Effect of questions used by psychiatrists on therapeutic alliance and adherence

Background Psychiatrists' questions are the mechanism for achieving clinical objectives and managing the formation of a therapeutic alliance – consistently associated with patient adherence. No research has examined the nature of this relationship and the different practices used in psychiatry. Questions are typically defined in binary terms (e.g. ‘open’ v. ‘closed’) that may have limited application in practice. Aims To undertake a detailed examination of the types of questions psychiatrists ask patients and explore their association with the therapeutic alliance and patient adherence. Method A coding protocol was developed to classify questions from 134 out-patient consultations, predominantly by syntactic form. Bivariate correlations with measures of patient adherence and the therapeutic alliance (psychiatrist-rated) were examined and assessed using generalised estimating equations, adjusting for patient symptoms, psychiatrist identity and amount of speech. Results Psychiatrists used only four of ten question types regularly: yes/no auxiliary questions, ‘wh-’ questions, declarative questions and tag questions. Only declarative questions predicted better adherence and perceptions of the therapeutic relationship. Conversely, ‘wh-’ questions – associated with positive symptoms – predicted poorer perceptions of the therapeutic relationship. Declarative questions were frequently used to propose an understanding of patients' experiences, in particular their emotional salience for the patient. Conclusions A refined defining of questioning practices is necessary to improve communication in psychiatry. The use of declarative questions may enhance alliance and adherence, or index their manifestation in talk, e.g. better mutual understanding. The function of ‘so’-prefaced declaratives, also used in psychotherapy, is more nuanced than negatively connotated ‘leading’ questions. Hearable as displays of empathy, they attend closely to patient experience, while balancing the tasks of assessment and treatment

Finding Low-Energy Conformations of Lattice Protein Models by Quantum Annealing

Lattice protein folding models are a cornerstone of computational biophysics. Although these models are a coarse grained representation, they provide useful insight into the energy landscape of natural proteins. Finding low-energy threedimensional structures is an intractable problem even in the simplest model, the Hydrophobic-Polar (HP) model. Description of protein-like properties are more accurately described by generalized models, such as the one proposed by Miyazawa and Jernigan (MJ), which explicitly take into account the unique interactions among all 20 amino acids. There is theoretical and experimental evidence of the advantage of solving classical optimization problems using quantum annealing over its classical analogue (simulated annealing). In this report, we present a benchmark implementation of quantum annealing for lattice protein folding problems (six different experiments up to 81 superconducting quantum bits). This first implementation of a biophysical problem paves the way towards studying optimization problems in biophysics and statistical mechanics using quantum devices.Chemistry and Chemical Biolog

Multi-point Assessment of the Kinematics of Shocks (MAKOS): A Heliophysics Mission Concept Study

Collisionless shocks are fundamental processes that are ubiquitous in space plasma physics throughout the Heliosphere and most astrophysical environments. Earth's bow shock and interplanetary shocks at 1 AU offer the most readily accessible opportunities to advance our understanding of the nature of collisionless shocks via fully-instrumented, in situ observations. One major outstanding question pertains to the energy budget of collisionless shocks, particularly how exactly collisionless shocks convert incident kinetic bulk flow energy into thermalization (heating), suprathermal particle acceleration, and a variety of plasma waves, including nonlinear structures. Furthermore, it remains unknown how those energy conversion processes change for different shock orientations (e.g., quasi-parallel vs. quasi-perpendicular) and driving conditions (upstream Alfv\'enic and fast Mach numbers, plasma beta, etc.). Required to address these questions are multipoint observations enabling direct measurement of the necessary plasmas, energetic particles, and electric and magnetic fields and waves, all simultaneously from upstream, downstream, and at the shock transition layer with observatory separations at ion to magnetohydrodynamic (MHD) scales. Such a configuration of spacecraft with specifically-designed instruments has never been available, and this white paper describes a conceptual mission design -- MAKOS -- to address these outstanding questions and advance our knowledge of the nature of collisionless shocks.Comment: White paper submitted to the Decadal Survey for Solar and Space Physics (Heliophysics) 2024-2033; 9 pages, 3 figures, 5 table

Recommended Revisions to the National SEP‐1 Sepsis Quality Measure: A commentary by the Society of Infectious Diseases Pharmacists on the Infectious Diseases Society of America Position Paper

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154912/1/phar2384.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154912/2/phar2384_am.pd

Multi-Timescale Perceptual History Resolves Visual Ambiguity

When visual input is inconclusive, does previous experience aid the visual system in attaining an accurate perceptual interpretation? Prolonged viewing of a visually ambiguous stimulus causes perception to alternate between conflicting interpretations. When viewed intermittently, however, ambiguous stimuli tend to evoke the same percept on many consecutive presentations. This perceptual stabilization has been suggested to reflect persistence of the most recent percept throughout the blank that separates two presentations. Here we show that the memory trace that causes stabilization reflects not just the latest percept, but perception during a much longer period. That is, the choice between competing percepts at stimulus reappearance is determined by an elaborate history of prior perception. Specifically, we demonstrate a seconds-long influence of the latest percept, as well as a more persistent influence based on the relative proportion of dominance during a preceding period of at least one minute. In case short-term perceptual history and long-term perceptual history are opposed (because perception has recently switched after prolonged stabilization), the long-term influence recovers after the effect of the latest percept has worn off, indicating independence between time scales. We accommodate these results by adding two positive adaptation terms, one with a short time constant and one with a long time constant, to a standard model of perceptual switching