Standardized Scripts Research Articles

Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect.

BackgroundEvidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service.ObjectiveAn embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention.MethodsQualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention.ResultsInterviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients’ lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients’ lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients’ motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address their specific risk factors. Implementation was not optimal in the early part of the CVD risk trial owing to technical difficulties and the need to adapt the intervention for use in practice. For both conditions, enthusiastic and motivated staff offering continuity of intervention delivery tailored to individual patients’ needs were identified as important for patient engagement with telehealth; this was not delivered consistently, particularly in the early stages of the trials. Finally, there was a lack of active engagement from primary care.ConclusionsThe conceptual model was supported and could be used to develop further telehealth interventions for chronic conditions. It may be possible to increase the effectiveness of this, and similar interventions, by attending to the human as well as the technical aspects of telehealth: offering it to patients actively wanting the intervention, ensuring continuity of delivery by enthusiastic and motivated staff, and encouraging active engagement from primary care staff.

Decision-Making Support Using a Standardized Script and Visual Decision Aid to Reduce Door-to-Needle Time in Stroke.

Decision-Making Support Using a Standardized Script and Visual Decision Aid to Reduce Door-to-Needle Time in Stroke.

Discrimination due to Ethnicity and Gender: How susceptible are video‐based job interviews?

Fairness toward job applicants differing in gender and ethnicity in a video‐based assessment interview was explored. For this purpose, 103 female and 105 male participants, including 38 who declared to have a migration background of their own, rated a behavior anchored rating scale after having watched the videotaped answers of a potential applicant. The domains assessed were communication skills and the capacity to work in a team. The videos of the applicants were generated with the help of standardized scripts and semi‐professional actors. Eight videos were made operationalizing a two (Turkish migration background–native German) by two (male–female) by two (more positive applicant answers–moderately good applicant answers) experimental design. A multivariate analysis of variance (MANOVA) revealed a small to moderate main effect only for migration background of the applicants. Subsequent ANOVAs found that in three of the four dependent variables this effect reached significance of p < .05. The effects were robust against consideration of the raters’ agreeableness and the raters’ own migration background as covariates. Applicants with Turkish background scored higher in the evaluation of their videotaped answers than German native applicants did. Social Identity Theory (Taijfel & Turner, ) provides an approach to integrate these findings.

Self-Reported Barriers to Healthcare Access for Rheumatoid Arthritis Patients in Rural and Northern Saskatchewan: A Mixed Methods Study.

The aim of the present study was to identify potential barriers for access to medical and allied health services from the perspective of rural and Northern Saskatchewan rheumatoid arthritis (RA) patients. A total of 100 adults with established RA, residing in rural and Northern Saskatchewan, were recruited from two rheumatology practices. Structured interviews with standardized scripts solicited patient perspectives on appointment waiting times, travel required to access medical services and satisfaction with healthcare provision. Thematic analysis was employed for qualitative data. Patients-reported concerns regarding waiting time for their first rheumatology appointment. There was reduced access to allied health professionals, with only 53% of the participants having seen a physiotherapist (PT), and only 26% an occupational therapist (OT). Patients had similar driving distances to their family physician, PT, pharmacy and laboratory services but commuted significantly further for rheumatologist and OT services. There were high levels of satisfaction with their rheumatologist and family physician appointments (8.96 and 8.04 on a ten-point scale). Patients with longer travel times had higher satisfaction with their health care appointments: Patients who travelled one, two and more than two hours had satisfaction scores of 0.93, 0.88 and 1.32 points higher on a ten-point scale (p < 0.03). Access to medical services is a concern for this population. Patients were dissatisfied with the waiting time for their first specialist appointment and with decreased access to allied health professionals. Patients travelling longer distances were more satisfied with their health care provider's care, suggesting that good patient-care giver relationships helped to ameliorate the difficulties of travelling to their appointments. Copyright © 2016 John Wiley & Sons, Ltd.

