portions consumed for liquid or amorphous food and preferred the ruler for solid foods.

APPLICATIONS

To obtain the best data from dietary recalls, expect answers that are possible for respondents to give, supply respondents with aids that help them recall amounts consumed, and guide respondents to appropriate aids that help them formulate focused responses.

Sublytic complement attack increases intracellular sodium in rat skeletal muscle

BACKGROUND

Although excessive complement activation and deranged sodium homeostasis in skeletal muscle are characteristic in sepsis, their relationship has not been examined. This study was designed to determine if sublytic complement activation can directly mediate changes in myocellular sodium content.

MATERIALS AND METHODS

Fast-twitch extensor digitorum longus muscles were freshly isolated from infant rats. Unsensitized muscles were incubated at 30 degrees C for 60 min in the media containing 10% human or rat serum under conditions of no complement activation, activation by zymosan, inactivation by heat, C7 or C9 deficiency, selective inhibition of complement pathway, and inhibition of Na(+)-K(+) ATPase by ouabain. Intracellular sodium ([Na(+)](i)) and potassium ([K(+)](i)) contents of the muscles, myocellular ATP, and LDH release from the muscles were then determined.

RESULTS

Normal human serum significantly increased [Na(+)](i) and the [Na(+)](i)/[K(+)](i) ratio in the muscles as well as zymosan-activated serum. Heat inactivation, C7 deficiency, and inhibition of the alternative pathway completely abolished the cationic changes. Average LDH release was identical in all groups and less than 6%. Complement activation did not impair ouabain-sensitive Na(+)-K(+) ATPase activity in the muscles or alter myocellular ATP. Thus, the observed alterations are not likely due to dysfunction of Na(+)-K(+) pump or depletion of myocellular energy. Instead, alterations in [Na(+)](i) were dependent upon the amount of C9 added to C9-deficient serum, which suggests that the alterations are likely dependent on transmembrane pores created by membrane attack complexes (MAC).

CONCLUSIONS

Sublytic amounts of MAC formed as a result of complement activation can directly alter [Na(+)](i) in ex vivo skeletal muscle.

Interrelationships among evaluations of beef longissimus and semitendinosus muscle tenderness by Warner-Bratzler shear force, a descriptive-texture profile sensory panel, and a descriptive attribute sensory panel

The objective of our study was to examine the interrelationships among Warner-Bratzler shear force (WBSF) determinations, evaluation by a highly trained descriptive-texture-profile (DTP) sensory panel, and evaluation by a trained descriptive attribute (DA) sensory panel as affected by muscle fiber orientation of samples and shear-blade type. Longissimus lumborum and semitendinosus muscles (n = 18 of each) were cut into 2.54-cm steaks, which were cooked to 71 degrees C. Cores were obtained with two methods (parallel to the muscle fiber orientation and perpendicular to the cut steak surface), used for WBSF determinations with the typical V-shaped blade and modified WBSF determinations with a flat blade, and presented to the DTP and DA sensory panels. The V-shaped blade resulted in 1.4 to 2.5 kg lower (P < .05) mean WBSF values than the flat blade for both muscles. Cores taken parallel to the longissimus muscle fiber orientation had .64 kg higher (P < .05) mean WBSF values than cores taken perpendicular to the cut steak surface. Both panels detected differences among carcass replications; however, a panelist x replication effect (P < .05) occurred for the DA panel. Both panels detected differences (P < .05) in muscle fiber orientation for attributes related to tenderness. Correlations between sensory panel scores and WBSF values were dependent on blade type and coring method. Blade type and coring method had greater effects on correlations between sensory scores and WBSF values for the DTP panel than for the DA panel. Correlations between scores by both sensory panels and WBSF values were comparable. The more highly trained DTP panelists were more consistent in their evaluations of texture attributes; however, they were more sensitive to muscle fiber orientation. Both panels were effective in detecting differences among carcass replications.

Evaluation of a novel ELISA screening test for detection of factor VIII inhibitory antibodies in haemophiliacs

Treatment of patients with haemophilia A with coagulation factor concentrates may result in the development of inhibitory antibodies directed against factor VIII (FVIII). In this study, a previously unpublished ELISA test for FVIII inhibitor screening (Genetic Testing Institute [GTI] FVIII inhibitor, Brookfield, WI, USA) was evaluated in 131 blood samples (124 samples from patients with haemophilia A, and seven serial samples from one patient with an acquired FVIII inhibitor). Comparisons were made with the routine screening assay (based on recovery of FVIII) and confirmed where positive (< 90% recovery) with the New Oxford assay. The ELISA kit had a sensitivity of 97.7% and specificity of 78.4%. The high negative predictive value of this new test (98.6%) suggests it may be useful as a reliable, rapid (< 2 h) and flexible (microwell strip format) tool for inhibitor screening of samples from both patients with haemophilia A and those with suspected acquired FVIII inhibitors.

Using sleep dysfunction to explore the nature of resilience in adult survivors of childhood abuse or trauma

OBJECTIVE

In early studies, resilience to trauma was equated with psychological well-being. This study explores the possibility that such resilience is better described as social-behavioral competency and that, in turn, such competency can conceal emotional pain.

METHOD

A university sample of 97 participants, 79 women and 18 men, completed measures of childhood abuse and trauma, resilient characteristics, and sleep dysfunction. The measures of sleep problems could be divided into those tapping psychological well-being (e.g., nightmare frequency) and those reflecting social-behavioral functioning (e.g., measures of the impact of nightmares on waking functioning).

RESULTS

Fifty-three participants reported experiencing one or more types of trauma or abuse in childhood. As a group they scored more negatively than those reporting no abuse on measures of sleep dysfunction. Resilient characteristics were only related to measures of social-behavioral functioning, not well-being.

