Behavioral Management of Auditory Hallucinations: Implementation and Evaluation of a 10-Week Course

A 10-session behavioral course for self-management of auditory hallucinations in patients with schizophrenia has demonstrated positive outcomes. This article evaluates both the course’s implementation and benefits to patients attending the course. Teleconferencing, electronic media, and 26 monthly conference calls were used to educate six advanced practice nurses (APNs) at six sites about the course implementation. Thirty-two patients within the U.S. Department of Veterans Affairs participated in the course. All of the APNs reported course helpfulness, improved communication with patients about voices, and improved harm assessment. Of the patients, 96% found the course helpful: 67% no longer heard voices to harm self or others, and 60% had improved auditory hallucination intensity scores. The project demonstrated successful implementation and practice integration with APNs’ activities corresponding to Rogers’ stages of innovation adoption. Facilitators and barriers to implementation are also described

Sense of community online : self-regulated learning and avoiding the drama triangle

xi, 105 leaves ; 29 cmThis project addresses how developing online students’ self-regulated learning skills and applying the concept of the drama triangle (Karpman, 1968)—part of the game theory associated with transactional analysis (Berne, 1961)—can be used by post secondary instructors teaching online to build a sense of community (Rovai, 2002a) and decrease students’ dependence on instructors. The project begins with an extensive overview of sense of community, highlighting the significant role online instructors have in online community formation. A detailed discussion on how fostering online students’ selfregulatory learning behaviours can contribute to their sense of community and encourage their community building efforts is presented. Utilizing experiences as an online instructor, the drama triangle and its applicability to online instruction is analyzed. Experiences as an online instructor are utilized to illustrate how drama triangle interactions in the online environment can stall sense of community formation. In addition, this project provides online instructors with specific online community-building strategies that focus on developing self-regulated learning skills and strategies for avoiding drama triangle interaction

Massive Lower Gastrointestinal Bleeding from the Appendix

Massive rectal bleeding from the appendix, considered a rare case of lower gastrointestinal bleeding, is not easily recognized by various diagnostic modalities. A multidisciplinary approach for both a diagnosis and a differential diagnosis is important because the identification of the bleeding site is crucial to proceed to a proper intervention and there are various causes of appendiceal bleeding. Because early colonoscopy plays an important role in the diagnosis and management of lower gastrointestinal hemorrhage, we report a case of a life threatening massive rectal bleeding from the appendix diagnosed by colonoscopy. We also present a review of the literature

Target screening of chemicals of concern in recycled water

The results of a characterisation study of water samples collected from an Advanced Water Recycling Plant (AWRP) operating in Perth, Western Australia are presented. The AWRP treats secondary wastewater by ultrafiltration, reverse osmosis (RO) and ultraviolet radiation (UV) to produce recycled water for groundwater replenishment. Water samples collected after RO and UV treatment were characterised by liquid chromatography-high resolution mass spectrometry, using an established protocol for target screening. The target screening of 291 compounds detected a total of 13 chemicals in post-RO and post-UV water, including 2 corrosion inhibitors (4+5-methyl-1H-benzotriazole, benzotriazole), 3 pesticides (metolachlor, propiconazol, prosulfocarb), 3 pharmaceuticals (lamotrigin, metformin, tramadol), 1 personal care product (galaxalidone), 3 artificial sweeteners (saccharin, acesulfame, sucralose) and 1 flame retardant (triethyl phosphate). The corrosion inhibitors benzotriazole and 4+5-methyl-1H-benzotriazole, and the pharmaceutical metformin were detected in hundreds of ng L−1, while the other compounds were present in low ng L−1 concentrations. Analysis of UV treated water samples showed that UV treatment also helped to reduced UV degradable compounds such as the corrosion inhibitors (>50% removal), triethyl phosphate (~50% removal) and the artificial sweetener acesulfame (~95% removal). Overall, the detection of 13 chemicals through target screening analyses did not account for the residual dissolved organic carbon (DOC) in post RO water, the majority of which is still an intriguing unknown. However, the target screening did show that there were no obvious “known” anthropogenic contaminants contributing to the majority of the DOC in post-RO and post-UV treated water. Calculated risk quotients (RQ) for all detected chemicals in UV treated water were 2 to 6 order of magnitude below 1, implying an high degree of safety associated with human consumption of recycled water. Overall the chemicals screening provided further evidence of the overall safety of the use of recycled wastewater treated by RO and UV as a potable water source

