Comparing Perceptions of Motivation to Change: Clinicians Versus Their Substance-Abuse Clients

Although some clients enter treatment voluntarily to seek intervention for their substance abuse problems, most enter under coercive external pressures that may be perceived by clinicians as less influenced by addressing substance abuse than by appeasing mandates from the judicial system, family, or employers. Little research has examined and compared how clinicians assess clients’ extrinsic and intrinsic motivation to change as opposed to how the clients assess themselves. A congruency between the two parties’ assessments may inform the quality of the therapeutic relationship and facilitate an effective treatment plan. Using the Circumstance, Motivation, and Readiness Scales (CMR) and availability sampling methods, we surveyed both the clinicians and their clients (N = 31 clients and 11 clinicians). Results showed that there is a statistically significant difference between the ratings of the clinicians and their clients. The clinicians tended to rate the clients as having lower motivation and being less ready to change than the clients rated themselves. In addition, the clinicians rated three groups of clients similarly; no significant difference existed comparing (a) a court-mandated group, (b) a conditional (e.g., referred by family or welfare office), and (c) a voluntary group. Likewise, there was no significant difference with respect to clients’ own ratings, comparing the three client groups. Implications for practice, policy, and future research are discussed

Coercion and Motivation: Construct Analysis and Factor Association in Entering Treatment for Substance-Abuse

Informed by the theoretical underpinnings of Self-determination theory (SDT), we aimed to examine relationships between motivation and independent measures of external pressure and explore whether or not a directional association exists between perceived coercion and motivation. Using the Circumstance, and Motivation subscales of the CMR and availability sampling method, we surveyed 63 clients seeking substance abuse treatment under legal coercion, social coercion, and voluntarily. Results suggest that motivation to engage in substance abuse treatment is not reliably inferred from referral source. Treatment seeking groups appear to experience greater external pressures to leave treatment than to enter treatment. Results are consistent with SDT—specifically, treatment motivation appears to be a personal consideration that likely moderates the effect of coercion

Contrasting Perceptions of Motivation to Change: Clinicians and Substance Abuse Clients

Substance abuse persists as one of the most costly, prevalent, and damaging health problems in the United States. As of 2012, an estimated 22 million individuals, approximately 8.9 percent of the total population, were diagnosed with substance abuse or dependence disorder. Considering the significant number of clients served, successful national completion rates among individuals utilizing outpatient care remain markedly low. In the state of Nevada, where the present study is conducted, successful intensive outpatient treatment (IOP) completion rate remains at an alarmingly low 20.1 percent. Early dropout is a particular concern in that duration of participation in treatment has been a reliable clinical and statistical predictor of positive treatment outcome. A myriad of factors including erosion of the therapeutic alliance between client and clinician, heterogeneity of client characteristics, and inadequate assessment are among factors that contribute to noncompliance with established treatment goals and premature termination. The extent to which external factors that hasten ingress to substance abuse treatment are perceived as coercive and diminish motivation has not been fully realized in empirical discourse. Informed by the theoretical underpinnings of the self-determination theory (SDT), the present study aims to examine perceptions of motivation, readiness, and external coercive circumstances that trigger substance use treatment entry among clients seeking substance use treatment under legal coercion (criminal), formal/informal coercion (non-criminal), those seeking substance use treatment voluntarily and their respective clinicians during the initial stages of treatment in outpatient treatment settings. The study will test the hypothesis: That a significant divergence exists between clinicians’ overall motivational ratings of clients who enter treatment under criminal legal coercion, non-criminal formal and informal coercion, and clients’ own ratings, as contrasted with ratings of voluntary groups. Utilizing convenience sampling, a total of 63 clients and 15 clinicians were recruited to participate in the study. One-way between subjects analysis of variance (ANOVA) were conducted to compare the effect of clients’ as well as clinicians’ perceptions of circumstances, motivation, and readiness in seeking treatment. Paired-samples t-tests were conducted to compare the clinicians’ and clients aggregate scores for the circumstance, motivation, and readiness scores. Key outcome of the study supports the hypothesis that a significant disparity, as measured by the aggregate scores on the CMR, appears to exist in levels of perceived motivation between client and clinician groups. The finding does not support the sub-hypothesis that clinicians perceive voluntary groups as being more motivated than those seeking treatment under various forms social or legal of coercion. Whereas analyses of sub dimensions of the scale suggest a significant effect in clinicians’ ratings of the readiness dimension between voluntary and (non-criminal) formal/informal coercion group, the clinicians and client groups did not differ in their appraisal of the circumstances dimensions. The convergence of findings supports the major hypothesis and suggests that clinicians’ overall assessments are consistently incongruent with clients’ own perspectives. Outcomes are congruent with SDT, which proposes that external pressures are not necessarily antagonistic to internal motivation—rather, external controls can differ in the extent to which they are perceived as self-determined, vis-à-vis controlled, depending on the degree to which they may be internalized by the individual. Research in this field must evolve in order to facilitate empirical examinations of the reciprocity between internal and external pressures on treatment motivation, retention, and outcomes while making a concerted effort to withdraw from rendering generalizations strictly on the basis of referral source

