Behavior In Clinical Settings Research Articles

How We Talk About "Perpetration of Intimate Partner Violence" Matters.

Many partners and children who are affected by intimate partner violence (IPV) are unable to leave abusive situations that put their health and safety at risk. Family physicians provide care for people who perpetrate IPV and are in a role that may allow them to recognize and counsel patients who are using violence. Appropriate referrals can potentially help these patients access effective interventions such as certified battering intervention programs in a manner that prevents violence for their families. The language used by physicians can facilitate or impede disclosures among patients perpetrating IPV who may be open or willing to discuss their use of violence. Talking about their behavior in ways that patients perceive as derogatory or confrontational may alienate people who use violence from initiating or engaging in meaningful discussions about their abusive behaviors in clinical settings and getting the help they need to stop their violence. To enable patients to safely talk about their own perpetration of violence, physicians need to develop appropriate language and a nuanced, evidence-based approach to broaching and discussing this issue with patients. As with other patient populations, being labelled may not accurately describe their identity, behavior, nor experiences, and result in them avoiding care. In keeping with trauma-informed approaches, we provide possible examples of respectful nonjudgmental language and nonthreatening clinically appropriate questions for people who use violence. Additional research is needed to identify how best to discuss perpetration of IPV with patients to help initiate change in their behavior while maintaining victim safety.

Emotions and feelings evoked in nursing students exposed to bullying behaviors in clinical settings.

Though not fully integrated into the profession, student nurses have been exposed to and experienced bullying behaviors with limited skills to mitigate the effects of the behaviors. This qualitative study analyzed the emotions evoked due to exposure to bullying behaviors. Desired to address the question: "How do student nurses feel when they are the recipient of bullying-type behaviors?" DESIGN: Qualitative descriptive design. SETTING: A nursing college at an urban university in the Midwestern United States; PARTICIPANTS: Matriculated students enrolled in a pre-licensure nursing program. METHODS: As part of a larger mixed informed pilot study, each participant was assigned to either the control or intervention group. Participants in the intervention group received an educational intervention focused on bullying two weeks prior to a scheduled clinical simulation. Participants in both groups each completed an individual clinical simulation during which they were exposed to bullying-type behaviors meant to replicate behaviors they may encounter in actual clinical settings. All participants were informed of their right to disenroll from the study at any point. For the health and safety of participants, individuals were provided with safeguards during the study as well as upon conclusion of their participation. Immediately following the simulation, participants completed an individual debrief interview during which they were asked to describe how the simulation made them feel. Responses were audio recorded and transcribed verbatim. Data were analyzed using a descriptive qualitative to generate thematic results. The three major themes developed included Past Bullying-like Behavior, Feelings Experienced during Simulation, and Perceptions of the Simulation. Participants reported experiencing negative emotions due to the bullying behavior exposure despite receiving an educational intervention. Harmful emotions, such as sadness, led participants to question their ability to perform simple tasks. Student nurses possess the skills and knowledge to perform routine tasks; however, when bullying behaviors target nursing students, the negative behaviors have the potential to adversely affect the whole student. Further research is warranted to identify programs to aid students in overcoming the negative bullying behaviors in the clinical setting.

Assumptions About Competency-Based Medical Education and the State of the Underlying Evidence: A Critical Narrative Review.

As educators have implemented competency-based medical education (CBME) as a framework for training and assessment, they have made decisions based on available evidence and on the medical education community's assumptions about CBME. This critical narrative review aimed to collect, synthesize, and judge the existing evidence underpinning assumptions the community has made about CBME. The authors searched Ovid MEDLINE to identify empirical studies published January 2000 to February 2019 reporting on competence, competency, and CBME. The knowledge synthesis focused on "core" assumptions about CBME, selected via a survey of stakeholders who judged 31 previously identified assumptions. The authors judged, independently and in pairs, whether evidence from included studies supported, did not support, or was mixed related to each of the core assumptions. Assumptions were also analyzed to categorize their shared or contrasting purposes and foci. From 8,086 unique articles, the authors reviewed 709 full-text articles and included 189 studies reporting evidence related to 15 core assumptions. Most studies (80%; n = 152) used a quantitative design. Many focused on procedural skills (48%; n = 90) and assessed behavior in clinical settings (37%; n = 69). On aggregate, the studies produced a mixed evidence base, reporting 362 data points related to the core assumptions (169 supportive, 138 not supportive, and 55 mixed). The 31 assumptions were organized into 3 categories: aspirations, conceptualizations, and assessment practices. The reviewed evidence base is significant but mixed, with limited diversity in research designs and the types of competencies studied. This review pinpoints tensions to resolve (where evidence is mixed) and research questions to ask (where evidence is absent). The findings will help the community make explicit its assumptions about CBME, consider the value of those assumptions, and generate timely research questions to produce evidence about how and why CBME functions (or not).