Multiple temporalities of knowing in academic research

Based on ethnographic research at five Czech universities from 2011 to 2013, this article explores how academics make sense of and claims to three qualitatively distinct temporal regimes in which their activities as knowledge producers are inscribed: disciplinary time, career time and project time. This conceptual framework, a modification of Shinn’s distinction between disciplinary, transitory and transversal knowledge-production regimes, seeks to replace images of competition and succession between regimes with images of their recombination and intersection. It enables an interpretation of the empirical findings beyond the indigenous complaint that excessive speed is compromising the quality of knowledge production. The relationship between projects, careers and disciplines emerges from the study as problematic rather than synergistic. In this respect the paper does not contradict the claim by critical theorists that we are witnessing the disintegration of what used to be a functional relationship between the multiple temporalities of academic knowledge production based on standardized career scripts, nor the related claim that this may reflect a deeper crisis of modernity as a predictive regime for the production of futures. It proposes, however, that transversal projects can still be mediators of ‘disciplinary respiration’ insofar as their timeframes are available for variable calibration commensurate with the increasingly heteronomous ways of knowing and knowledge routines that academic researchers practise.

O7. The Primary Care Osteoarthritis Consultation: Dissonance and Consonance

Background: OA is the commonest long-term condition in primary care. The NICE guidelines in the UK are clear that much can be done to improve patient outcomes but existing research suggests the guidelines are not widely implemented and general practitioners (GPs) and patients are pessimistic about OA treatment. The primary care consultation may be important in shaping and influencing this dichotomy. This study aimed to uncover what happens when patients with OA present to their GP, in order to identify possible areas for intervention to enhance patient care. Methods: With ethical approval, 15 GPs consented to have two half day surgeries video recorded. Patients aged 45 and over were approached prior to the consultation to consent to being video recorded. Consent was verified immediately after the consultation and 48 h later by phone. All videos were initially watched once, and consultations containing reference to OA selected. Patients and GPs were then invited to participate separately in post consultation individual interviews, during which the video recorded consultation was played back to them to stimulate recall. Analysis involved comparing and contrasting patient and GP interviews with the matched observed consultation findings, using thematic analysis. Results: 195 videos were collected, with a consent rate of 79.4%. 19 OA consultations were identified, the majority (15) of which were consultations where more than one symptom or problem was discussed. The over-arching theme emergent in the qualitative analysis was that of dissonance between the GP and patient and this was observed in three situations. First, dissonance occurred when patients’ and doctors’ agendas were not aligned; for example when patients were seeking information and/or reassurance and were given symptom management, or vice versa. Reassurance was described as important by GPs who were wary of provoking alarm in patients; this contributed to an avoidance of using the term OA. Secondly, dissonance resulted when doctor and patient agendas were aligned, but messages of reassurance (e.g. that OA is a normal part of ageing) failed to validate or lead to action on patients’ symptoms. Thirdly, GP’s use of standardized scripts in explanations and advice resulted in dissonance when patients perceived this as lacking relevance and meaning to their own individual and personal case. Conclusion: Eliciting the patient’s agenda is likely to be crucial in achieving consonance in the consultation; however patients often find it hard to articulate their agenda and the complexity of the consultation is a further practical barrier to identifying patient concerns. Future research could explore the usefulness of employing the term OA in primary care consultations with patients, consider patient-centred toolkits to help in identifying and communicating their agenda, and investigate whether improving concordance in consultations between GP and patient improves the quality of care.

