The enigma of patient centredness, the therapeutic relationship and outcomes of the clinical encounter

The increasingly ubiquitous notion of ‘patient centredness’ often causes confusion; indeed instruction received on this subject often left trainees with only the vaguest notion of how it could be put into practice, sometimes leading to bizarre interpretations of this idea. For example, one colleague described how he, in an attempt at ‘real’ patient centredness, had attempted a whole surgery without saying anything at all for as long as possible, presumably just nodding and gesticulating to compensate. Although we readily agree that non-verbal expression accounts for a considerable content of communication, this is perhaps taking things just too far. Patient centredness remains a central plank of clinical learning, teaching and assessment and nowadays is also central of policy development in the health service. But what do we mean by patient centredness? Is it really important? How important is it compared to other aspects of the consultation? Does it make a difference

Bessel beams: a novel approach to periodic structures

Bessel and Bessel-like beams in Kerr-like nonlinear materials are numerically investigated. This is conducted with a view to exploiting the behaviour of such profiles for the direct laser writing of periodic structures in highly nonlinear glasses. A highly efficient numerical model is developed for the propagation of radially symmetric profiles based on the quasi-discrete Hankel transform (QDHT), making use of a reconstruction relation to allow the field to be sampled at arbitrary positions that do not coincide with the numerical grid. This Hankel-based Adaptive Radial Propagator (HARP) is shown to be up to 1000 times faster than standard FFT-based methods. The critical self-focusing of the Gaussian beam is reproduced to confirm the accuracy of HARP. Following this the critical self-focusing behaviour of a Bessel-Gauss beam is investigated. It is observed that, for certain parameters, increasing the beam power may prevent blowup in the Bessel-Gauss beam. Below the threshold for self-focusing the Bessel-Gauss beam exhibits periodic modulation in the direction of propagation. The existing equation describing this behaviour is shown to be inaccurate and a modification is proposed based on a power dependent beat-length. This modified beat-length equation is demonstrated to be accurate in both the paraxial and quasi-nonparaxial regime. As the beam decays, the intensity modulation appears negatively chirped. It is demonstrated that this chirp may be controlled through careful shaping of the window. It is also shown that a small Gaussian seed beam may be used to control the positions of the maxima. It is demonstrated that a set of nonlinear Bessel functions exist that exhibit a similar quasi-stationary behaviour in a nonlinear medium to the linear Bessel beam in a linear medium. Furthermore it is shown for the first time that higher-order, Bessel-like, stationary solutions exist for beams with azimuthal phase, and boundary conditions for these functions are derived

The Cost of a Positive integer

The cost CS of a positive integer m relative to a set S of binary operations is defined to be the lesser of m and the minimum of CS(a) + CS(b) where a and b are positive integers and m = a ◦ b for some binary operation ◦ ∈ S. The cost of a positive integer measures the complexity of expressing m using the operations in S, and is intended to be a simplification of Kolmogrov compelexity. We show that, unlike Kolmolgorov complexity, CS is computable for any finite set S of computable binary operations. We then study CS for various choices of S. If S = {∗} and m \u3e 1 then CS(m) is the sum of the prime factors of m (with repetition). A positive integer m is defined to be completely multiplicative if C{+,∗} (m) = C{∗} (m). We show that if m is completely multiplicative then m is of the form 2a ∗ 3b ∗ 5c. The converse is an open question. If S = {+, ∗} we prove logarithmic upper and lower bounds implying that CS(m) ∈ O(log m). We use the notations +1 and −1 to denote the binary operations a + b and a − b restricted to the cases where b = 1, and we conjecture that C{+,∗,−} = C{+1,∗,−1} . However, we give an example to show that C{+,∧} ≠ C{+1,∧} where ∧ represents exponentiation. Several interesting open questions are also discussed

The neglected parental mental health problem? Borderline personality disorder: A preliminary exploration of borderline mothers' attributions of children's behaviour