Retraction to: M111. QUANTITATIVE ASSESSMENT OF MANIA AND PSYCHOSIS DURING HOSPITALIZATION USING AUTOMATED ANALYSIS OF FACE, VOICE, AND LANGUAGE

Abstract Background A major challenge for reliable and effective mental health care is the lack of objective markers of illness. Computational approaches to measuring naturalistic behavior in clinical settings could therefore provide an objective backstop for mental health assessment and disease monitoring. This study aimed to train machine-learning (ML) classifiers to estimate conventional clinical measures of severe mental illness using quantitative metrics derived from computational analysis of facial and vocal behaviors. Methods Individuals hospitalized for any active psychotic condition were recruited to participate in up to ten recorded study visits, comprised of three segments. Each visit was captured using two synchronized HD webcams and cardioid microphones, to obtain high quality audiovisual (AV) data from both patient and interviewer. We performed automated facial action coding, vocal analysis, and speech transcription using publicly available software (e.g., openFace, openSmile, TranscribeMe). Results A total of 34 participants, participated in 66 sessions between 2015 and 2018, resulting in over 40 hours of AV recordings. In our visual and vocal analysis, we found that several features derived from face, voice, and use of language (i.e. eyebrow furrowing, eye widening, smile variability, characteristics of vowels) were both robustly measured using our approach, and allowed us to accurately estimate multiple symptom domains (i.e. mania, depression, psychosis) with (R= >0.7, p = <0.05). In our linguistic analysis, we found that abundance of power words (i.e. superiority, important) and lack of contextual language (i.e. yesterday, nearby) are highly indicative of positive psychotic symptoms with (R= +0.417, p = 0.002) and (R= -0.302, p = 0.028) respectively. Discussion Automated analysis of face, voice, and speech provides a number of robust behavioral markers sensitive enough to detect changes in psychopathology within individuals over time. Therefore, naturalistic, quantitative assessments can yield objective markers of mood and cognition that can be used to optimize both access and quality of treatments for a wide range of psychiatric conditions.

Marginalization of Professionalism in Clinical Settings; A qualitative study at Tehran University of Medical Sciences

Background: Management-level challenges are among the factors that undermine the individuals' adherence to professional behavior in clinical settings. This study investigated glitches of the management system in clinical settings from the perspective of staff, faculty members, and medical students/residents in hospitals affiliated to Tehran University of Medical Sciences. Methods: This qualitative study was conducted in 2 parts by exploring the viewpoints of personnel and physicians. In this regard, 8 focus group discussions were performed with 85 faculty members, clinical residents, and interns. Furthermore, 15 focus group discussions were held with 165 staffs. Available sampling method was applied to collect the participants and the data were analyzed using the content analysis method. Results: A total of 22 focus-group discussions were conducted with 250 participants; Participants' age ranged from 24 to 65 years. Participants' education levels varied from diploma to postgraduate for the staff and from medical student to sub-specialist for the physicians. Finally, management-level barriers, which undermine the staffs' ability to adhere to professional behavior in clinical settings were explained with 315 codes, 12 subcategories, and 2 main categories of "macro management issues " and "hospital management issues". Conclusion: Managers are required to consider providing a proper context for enforcing the professional behavior law, selecting middle managers based on their empowerment in performing the professional behaviors, prioritizing the professional behavior in policy making, and promoting the professional behavior in an administrative system consistent with the health system. In selecting the hospital managers, authorities are recommended to consider the managers' professional behavior and power in implementing the professionalism leadership. Moreover, the possibility of conducting professional behavior should be considered in making the policies.