The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial

The effect of positive vs. negative comments (praise vs. criticism) on trainees' subsequent cognitive and technical performance is unknown, but of potential importance. We performed a randomized trial of giving either praise or criticism during simulated normal vaginal deliveries (using a high-fidelity birthing simulator) to assess the differential effect of these types of comments on students' cognitive and technical performance, and perceived confidence after their learning experience. Medical and nursing students underwent stratified randomization to praise or criticism. Students (n=59) initially participated in a teaching demonstration and practiced normal spontaneous vaginal delivery using a birthing simulator. A baseline assessment of cognitive and technical skills, and of self-confidence, was followed by a second simulation during which positive or negative comments were given using standardized scripts. Cognitive performance, technical performance and confidence measures were then scored again. Cognitive and technical performance scores in the "praise" group improved significantly by 2.5 (P=0.007) and 1.8 (P=0.032), respectively, while those in the "criticism" group remained unchanged. The self-reported confidence scores did not show any significant change from baseline in either group. Praise strengthens students' cognitive and technical performances, while criticism does not.

“I'll See What I Can Do”: What Adolescents Experience When Requesting Emergency Contraception

To understand the experiences of adolescent females when they try to obtain emergency contraception (EC) from pharmacies. Female callers, posing as 17-year-old adolescents, used standardized scripts to telephone 943 pharmacies in five United States cities. Two investigators independently coded qualitative data from these calls. Codes were discussed and a thematic analysis was conducted. Investigator, expert, and informant triangulation were used to ensure data credibility. Four major themes emerged. First, ethical terms (personal or religious) were used to explain institutional pharmacy policies on EC availability. Second, there was confusion about the dispensing regulations regarding EC, given recent changes in United States policies. Third, pharmacy staff often introduced false barriers to EC access. In some cases, pharmacy staff used these barriers as justification for refusing to dispense EC; however, in other cases, pharmacy staff helped the adolescents overcome these false barriers. Finally, the degree of confidentiality in providing EC was unpredictable, with some pharmacies guaranteeing strict confidentiality and others explicitly telling adolescents, incorrectly, that their parents had to be informed. Adolescents requesting EC from pharmacies are often explained pharmacy policies in ethics-laden terms, and confidentiality is not always guaranteed. They are told of false barriers to EC access, and there is confusion concerning the evolving policies regarding EC dispensing. It is important for clinicians, pharmacy staff and others to be aware of these experiences as they work to help improve adolescents' access to EC.

Protocol for a collaborative meta-analysis of 5-HTTLPR, stress, and depression

BackgroundDebate is ongoing about what role, if any, variation in the serotonin transporter linked polymorphic region (5-HTTLPR) plays in depression. Some studies report an interaction between 5-HTTLPR variation and stressful life events affecting the risk for depression, others report a main effect of 5-HTTLPR variation on depression, while others find no evidence for either a main or interaction effect. Meta-analyses of multiple studies have also reached differing conclusions.Methods/DesignTo improve understanding of the combined roles of 5-HTTLPR variation and stress in the development of depression, we are conducting a meta-analysis of multiple independent datasets. This coordinated approach utilizes new analyses performed with centrally-developed, standardized scripts. This publication documents the protocol for this collaborative, consortium-based meta-analysis of 5-HTTLPR variation, stress, and depression.Study eligibility criteria: Our goal is to invite all datasets, published or unpublished, with 5-HTTLPR genotype and assessments of stress and depression for at least 300 subjects. This inclusive approach is to minimize potential impact from publication bias.Data sources: This project currently includes investigators from 35 independent groups, providing data on at least N = 33,761 participants.The analytic plan was determined prior to starting data analysis. Analyses of individual study datasets will be performed by the investigators who collected the data using centrally-developed standardized analysis scripts to ensure a consistent analytical approach across sites. The consortium as a group will review and interpret the meta-analysis results.DiscussionVariation in 5-HTTLPR is hypothesized to moderate the response to stress on depression. To test specific hypotheses about the role of 5-HTTLPR variation on depression, we will perform coordinated meta-analyses of de novo results obtained from all available data, using variables and analyses determined a priori. Primary analyses, based on the original 2003 report by Caspi and colleagues of a GxE interaction will be supplemented by secondary analyses to help interpret and clarify issues ranging from the mechanism of effect to heterogeneity among the contributing studies. Publication of this protocol serves to protect this project from biased reporting and to improve the ability of readers to interpret the results of this specific meta-analysis upon its completion.