BACKGROUND: Despite the significant interpersonal difficulties experienced by individuals with borderline personality disorder (“BPD”) and the high family aggregation of BPD, the relationship between borderline parents and their children has been largely neglected. The unstable relationships of borderline individuals are characterised by alternating views of others as alternately ‘malevolent’ and ‘protective’. In experimental studies, the former representation dominates borderline individuals’ view of other adults. However, the preliminary findings of studies of borderline parents indicate that borderline mothers may view the child from an idealised frame of reference. Parental attributions are proposed to play a critical mediating or moderating role in relation to parents’ affect and behaviour. Exploring the nature of borderline parents’ attributions may, therefore, offer valuable insight into the potential pathways underlying the increased psychiatric risk posed to their children.OBJECTIVES: This study aimed to explore the borderline parents’ child-centered attributions in relation to:I.The degree of hostile intent attributed to ambiguous and negative child behaviour.II.The perceived balance of control in negative adult-child interactions.METHOD: Nine mothers with a confirmed diagnosis of BPD and nine mothers with mild to moderate mental health difficulties without a diagnosis of BPD completed a parent report questionnaire, which included measures of parental attributions, maternal depression and children’s emotional and behavioural strengths and difficulties. Screening measures for personality disorder and psychological distress were also included, to exclude participants with potential Cluster B personality disorders or severe mental health difficulties from the control group.RESULTS: Non-parametric Mann-Whitney U-tests indicated that, relative to mothers in the control group, borderline mothers attributed significantly less hostile intent and considered significantly lower levels of punishment in response to ambiguous or negative child behaviour. No significant differences emerged in relation to maternal attributions of the balance of control in negative adult-child interactions. Exploratory analysis clarified the potential role of maternal depression and emotional and behavioural difficulties of participants’ children in mediating or moderating these findings. All significant results were marked by large effect sizes.CONCLUSIONS: The findings in the present study are consistent with the picture that emerges from empirical studies of borderline mothers, where maternal behaviour is characterised as helpless and frightened as opposed to hostile and frightening. The absence of attributions linked to parental abuse or hostile affect potentially call into question the assumptions of hostile and abusive parenting in borderline parents that dominate clinical texts, and may indicate different pathways to abuse in this population. The findings further pointed to the possibility of a permissive parenting styles and an idealised representation of the child in borderline mothers, potentially offering new insights into the possible mechanism underlying the risk to children of borderline parents

Establishing Cognitive Predictor Thresholds for Proficiency in Reading and Mathematics: Analysis of the Woodcock-Johnson IV Developmental-Age Norming Sample

Assessment of specific learning disabilities (SLD) in educational settings is one important function of a school psychologist. The federal definition of SLD describes underlying cognitive processing deficits as part of the assessment criteria, that is also incorporated into several states\u27 SLD eligibility criteria, that is difficult to directly evaluate using traditional assessment methods. Traditionally, use of norm-referenced scores have been used to compare an examinee\u27s relative performance on assessment tests. Such a method does not provide direct evidence of underlying cognitive processing deficits associated with poor academic achievement. In an effort to directly inform this cognitive processing ability and academic proficiency relation, the current study utilized measures of absolute level of performance—W scores from cognitive (COG) and achievement (ACH)tests from the Woodcock-Johnson IV (WJIV)—to search for optimal cognitive predictors of proficiency in reading and mathematics domains. The study included two phases. The first phase consisted of determining proficiency standards for WJIVACH tests related to reading and mathematics SLDeligibility areas through expert review of test item content to establish cut scores for proficient performance. The second phase employed theoretically relevant WJIVCOG tests as predictor variables in multiple receiver operating characteristic (ROC) curve analyses for proficiency classification purposes for the reading and mathematics SLD eligibility area clusters and their contributing WJIVACH tests. Results indicate that the WJIVCOGtests are generally good to excellent predictors of academic proficiency, when considering absolute levels of performance. Oral Vocabulary, a measure of Comprehension-Knowledge (Gc), and Number Series, a measure of Fluid Reasoning (Gf), demonstrated the greatest diagnostic accuracy for classification of proficiency in reading and mathematics. Groundwork has been laid for establishing cognitive predictors that accurately predict proficiency in reading and mathematics that can strengthen the case that an examinee meets the underlying criteria for an SLD(i.e., a related cognitive processing deficit)

Inclusive Land Governance in Mozambique: Good Law, Bad Politics?

This paper analyses inclusive land governance in Mozambique. It focuses on the country’s legal framework and the DUAT, the right to use and benefit from the land. The DUAT is a distinctive element of the Mozambican legislation that has land as the property of the state but recognises land use rights for occupants and users on the basis of a unitary system of tenure. The challenges of putting in practice what is thought to be one of Africa’s most progressive legal frameworks are discussed. These are set against a context where despite land abundance there are concerns over land grabbing and dispossession of rural communities, which constitute over 70 per cent of the country’s population. The law may be progressive but government politics are not, as an increasingly hegemonic elite controls Mozambique’s political system and resources