Modeling HIV Pre-Exposure Prophylaxis.

Pre-exposure prophylaxis (PrEP) has emerged as a promising strategy for preventing the transmission of HIV. Although only one formulation is currently approved for PrEP, research into both new compounds and new delivery systems for PrEP regimens offer intriguing challenges from the perspective of pharmacokinetic and pharmacodynamic modeling. This review aims to provide an overview the current modeling landscape for HIV PrEP, focused on PK/PD and QSP models relating to antiretroviral agents. Both current PrEP treatments and new compounds that show promise as PrEP agents are highlighted, as well as models of uncommon administration routes, predictions based on models of mechanism of action and viral dynamics, and issues related to adherence to therapy. The spread of human immunodeficiency virus (HIV) remains one of the foremost global health concerns. In the absence of a vaccine, other prophylactic strategies have been developed to prevent HIV transmission. One approach, known as pre-exposure prophylaxis (PrEP), allows HIV-negative individuals who are at high risk of exposure to the virus, be it through an HIV-positive sexual partner or through the shared use of drug injection equipment, to substantially reduce the risk of developing an HIV infection. PrEP is a relatively recent approach to combating the HIV epidemic, with the only currently approved treatment being Truvada, a daily oral antiretroviral (ARV) therapy initially indicated in the treatment of active HIV-1 infections, but approved for HIV PrEP in 2012. Although PrEP therapy has consistently demonstrated high efficacy in preventing HIV infection, this efficacy is dependent on patient adherence to the prescribed treatment regimen. This can present a significant problem in low- and middle-income countries, which may lack the infrastructure to provide sufficient access to PrEP medication to maintain daily dosing regimens. Furthermore, while the conventional approach has generally been to advocate for continuous administration akin to regimens used for viral suppression in infected patients, there has been some discussion of whether a better treatment paradigm might be to push for PrEP therapy primarily during those known periods of heightened exposure risk, while relying on post-exposure prophylaxis regimens to prevent infection after unanticipated exposures during low-risk periods. These considerations have led to a push for the development of long-duration and on-demand PrEP formulations, including subdermal and subcutaneous implants, slow-release intramuscular depot injections, vaginal and rectal antimicrobial gels, and intravaginal rings and dissolving films. PrEP therapy is a quickly evolving field, with a variety of antiretroviral compounds and formulations under investigation. This review aims to report on notable drugs and formulations from a pharmacokinetic/pharmacodynamic (PK/PD) modeling perspective. Given the nature of PrEP as a preventive therapy designed for long-term use, clinical trials for PrEP therapies can last for months or even years, particularly in the case of long-duration formulations. Furthermore, in contrast to antiretroviral trials in infected patients, pharmacodynamic endpoints in PrEP therapies are difficult to quantify, as the primary endpoint for efficacy is generally the rate of seroconversion. Computational modeling approaches offer flexible and powerful tools to provide insight into drug behavior in clinical settings, and can ultimately reduce the time, expense, and patient burden incurred in the development of PrEP therapies.

Self-Harm Inventory (SHI) Versi Indonesia Sebagai Instrumen Deteksi Dini Perilaku Self-Harm

Background: Self-harming behavior (SHB) is an iceberg phenomenon commonly occurred in both normal population and patients with mental illness. This behavior showed an increase in trend and may develop into suicidal behavior if not treated properly. Therefore an effort in screening and prevention of self-harm is necessary to prevent early deaths caused by suicide. Currently Indonesian version of self-harm screening instrument has not been developed yet.Purpose: Conducting validity and reliability test of Indonesian version of self-harm questionnaire.Method: This research was a descriptive analytic study with cross-sectional design. We recruited 110 psychiatric outpatients from Bantul Hospital Yogyakarta (n=110). SHB was measured using Indonesian version of Self Harm Inventory (SHI). Internal validation was tested using Aiken's Validity Index (AVI) and Pearson Product Moment Correlation (PPMC). Reliability was tested using Cronbach Alpha (CA). Statistical significance was defined as p<0,05.Result: The respondents consisted of 57 men (51.8%) and 53 women (48.2%). Twenty four respondents had done more than 5 items of SHB. AVI value ranged from 0.83 to 0.97 which considered good. PPMC obtained 21 valid items with correlation coefficient >0.25 (p <0.05). Item number 22 was excluded because coefficient value was <0.25. Rresult of Keizer Meyers Oklin was 0,686 and Barlett Test of Spherecity 0,000 (p <0,05). CA was 0.831 which means very good.Conclusion: Indonesian version of Self-Harm Inventory is a valid and reliable screening tool against self-harm behavior in clinical setting.