Testing the use of standardized scripts for disclosing ‘hypothetical/mock’ amyloid PET scan results to nondemented cognitively impaired patients and their care partners

Testing the use of standardized scripts for disclosing ‘hypothetical/mock’ amyloid PET scan results to nondemented cognitively impaired patients and their care partners

Pharmacy Communication to Adolescents and Their Physicians Regarding Access to Emergency Contraception

Emergency contraception (EC) is an effective pregnancy prevention strategy. EC is available without a prescription to those aged 17 years or older. The objective of this study was to assess the accuracy of information provided to adolescents and their physicians when they telephone pharmacies to inquire about EC. By using standardized scripts, female callers telephoned 943 pharmacies in 5 US cities posing as 17-year-old adolescents or as physicians calling on behalf of their 17-year-old patients. McNemar tests were used to compare outcomes between adolescent and physician callers. Seven hundred fifty-nine pharmacies (80%) indicated to adolescent callers, and 766 (81%) to physician callers, that EC was available on the day of the call. However, 145 pharmacies (19%) incorrectly told the adolescent callers that it would be impossible to obtain EC under any circumstances, compared with 23 pharmacies (3%) for physician callers. Pharmacies conveyed the correct age to dispense EC without a prescription in 431 adolescent calls (57%) and 466 physician calls (61%). Compared with physician callers, adolescent callers were put on hold more often (54% vs 26%) and spoke to self-identified pharmacists less often (3% vs 12%, P < .0001). When EC was not available, 36% and 33% of pharmacies called by adolescents and physicians respectively offered no additional suggestions on how to obtain it. Most pharmacies report having EC in stock. However, misinformation regarding who can take EC, and at what age it is available without a prescription, is common. Such misinformation may create barriers to timely access.

687: The relationship of type of feedback to learning during simulation: a randomized clinical trial