CONCLUSIONS

The findings are consistent with current conceptualizations of trauma/abuse recovery as involving multiple dimensions of functioning, some of which are more publicly observable than others. Therefore, some apparently resilient individuals may have good social-behavioral competency while still experiencing psychological pain.

Effects of spaceflight on morphology of the rat adenohypophysis

To determine the effects of spaceflight on the anterior pituitary gland, the adenohypophyses of rats after a 7-day spaceflight aboard the space shuttle Endeavor (STS-54) were investigated by histology, immunohistochemistry, morphometry, electron microscopy, and in situ hybridization and were compared with synchronous control rats. Morphometry revealed the corticotrophs of space-flown rats to be significantly enlarged, demonstrating 46-48% increases in mean cell, nuclear, and cytoplasmic areas. These corticotrophs also exhibited striking ultrastructural signs of heightened secretory activity. Furthermore, their expression of proopiomelanocortin mRNA, the transcript encoding the precursor protein from which adrenocorticotropic hormone is posttranslationally cleaved, was also significantly enhanced, a finding consistent with their hypersecretory state. Gonadotrophs also exhibited significant increments in mean nuclear, cell, and cytoplasmic areas of 22, 45, and 51%, respectively; however, they were not accompanied by ultrastructural evidence of increased secretory function. There were no morphological changes in somatotrophs, lactotrophs, or thyrotrophs, nor were there any significant changes in the overall frequency of any one adenohypophyseal cell type in comparison with control. The structural integrity of all adenohypophyseal secretory and vascular elements was preserved after spaceflight, as there was neither evidence of necrosis nor other forms of cellular injury in spaceflown specimens. Capillaries were patent, and neither endothelial damage nor thrombosis was noted. These data suggest that spaceflight is accompanied by a selective morphological response in the anterior pituitary, one characterized by hypertrophy of both corticotrophs and gonadotrophs and by enhanced endocrine activity of the former.

Are events after endotoxemia related to circulating phospholipase A2?

OBJECTIVE

The authors sought to determine whether the signs and symptoms of endotoxemia were related to the endotoxin-stimulated increase in circulating phospholipase A2 (PLA2) activity.

BACKGROUND

Because hypotension and pulmonary injury have been associated with elevated PLA2 activity in septic shock and PLA2 levels are reduced with the administration of glucocorticoids, the PLA2 response to endotoxin was investigated in volunteers pretreated with and without hydrocortisone.

METHODS

Carefully screened human subjects were studied under four conditions: (1) saline, (2) hydrocortisone, (3) endotoxin, and (4) hydrocortisone administration before endotoxin exposure. Pulse rate, blood pressure, temperature, and symptoms of endotoxemia were serially measured. Plasma for tumor necrosis factor concentrations and PLA2 activity was obtained.

RESULTS

After lipopolysaccharide, pulse rate and tumor necrosis factor concentrations rose at 1 to 2 hours; temperature increased maximally at 4 hours. PLA2 activity reached peak levels at 24 hours. With hydrocortisone pretreatment, a 50% reduction in the concentrations of tumor necrosis factor and PLA2 occurred. Significant correlations between other variables and PLA2 activity were not observed. The enzyme identified by monoclonal antibody was the secreted nonpancreatic PLA2 (SNP-PLA2).

CONCLUSIONS

The results of this study suggest that elevations in circulating SNP-PLA2 activity and systemic events associated with intravenous endotoxin administration are unrelated.

Elaboration of interleukin 1-receptor antagonist is not attenuated by glucocorticoids after endotoxemia

The body's response to infection/inflammation is initiated by the elaboration of cytokines, such as tumor necrosis factor, interleukin 1-beta (IL-1-beta), IL-6, and IL-8. Cytokines, in turn, stimulate the pituitary-adrenal axis, and it has been suggested that the corticosteroids elaborated serve as negative feedback signals to diminish inflammatory events. To test this hypothesis, we administered hydrocortisone shortly before endotoxin administration to normal volunteers. Steroids greatly reduced the clinical response to endotoxin and attenuated the appearance of tumor necrosis factor, IL-6, and IL-8 in the circulation. In contrast, IL-1-receptor antagonist, a competitive antagonist of the IL-1 receptor, was unaffected by steroid administration. These data suggest that IL-1-receptor antagonist may act in synergism with corticosteroids to reduce inflammation. Elevation of concentrations of these two factors, corticosteroids and IL-1-receptor antagonist, in plasma appears to be the mechanism used by the body to overcome the effects of inflammatory cytokines.

The effect of nifedipine alone or combined with cytotoxic chemotherapy on the mouse NC carcinoma in-vitro and in-vivo

Effects of the calcium antagonist nifedipine on the response of the murine NC carcinoma has been examined alone and together with cytotoxic chemotherapy in-vitro and in-vivo. The cytotoxic drug combination of methotrexate and melphalan, or nifedipine alone (0.2-25 micrograms mL-1), caused a concentration-related reduction of NC cell growth in culture. At the lower concentrations, combination to the cytotoxic drugs with nifedipine resulted in an addition of the separate drug effects, but with drug concentrations that on their own approached maximal effectiveness the combined response was less than additive. NC tumours were excised from mice 14 days after inoculation s.c. with NC cells, weighed, and extracted for prostanoids. Mouse survival was determined up to day 121, and cancer spread was recorded postmortem. Nifedipine 1, 5 or 10 mg kg-1 had little or no effect on the tumour weight, tumour prostanoid content, metastasis to the lymph nodes or lungs, or on the increase of mouse longevity by the cytotoxic drugs.