Clinical Utility of Multisensory Environments for People With Intellectual and Developmental Disabilities: A Scoping Review.

Adults with intellectual and developmental disabilities (IDD) are twice as likely as their peers without disabilities to have had a physical exam in the past year; however, as a result of challenging behavior during office visits, they are significantly less likely to have received recommended health screenings. Challenging behaviors in clinical settings have been identified as a barrier to providing adequate care for this population. This scoping review examined the within-session effects of multisensory environments (MSEs) on people with IDD to determine the clinical utility of MSEs for this population. Studies published between January 1, 2000, and August 1, 2018, were identified using Summon and Google Scholar. Studies were included in the review if they systematically collected and reported data on within-session effects of an MSE intervention on people with IDD. Thirteen studies met criteria for this review: 4 with Level I evidence, 2 with Level II evidence, 3 with Level III evidence, and 4 with Level IV evidence. Studies examined the effects of MSEs on maladaptive behaviors, positive behaviors, distress and discomfort, activity and alertness states, and cost of care for people with IDD. Preliminary support was found for the use of MSEs in clinical settings to reduce anxiety and challenging behaviors in patients with IDD during clinical care. Further research is needed to determine the efficacy of MSEs for producing the effects described in this review. The findings support the potential of MSEs as a tool that occupational therapy practitioners can use to support their clients with IDD who have sensory sensitivities in clinical settings. This article also highlights a multidisciplinary approach whereby medical providers and occupational therapy practitioners could work together in nontraditional ways to support this population.

Nurse Students versus Faculty Staff Assistants Perception Regarding to Teaching Behaviors in Clinical Setting

Background: Effective teaching behaviors are identified as important factors in nurse students and faculty staff assistants' relationship. Aim: Identify nursing students' perception regarding teaching behaviors of their faculty staff assistants in clinical setting, determine faculty staff assistants' perception regarding teaching behaviors in clinical setting, compare among perceptions of nursing students and faculty staff assistants regarding teaching behaviors in clinical setting. Design: Descriptive, cross-sectional, comparative research design was used. Setting: The study was conducted at Faculty of Nursing Ain-Shams University. Subjects: 355 nurse student and 55 faculty staff assistant. Tools: Data were collected using two tools; Nurse Students’ perception regarding teaching behaviors questionnaire sheet and faculty staff assistants’ perception regarding teaching behaviors questionnaire sheet. Results: Regarding effective teaching characteristics, nurse students perceived evaluation procedures as the most important dimension while personality traits are the lowest dimension. Regarding caring behaviors, nurse students perceived instills confidence as the highest demonstrated caring behaviors while control versus flexibility as the lowest demonstrated caring behaviors. Regarding effective teaching characteristics, faculty staff assistants perceived evaluation procedures as the most important dimension while personality traits are the lowest dimension. Regarding caring behaviors, faculty staff assistants perceived instills confidence as the highest demonstrated caring behaviors while supportive learning climate as the lowest demonstrated caring behaviors. Data revealed that nurse students and faculty staff assistants had a positive perception of teaching behaviors in clinical setting for all components. Conclusion: Although there is a positive perception from both study subjects regarding teaching behaviors in clinical setting, there is a highly statistically significant difference between their perceptions. Recommendations: Providing support and encouragement for nurse students in the clinical setting. Continuous support and reward from the faculty for effective performance of faculty staff assistants.