s 687 – 838 687 The relationship of type of feedback to learning during simulation: a randomized clinical trial Sumit Saraf, Jyothshna Bayya, Howard Minkoff, Jaimie Glick, Nelli Fisher Maimonides Medical Center, OB Gyn, Brooklyn, NY, Maimonides Medical Center, Obstetrics and Gynecology, Brooklyn, NY, Maimonides Medical Center, Ob/Gyn, Brooklyn, NY, Albert Einstein College of Medicine/Montefiore Medical Center, Obstetrics & Gynecology and Women’s Health, Bronx, NY OBJECTIVE: To compare the effect of negative vs. positive feedback on students cognitive and technical performance, and confidence level during obstetrical simulation. STUDY DESIGN: Medical and nursing students without prior experience in performing normal vaginal delivery (NVD) were randomized to positive feedback (PF) or negative feedback (NF) groups. All students (N 59) participated in a teaching demonstration and practiced NVD using a simulator (Noelle 575, Gaumard Scientific). A baseline skills assessment in NVD was followed by a second intervention simulation, during which positive or negative feedback was provided using standardized scripts at predetermined stages of the simulation. Previously validated checklists assessing cognitive and technical performance as well as confidence measures were scored. Mean baseline and intervention scores were compared between groups. For each of the three measures (cognitive, technical, confidence) as dependent variable, a mixed linear model was constructed, with profession (medical, nursing), assessment (baseline, intervention), feedback arm (positive, negative) as factors. RESULTS: Considering both medical and nursing students, all participants in the PF arm demonstrated significant performance improvement after the intervention in all three assessment scores while participants in the NF arm registered a non-significant decline. Specifically, cognitive and technical performance scores, and the confidence scores in the PF group improved significantly with p values of 0.012, 0.026 and 0.036 respectively; while those of the NF group did not (p not statistically significant). CONCLUSION: A positive feedback environment strengthened students cognitive and technical performances and confidence while negative feedback worsened them. Further studies are needed to see if these differences persist over time, and whether they are replicable in a real world environment. 688 Comparison of perinatal outcomes in twins conceived by artificial reproductive techniques and spontaneous conception–a secondary analysis of ESPRiT study data Akila Anbazhagan, Alyson Hunter, Fionnuala Breathnach, Fionnuala McAuliffe, Mike Geary, Sean Daly, John Higgins, John Morrison, Gerry Burke, Shane Higgins, Pat Dicker, Fiona Manning, Steve Carroll, Fergal Malone Royal Jubilee Maternity Hospital, Obstetrics and Gynaecology, Belfast, United Kingdom, Royal College of Surgeons in Ireland, Obstetrics and Gynaecology, Dublin, Ireland, UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, National Maternity Hospital, Holles St, Dublin, Ireland, Rotunda Hospital, Obstetrics and Gynaecology, Dublin, Ireland, The Coombe Women and Infants University Hospital, UCD School of Medicine and Medical Science, UCD, Dublin, Ireland, Cork University Maternity Hospital, Obstetrics, Cork, Ireland, National University of Ireland, Obstetrics & Gynaecology, Galway, Ireland, Regional Maternity Hospital, Obstetrics and Gynaecology, Limerick, Ireland, Our Lady of Lourdes Hospital, Obstetrics and Gynaecology, Drogheda, Ireland, Royal College of Surgeons in Ireland, Epidemiology and Public Health, Dublin, Ireland, National Maternity Hospital, Holles St, Dublin, Ireland OBJECTIVE: To compare perinatal outcomes of twin pregnancies conceived by assisted conception with those of natural conception. STUDY DESIGN: Evaluation of Sonographic Predictors of Restricted growth in Twins (ESPRiT) is a multicentric prospective observational study conducted in eight maternity centres in Ireland, by the Perinatal Ireland Research consortium. Of 1001 twin pregnancies completing the study over a 24 month period, method of conception was available for 874 twins. Statistical comparisons were made between methods of conception and types of artificial reproductive techniques (ARTs) for demographics, baseline characteristics and perinatal outcomes. RESULTS: There were 636 (73%) spontaneously conceived twins and 238 (27%) conceived by ART in the study. Nearly all (97%) of the ART twins were dichorionic as compared to 74% dichorionic twins of those conceived naturally. The ART group was older with a maternal age of 35 years as compared to 31 years for the spontaneous conception group (p 0.0001). The ART group was also more likely to be nulliparous (70% vs 40%, p 0.0001) and were less likely to be smokers (4% versus 15%, p 0.0001). There were no significant differences between the obstetric features such as preeclampsia, gestational diabetes, antepartum haemorrhage or preterm delivery. There were 16(1%) neonatal deaths in the naturally conceived group and 3(0.6%) in the assisted conception group (p 0.124) We found no difference (p-value 0.05) in gestational age at delivery for the ART group Poster Session V www.AJOG.org Saturday, February 11, 2012 • 10:00 am – 12:00 pm • Marsalis Hall, Dallas Hyatt Regency Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology S307

Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial

The recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age. The purpose of this investigation was to evaluate the efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES), initiated 48 hours after TKA, as an adjunct to standard rehabilitation. This was a prospective, longitudinal randomized controlled trial. Sixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA, were randomly assigned to receive either standard rehabilitation (control) or standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48 hours after surgery). The NMES was applied twice per day at the maximum tolerable intensity for 15 contractions. Data for muscle strength, functional performance, and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and 52 weeks after TKA. At 3.5 weeks after TKA, significant improvements with NMES were found for quadriceps and hamstring muscle strength, functional performance, and knee extension active range of motion. At 52 weeks, the differences between groups were attenuated, but improvements with NMES were still significant for quadriceps and hamstring muscle strength, functional performance, and some self-report measures. Treatment volume was not matched for both study arms; NMES was added to the standard of care treatment. Furthermore, testers were not blinded during testing, but used standardized scripts to avoid bias. Finally, some patients reached the maximum stimulator output during at least one treatment session and may have tolerated more stimulation. The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.

