Spatial and temporal trends of gas and particle phase atmospheric DDT and metabolites in Michigan: Evidence of long‐term persistence and atmospheric emission in a high‐DDT‐use fruit orchard

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94663/1/jgrd13089.pd

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

BackgroundResearch evidence supports the positive impact on resident outcomes of nurse practitioners (NPs) working in long term care (LTC) homes. There are few studies that report the perceptions of residents and family members about the role of the NP in these settings. The purpose of this study was to explore the perceptions of residents and family members regarding the role of the NP in LTC homes.MethodsThe study applied a qualitative descriptive approach. In-depth individual and focus group interviews were conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional content analysis was used to identify themes and sub-themes.ResultsTwo major themes were identified: NPs were seen as providing resident and family-centred care and as providing enhanced quality of care. NPs established caring relationships with residents and families, providing both informational and emotional support, as well as facilitating their participation in decision making. Residents and families perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary hospitalization.ConclusionsThe perceptions of residents and family members of the NP role in LTC are consistent with the concepts of person-centred and relationship-centred care. The relationships NPs develop with residents and families are a central means through which enhanced quality of care occurs. Given the limited use of NPs in LTC settings, there is an opportunity for health care policy and decision makers to address service inadequacies through strategic deployment of NPs in LTC settings. NPs can use their expert knowledge and skill to assist residents and families to make informed choices regarding their health care and maintain a positive care experience

Do positive expectancies explain the effects of expressive writing?

Writing expressively about personal trauma, upsetting experiences, and illness has been demonstrated to have beneficial consequences on psychological well-being and physical health. Many theories of written emotional disclosure, or expressive writing, have been proposed but none have offered a convincing explanation of how expressive writing achieves its beneficial results. A recent model of written emotional disclosure that has received little attention is an expectancy model, which proposes that the benefits of expressive writing are the result of positive expectancies. People popularly believe that emotional expression of an upsetting event is beneficial; therefore, expectancies may be responsible for the observed changes and the act of writing expressively about a trauma may have little or no importance. From this expectancy perspective, the beneficial effects of expressive writing can be viewed as a specific case of the related theories of placebo, optimism, and hope, among others. In support of this view, one recent study found that positive expectancies about expressive writing were related to improvements in emotional and physical well-being. The current study experimentally manipulated positive expectancies by creating a writing group in which students who write about their daily activities (the standard control) were given positive expectancies about the beneficial nature of the writing (control + expectancy). Expectancies were induced in this group by showing students a video in which a professor of psychology explained the beneficial effects of engaging in this writing exercise. Because the control writing topic, writing non-emotionally about one\u27s daily activities, has no documented therapeutic benefit, any changes in the outcome variables in the control + expectancy group could then be attributed to expectancies. In this study, students were assigned to either the traditional expressive writing group (writing expressively about trauma), traditional control group (writing about daily activities), or the expectancy group (control + expectancy). The outcome measures of psychological and physical health were assessed both before and after writing. Consistent with previous research findings, it was hypothesized that the participants in the expressive writing group would have greater health and psychological benefits, when compared to the control. It was further hypothesized that those participants in the control + expectancy group would also have greater health and psychological benefits, when compared to the control. The hypotheses were tested using multiple regression, which allowed for examination of the main effects for expectancy and experimental group and a group x expectancy interaction. The hypotheses were not supported. No significant differences were found between the three groups on any of the three outcome variables. This lack of findings is examined within a motivational placebo model and suggestions are made for future research examining the role of expectancy in expressive writing

The role of motivation and expectancy in the placebo effect

Placebo has been found to be an important component of treatments including psychological and pharmacological treatment of depression, transplant surgery for Parkinson\u27s, acupuncture, smoking cessation interventions, and analgesic treatment of pain. Although the placebo effect has been observed across a wide range of disciplines, the effect sizes vary widely and it is not well understood how placebo effects are produced. The current study draws upon research in perception and motivation to propose a more comprehensive model of the placebo effect. Specifically, the model proposes that more motivated persons pay greater attention to bodily sensations and other stimuli, which are then interpreted according to expectations, producing a placebo response. In the current study, both motivation and outcome expectancy were manipulated, creating a 2x2 study design. College students (N=152) were asked to evaluate a series of placebo pheromone substances (slightly scented water) and attention/task diligence was assessed as the amount of time spent on the rating task and the number of evaluations made. The placebo response was assessed as the attractiveness rating of the chosen sample and the variability in ratings, with greater variability and higher attractiveness ratings indicating greater placebo response. It was predicted that those in the high motivation group would have greater diligence on the rating task, which would, in turn, lead to greater placebo response. It was further predicted that there would be a main effect for expectancy on placebo response. Consistent with hypothesized effects, more highly motivated students had greater placebo responses, and the relationship was mediated by task diligence. Thus, as students spent greater time on the evaluation task, they found the scent of their chosen sample to be more pleasing and perceived greater differences among samples. No effect was found for expectancy. These findings are important because they suggest possible mechanisms for maximizing treatment effects in medical and psychological settings, where factors such as nonspecific treatment effects and placebo are believed to influence outcomes. Future research should seek to further clarify the relationship of expectancy and motivation to placebo outcomes, examining mediating factors such as attention, and carefully manipulating both variables to ensure maximum effects