Clear cell carcinoid tumor of the distal common bile duct

BACKGROUND: Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC) tumors in the distal bile duct (DBD) to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. CASE PRESENTATION: A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2(nd )portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size). The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE), chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. CONCLUSION: Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct

Linear Cryptanalysis of a Quasigroup Block Cipher

The purpose of this research was to determine if any key material could be found from conducting a linear cryptanalytic attack against the quasigroup block cipher using two key bytes. Linear cryptanalysis involves determining the likelihood that a set of plaintexts is known to have a specific statistical relationship to a second set of ciphertext all encrypted using the same key (Swenson, 2012, p. 168 ). Using Matsui’s Algorithm 2 for DES S-box transformations as an example (Matsui, 1993), this research sought to find a suitable linear approximation of the quasigroup block cipher, the number of plaintext-ciphertext pairs to test, and the attack complexity required to mount a known-plaintext attack on the quasigroup block cipher (Swenson, 2012). The focus of this research was on the keyed transformations during table lookups of the quasigroup in order to determine how key bits used during encryption impacted the ciphertext. Upon completing a modified application of the linear cryptanalytic attack on the quasigroup block cipher, it was found that the probability bias derived from the research model used against a lower ordered quasigroup was statistically insignificant. No key bits could be extracted using the general tenants of linear cryptanalysis on the quasigroup block cipher structure. Due to a lack of key material being recovered from the research, the attack complexity of this model is no better than a brute force attack on the key space

Comparison and prediction of completers and non-completers of a domestic violence program

Thesis (Ph. D.)--University of Washington, 1999Sixty-two male batterers and 31 female victim/partners were recruited from an existing batterers' rehabilitation program from June 1997 through December 1997. Forty-eight men were veterans and 14 active duty. All subjects were interviewed at the initial or second contact with the program. In addition, the batterers were given eight research tools and the victims' two tools to complete. Of the 62 men who volunteered for the study, one man transferred to another duty station, 38 dropped out of the program, and 23 made the transition from the rehabilitation to maintenance phase of the program.Using t-test and Chi-square analysis, comparisons were made between batterers' and victims' reports and completion status on the descriptive variables and research tools. A logistical regression was preformed to predict completion/non-completion status. The results of the logistical regression was a Model Chi-square statistic of 31.08 (p = .000). The model predicted 88.89% of the non-completers, 78.26% of the completers, and had an over-all predictive ability of 84.75% for the research sample. Completers were found to be more likely young, to be court-monitored, to have lower levels of stress (SOS Inventory) and post-traumatic stress (PCL), and to have higher levels of mutuality (MPDQ) in their relationships than non-completers

Intimate Partner Violence, Military Personnel, Veterans, and Their Families

The United States has been at war for over a decade. Over 2.5 million people have served in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) in Afghanistan. Many military service members have deployed multiple times to war zones over the past decade. Some have returned with visible and invisible injuries that have significantly affected them and their families (RAND Center for Military Health Policy Research, 2008). Communities throughout the country are grappling with the aftermath of war and how to serve military personnel, veterans, and their families effectively with sensitivity to the experiences they have had and the issues they face. This article will focus on the intersection between intimate partner violence (IPV) and combat-related conditions such as posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance abuse, and depression and the implications for family court personnel working with military and veteran families. Terminology It is important to make a few comments about the terminology used in this article. The authors choose to use the term “intimate partner violence ” since it is most descriptive of the nature of the relationship in which the abuse and violence occur. The terms “battering ” an