Cognitive reappraisal in trauma-exposed women with borderline personality disorder

Borderline personality disorder (BPD) is characterized by emotional dysregulation and a high prevalence of traumatic stress. Recent estimates suggest that 2-6% of non-clinical populations suffer from BPD. Despite this relevance, this is the first study considering the neural mechanisms underlying trauma-history and temporal features of cognitive reappraisal in non-clinical BPD patients using script-driven stimuli. Using functional magnetic resonance imaging (fMRI), we examined subjective ratings of negative emotional experience and brain activity following up- and down-regulation of emotional responses to standardized negative scripts in 43 women: 14 trauma-exposed BPD patients (BPD), 14 trauma-exposed healthy subjects without posttraumatic stress disorder (non-PTSD), and 15 non-traumatized healthy subjects (HC). Behaviorally, all groups were able to use cognitive reappraisal to up- and down-regulate negative emotions. HC subjects showed increased early activation in the prefrontal cortex (PFC) and the amygdala following up-regulation of emotions to negative scripts, whereas BPD and non-PTSD subjects showed early deactivation in the PFC. Additionally, the anterior cingulate cortex was more activated in HC subjects than in BPD and non-PTSD subjects during up- and down-regulation. No significant group differences were found between BPD patients and non-PTSD. BPD patients and healthy individuals with trauma history do not engage the cognitive control regions to the extent than HC subjects do when employing down-regulation of negative emotions. They also do not activate the brain regions associated with emotional up-regulation. These findings may reflect compensatory changes associated with trauma-exposure.

Clonidine blocks stress-induced craving in cocaine users

Reactivity to stressors and environmental cues, a putative cause of relapse in addiction, may be a useful target for relapse-prevention medication. In rodents, alpha-2 adrenergic agonists such as clonidine block stress-induced reinstatement of drug seeking, but not drug cue-induced reinstatement. The objective of this study is to test the effect of clonidine on stress- and cue-induced craving in human cocaine users. Healthy, non-treatment-seeking cocaine users (n = 59) were randomly assigned to three groups receiving clonidine 0, 0.1, or 0.2 mg orally under double-blind conditions. In a single test session, each participant received clonidine or placebo followed 3 h later by exposure to two pairs of standardized auditory-imagery scripts (neutral/stress and neutral/drug). Subjective measures of craving were collected. Subjective responsivity ("crave cocaine" Visual Analog Scale) to stress scripts was significantly attenuated in the 0.1- and 0.2-mg clonidine groups; for drug-cue scripts, this attenuation occurred only in the 0.2-mg group. Other subjective measures of craving showed similar patterns of effects but Dose × Script interactions were not significant. Clonidine was effective in reducing stress-induced (and, at a higher dose, cue-induced) craving in a pattern consistent with preclinical findings, although this was significant on only one of several measures. Our results, though modest and preliminary, converge with other evidence to suggest that alpha-2 adrenergic agonists may help prevent relapse in drug abusers experiencing stress or situations that remind them of drug use.

Public health clinical demonstration project for smoking cessation in american veterans who served since september 11, 2001.

The purpose of this clinical demonstration project was to increase the reach of effective treatments, such as pharmacotherapy and telephone or web-based support, by offering these treatments in a low cost and convenient manner to a population of Veterans. Six hundred nine veteran smokers who had served in the military since September 11, 2001 were contacted by invitational letters. Veterans indicating interest in further contacts received telephone calls using standardized scripts that offered referral to the National Cancer Institute's Smoking QuitLine, web-based counseling, and local Department of Veteran Affairs pharmacologic treatment for smoking cessation. Seven percent of survey recipients participated in the clinical program. At follow-up, 23% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a reach of 8.6% (number of smokers who accessed the intervention/the number of targeted smokers), an efficacy of 26% (number of abstinent smokers at follow-up/number who accessed the intervention), and a 24-hour abstinence impact rate of 2.2% (number of smokers with 24-hour abstinence/number of targeted smokers). Results suggested that this project enhanced access to care and promoted short-term smoking cessation in Veterans who have served since September 11. 2001.