Classifying and Identifying Motor Learning Behaviors in Voice-Therapy Clinician-Client Interactions: A Proposed Motor Learning Classification Framework

We studied whether concepts in motor skill learning could be operationalized to identify clinical interactions and behaviors in a voice therapy setting. Our aim was to test the feasibility of measuring these behaviors in the prepractice phase so that we could eventually evaluate and apply principles of motor learning and skill acquisition to Speech-Language Pathology. Four general categories of behaviors that have been identified in the client-clinician prepractice phase were identified: motivation, modeling, verbal information, and feedback. All variables were extracted from a proposed Motor Learning Classification Framework. Nine participants categorized clinician behaviors in three voice therapy training videos into specific, described, prepractice variables. Good intrarater reliability was shown across viewings. Inter-rater reliability was high for modeling and verbal information, but raters were not consistent when identifying behaviors classified as motivation and feedback. Raters responded positively to the classification exercise and the categories encompassed nearly all noted behaviors. Behaviors described within the motor learning literature can be identified in the initial stages of voice therapy, providing evidence that motor learning concepts can be used to identify interactions and behaviors in clinical settings. Disagreement in classification among raters was influenced by differences in implicit and explicit interpretations of verbal information. This suggests that greater clarity in specific concepts is needed to support teaching of motor learning principles and implementation of these principles in clinical practice for the treatment of speech-language pathology.

Educational system defects and observing professional behavior: A qualitative study.

BACKGROUND:Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated.MATERIALS AND METHODS:This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data.RESULTS:One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include “educators’ imperfections,” “inadequate initial training,” “lack of attention to continuous professional education,” and “lack of passion for professionalism education.”CONCLUSION:Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others.

Pediatric Adapted Liking Survey: A Novel, Feasible and Reliable Dietary Screening in Clinical Practice

Purpose: Rapid yet useful methods are needed to screen for dietary behaviors in clinical settings. We tested the feasibility and reliability of a pediatric adapted liking survey (PALS) to screen for dietary behaviors and suggest tailored caries and obesity prevention messages. Methods: In an observational study, children admitted to a pediatric emergency department (PED) for nonurgent care were approached to complete the PALS (33 foods, 4 nonfoods including brushing teeth). Measured height/weight were used for body mass index (BMI) percentile determination. Feasibility was assessed by response rate and PALS completion time. Reliability was assessed by internal consistency of food groups and test-retest reliability for PED-home reported PALS. Results: PALS was completed by 144 children (96% of approached) – 54% male (average age = 11 ± 3 years) with diversity in family income (43% publicly insured), race/ethnicity (15% African American, 33% Hispanic, 44% Caucasian) and adiposity (3% underweight, 50% normal, 31% overweight, 17% obese, 8% extremely obese). The average completion time was 3: 52 min, and conceptual food groups had reasonable internal reliability. From 57% (n = 82) with PED-home completion, PALS had a good/excellent test-retest reliability. Relative preferences for sweets versus brushing teeth identified unique groups of children for tailored prevention messages (high sweet/brushing preference, sweets > brushing, brushing > sweets). Females with higher adiposity reported significantly greater preference for sweet/high-fat foods, independently of demographic variables; the relationship was nonsignificant in males and with the other food groups. Conclusion: The PALS appears to be a fast, feasible and reliable dietary screener in a clinical setting to assist in forming tailored diet-related messages for dental caries and obesity prevention.

Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System.

BackgroundSmoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients’ behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed.ObjectiveThe objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey).MethodsPatients and their family members or friends were recruited from gastrointestinal medical–surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey.ResultsOf 782 patient participants, 29.6% were addicted to nicotine, 13.3% were hazardous, harmful, or dependent alcohol drinkers, and 1.5% were dependent on chewing betel quid. Of 425 family or friend participants, 19.8% were addicted to nicotine, 5.6% were hazardous, harmful, or dependent alcohol drinkers, and 0.9% were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes.ConclusionsThe Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6%-12.3% of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan.

Surveying Dentists' Perceptions of Caregiver Refusal of Topical Fluoride.

The objective of this study was to assess dentists' perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ2 tests between dentists' location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors. Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.