Non-Idiographic Emotional Script-Driven Imagery in Posttraumatic Stress Disorder

Abnormal emotional responses to standardized emotional stimuli in posttraumatic stress disorder (PTSD) implicate problems in emotional processing less obviously linked to traumatic experiences. However, the personal meaningfulness and association of standardized emotional stimuli with specific episodic memories in PTSD participants has not been investigated. This paper takes the position that emotional processing of standardized stimuli cannot be divorced from the personal meaning these stimuli are ascribed, such as via the priming of episodic memory. Women with PTSD reported greater priming of episodic memories within the context of emotional imagery of standardized scripts, and episodic recall predicted emotional responses to script-driven imagery. Furthermore, greater priming of episodic recall during imagery of fear-anxiety scripts was associated with less response within the ventral medial prefrontal cortex. Clinical, theoretical, and methodological issues are discussed.

Public health clinical demonstration project for smoking cessation in veterans with posttraumatic stress disorder

Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Five hundred eighty-four veteran smokers were contacted by invitational letters. Interested veterans received follow-up telephone calls using standardized scripts offering three intervention resources: 1) a referral to the National Cancer Institute's Smoking Quitline, 2) web-based counseling, and 3) local Veteran Affairs pharmacologic treatment for smoking cessation. Twenty-three percent of survey recipients participated in the clinical program. Two months after these resources were offered by phone, follow-up phone calls indicated that 25% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a 2.6% impact (i.e., reach [31.1% of smokers accessed intervention] by efficacy [8.4% of those accessing intervention quit]), meaning that 2.6% of the total number of targeted smokers reported 8 week abstinence. Results suggested that this brief, low-cost intervention was feasible and promoted smoking cessation in veterans with posttraumatic stress disorder.

Preliminary Findings from a Clinical Demonstration Project for Veterans Returning from Iraq or Afghanistan

Military veterans are at high risk for nicotine dependence. This clinical demonstration project used invitational letters, referral to the National Cancer Institute's Smoking Quitline, and local Veteran Affairs prescriptions for tobacco cessation to evaluate whether this low-cost method would potentially reduce smoking in separated veterans who served in Afghanistan and Iraq. Three cohorts (500 each) of recently separated veterans from Afghanistan and Iraq were contacted by survey letters. Interested veterans received follow-up telephone calls using standardized scripts. They were referred to the National Cancer Institute's Smoking Quitline (1-877-44U-QUIT) and offered local Veteran Affairs pharmacologic treatment for smoking cessation. Forty-three percent of respondents who were smokers were interested in the clinical program; of these, 77% participated. At 2 months follow-up, 38% of participants self-reported maintained smoking abstinence. Results suggested that the intervention was feasible and assisted the small number of veterans who participated.

MEDIATING INFANTICIDE: Theorizing Relations between Narrative and Violence

Much anthropological research on narrative and violence treats their relationship as immanent and performative, an assumption shared by many media, legal, medical, and other professionals and lay persons. This view is predicated on constructing the production, circulation, and reception of knowledge about violence in particular ways. In this article, I examine newspaper accounts of infanticide in Venezuela, along with interviews with reporters, detectives and legal professionals and focus groups. This analysis suggests that these articles, which receive widespread attention, become stories about stories—specifically narratives that recount how the story of the crime unfolded naturally and automatically from material and corporeal evidence, and the words of relatives, neighbors, doctors, detectives, defendants, and the vox populi. These constructions of discourse about violence create a very limited range of subject positions, generate standardized scripts for persons interpellated in each slot, and make it difficult to advance counternarratives, thereby inscribing the legitimacy of state institutions during a period (the 1990s) when the nation-state project seemed to be collapsing.