Stimuli previously associated with reinforcement mitigate resurgence

Resurgence refers to the recurrence of an extinguished target behavior following subsequent suspension of alternative reinforcement. Delivery of reinforcers during extinction of alternative behavior has been shown to mitigate resurgence. The present experiment aimed to determine whether delivering stimuli associated with reinforcers during resurgence testing similarly mitigates resurgence. Three groups of rats pressed target levers for food according to variable-interval 15-s schedules during Phase 1. In Phase 2, lever pressing was extinguished, and an alternative nose-poke response produced alternative reinforcement according to a variable-interval 15-s schedule. Food reinforcement was always associated with illumination of the food aperture and an audible click from the pellet dispenser during Phases 1 and 2. Phase 3 treatments differed between groups. For one group, nose poking continued to produce food and food-correlated stimuli. Both of these consequences were suspended for a second group. Finally, nose poking produced food-correlated stimuli but not food for a third group. Target-lever pressing resurged in the group that received no consequences and in the group that received only food-correlated stimuli for nose poking. Resurgence, however, was smaller for the group that received food-correlated stimuli than for the group that received no consequences for nose poking. Target-lever pressing did not increase between phases in the group that continued to receive food and associated stimuli. Thus, delivery of stimuli associated with food reinforcement after suspension of food reduced but did not eliminate resurgence of extinguished lever pressing. These findings contribute to potential methodologies for preventing relapse of extinguished problem behavior in clinical settings.

Toward Expert Systems in Mental Health Assessment: A Computational Approach to the Face and Voice in Dyadic Patient-Doctor Interactions

Background: Computational approaches to measure naturalistic behavior in clinical settings could provide an objective backstop for mental health assessment and disease monitoring, both of which are costly and unreliable using traditional methods. Objective: The objective of this pilot study was to determine which parts of the mental status exam could be reliably predicted by a combination of facial and vocal features extracted from a recorded interview using a combination of computer-assisted methods, in order to assess feasibility of our approach to quantify behavior for a longitudinal study of patients receiving psychiatric treatment. Methods: A total of 18 patients carrying diagnoses of schizophrenia, bipolar disorder, and related conditions were recruited from an inpatient psychiatric unit and participated in a total of 24 semi-structured interviews lasting 5-15 minutes (modeled after clinical rounds). Synchronized audio and video data were acquired from both patient and doctor during each encounter using 1080p webcams focused on the face and upper torso and cardioid headset microphones. Standardized psychiatric symptom scales was obtained after each recorded interview. Behavioral features, including facial action units (AUs), gaze, and speech characteristics (eg, prosody, pitch, tone, texture) were computed automatically using in-house and publicly available software. To predict clinical scales we trained a linear kernel support vector regressor (SVR) using features from both the entire session (ie, global mean) and each experimental epoch (eg, means during time spent alone and each individual question), leading to 15 predictors for each clinical scale item and scale totals. We used leave-one-out validation on the training data (maximizing the Pearson correlation coefficient) to determine the C parameter for the SVR models; for testing, we used leave-one-subject-out cross-validation (ie, leaving 17 participants for training/validation in each fold). Results: Providing evidence of our approach's ability to capture and quantify relevant signal that confirms or verifies clearly visible psychopathology, we found that parameters such as brow furrowing (AU4, R=0.744) and eye widening (AU5, R=–0.601) were correlated with depression measures on the BPRS. In many cases, these effects were specific to the question or experimental epoch. For instance, unusual thought content was most evident in increased frequency of brow flashes (AU2, R=0.752) and greater smile variability (R=0.656) that occurred while participants were alone in the room. Individuals with higher ratings of delusions also showed increased brow flashes in response to a question about their self confidence (R=0.739). Many relationships showed a “dose effect” with midrange scores corresponding with moderate psychopathology. Conclusions: Our experiments show that automatically detected facial action units and speech properties can be used to predict and quantify a number of psychiatric symptoms from multiple domains of psychopathology, including both mood and psychosis. We demonstrate the importance of analyzing behaviors in the appropriate context (ie, while participants are alone or prompted with a specific question) in order to optimally extract clinically relevant information from objective indices of behavior. Thus, quantitative assessment of behavior in naturalistic settings is both feasible and informative as an adjunct to traditional methods of mental status assessment. [iproc 2016;2(1):e44]

Seeing Students Squirm: Nursing Students' Experiences of Bullying Behaviors During Clinical Rotations.

Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However, they may not be adequately prepared to recognize and handle bullying behavior when it occurs. This study's purpose was to gain a greater understanding of nursing students' experiences of bullying behaviors in the clinical setting. Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Four categories were identified: Bullying Behaviors, Rationale for Bullying, Response to Bullying, and Recommendations to Address Bullying. Each category and its corresponding themes are presented. Interventions for nurse educators to address the bullying of nursing students in clinical settings are presented. [J Nurs Educ. 2016;55(9):505-513.].

The Reliability and Validity of the Turkish Version of the Beck Scale for Suicide Ideation (Turkish BSSI)

Objective: Although several self-report tools measuring suicidal ideation are used in Turkey, the validity and reliability of the Beck Scale for Suicide Ideation (BSSI), an important tool administered clinically, has not yet been examined. We hope that establishing the validity and reliability of the BSSI can improve the detection of suicidal ideation.Methods: The sample for this study consisted of 120 individuals who participated voluntarily. One hundred of the 120 participants were administered related relevant instruments, the Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI], Beck Hopelessness Scale [BHS], and Suicidal Ideation Scale [SIS], to determine concurrent validity. Separately, two clinicians interviewed twenty different participants to assess inter-rater reliability. To assess internal consistency, Cronbach's alpha coefficients were computed. In addition, a principal component analysis with a Varimax rotation was performed to examine the test's factor structure.Results: Cronbach's alpha value was 0.84 and every item was positively correlated to the total scores on the BSSI. Inter-rater correlation was very strong and significant (r=0.94, p<0.01). Correlation coefficients for similar measures showed significant results [i.e., SIS (r=0.40) and BHS (r=0.58)]. There was a mild correlation between the BSSI and BDI (r=0.40) but no correlations were found with the BAI.Conclusion: The BSSI is a valid and reliable measure that has good potential to detect suicidal ideation and behavior in clinical settings when compared to other self-rating measures. These results suggest that measuring suicidal ideation and behaviors using the BSSI across different diagnoses may provide valuable information for clinical research.

Nonverbal communication of patients with borderline personality disorder during clinical interviews: a double-blind placebo-controlled study using intranasal oxytocin.

Interpersonal dysfunction is central to borderline personality disorder (BPD). Recent research has focused on the role of oxytocin (OT) in BPD, with mixed results regarding the processing of social information. Fifteen BPD patients and 15 controls participated in two clinical interviews, one under OT and one under placebo, which were randomly conducted 1 week apart in a double-blind fashion. Nonverbal behavior was evaluated using the Ethological Coding System for Interviews. Childhood trauma was examined using the Childhood Trauma Questionnaire. The patients with BPD showed less affiliative behavior than the controls. Notably, the controls, but not the patients, displayed more affiliation when OT was given at T1 compared with OT given at T2. OT was also associated with less flight behavior in both groups when given at T1 compared with placebo. OT responses were unrelated to the patients' history of childhood trauma. The present findings are informative with respect to patients' nonverbal prosocial behavior in clinical settings.

The clinical utility of the MMPI-2-RF Suicidal/Death Ideation Scale.

Suicide is a major public health concern, with over 100 individuals dying by suicide per day in the United States alone. Therefore, suicide risk assessment is an essential aspect of mental health care. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008-2011; Tellegen & Ben-Porath, 2008) has a Suicidal/Death Ideation (SUI) scale consisting of 5 items that describe recent suicidal ideation or behaviors. Although this scale has clear face validity, few studies have examined the clinical utility of this scale. The purpose of the current study was to examine associations between the SUI scale and other established measures of suicidal ideation and behavior, including the Depressive Symptom Inventory Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997), Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991; Beck, Steer, & Ranieri, 1988), self-report of lifetime suicide attempts, and clinician ratings of suicide risk. Participants were 998 therapy- and assessment-seeking outpatients. Analyses indicated that the SUI scale was positively associated with other self-reported measures of suicidal ideation and behavior. Significant differences in SUI scale scores also emerged among the clinician rating categories of suicide risk. The SUI scale was able to predict previous suicide attempts over and above age, gender, and other MMPI-2-RF scales related to depression. Finally, relative risk ratios for suicide attempts indicate increased risk of suicidality, with higher T scores on the SUI scale. Overall, findings suggest that the MMPI-2-RF SUI scale may be a useful tool for identifying individuals at risk for suicidal ideation and behavior in clinical settings.