Doctor, Lawyer, Social Worker?: Exploring the Experiences of Asian American Pacific Islander (APIA) Social Work Students

This study examined preliminary result using a snowball sample of 121 APIA social work students from accredited institutions that offer social work programs. The purpose of this study was to explore APIA social work students’ perceptions and experiences in the program and their expectations from classmates, APIA faculty, field liaison, and agencies. A 44-item survey was sent through an online survey site to APIA students. The results indicated that while most participants reported that family do not have a strong influence on their profession, 39% out of 83 respondents reported positive experiences with social workers drove them to pursue this profession. Students who have APIA faculty in their institution found strong importance of having APIA faculty in the program. The implication of this study was also discussed

One-dimensional Model of a Gamma Klystron

A new scheme for amplification of coherent gamma rays is proposed. The key elements are crystalline undulators - single crystals with periodically bent crystallographic planes exposed to a high energy beam of charged particles undergoing channeling inside the crystals. The scheme consists of two such crystals separated by a vacuum gap. The beam passes the crystals successively. The particles perform undulator motion inside the crystals following the periodic shape of the crystallographic planes. Gamma rays passing the crystals parallel to the beam get amplified due to interaction with the particles inside the crystals. The term `gamma klystron' is proposed for the scheme because its operational principles are similar to those of the optical klystron. A more simple one-crystal scheme is considered as well for the sake of comparison. It is shown that the gamma ray amplification in the klystron scheme can be reached at considerably lower particle densities than in the one-crystal scheme, provided that the gap between the crystals is sufficiently large.Comment: RevTeX4, 22 pages, 4 figure

Unicellular Origin of the Animal MicroRNA Machinery

The emergence of multicellular animals was associated with an increase in phenotypic complexity and with the acquisition of spatial cell differentiation and embryonic development. Paradoxically, this phenotypic transition was not paralleled by major changes in the underlying developmental toolkit and regulatory networks. In fact, most of these systems are ancient, established already in the unicellular ancestors of animals [1, 2, 3, 4, 5]. In contrast, the Microprocessor protein machinery, which is essential for microRNA (miRNA) biogenesis in animals, as well as the miRNA genes themselves produced by this Microprocessor, have not been identified outside of the animal kingdom [6]. Hence, the Microprocessor, with the key proteins Pasha and Drosha, is regarded as an animal innovation [7, 8, 9]. Here, we challenge this evolutionary scenario by investigating unicellular sister lineages of animals through genomic and transcriptomic analyses. We identify in Ichthyosporea both Drosha and Pasha (DGCR8 in vertebrates), indicating that the Microprocessor complex evolved long before the last common ancestor of animals, consistent with a pre-metazoan origin of most of the animal developmental gene elements. Through small RNA sequencing, we also discovered expressed bona fide miRNA genes in several species of the ichthyosporeans harboring the Microprocessor. A deep, pre-metazoan origin of the Microprocessor and miRNAs comply with a view that the origin of multicellular animals was not directly linked to the innovation of these key regulatory components

The Dementias Platform UK (DPUK) Data Portal

Abstract: The Dementias Platform UK Data Portal is a data repository facilitating access to data for 3 370 929 individuals in 42 cohorts. The Data Portal is an end-to-end data management solution providing a secure, fully auditable, remote access environment for the analysis of cohort data. All projects utilising the data are by default collaborations with the cohort research teams generating the data. The Data Portal uses UK Secure eResearch Platform infrastructure to provide three core utilities: data discovery, access, and analysis. These are delivered using a 7 layered architecture comprising: data ingestion, data curation, platform interoperability, data discovery, access brokerage, data analysis and knowledge preservation. Automated, streamlined, and standardised procedures reduce the administrative burden for all stakeholders, particularly for requests involving multiple independent datasets, where a single request may be forwarded to multiple data controllers. Researchers are provided with their own secure ‘lab’ using VMware which is accessed using two factor authentication. Over the last 2 years, 160 project proposals involving 579 individual cohort data access requests were received. These were received from 268 applicants spanning 72 institutions (56 academic, 13 commercial, 3 government) in 16 countries with 84 requests involving multiple cohorts. Projects are varied including multi-modal, machine learning, and Mendelian randomisation analyses. Data access is usually free at point of use although a small number of cohorts require a data access fee

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Visuomotor integration deficits precede clinical onset in Huntington's disease.

OBJECTIVES: Visuomotor integration deficits have been documented in Huntington disease (HD), with disproportionately more impairment when direct visual feedback is unavailable. Visuomotor integration under direct and indirect visual feedback conditions has not been investigated in the stage before clinical onset ('premanifest'). However, given evidence of posterior cortical atrophy in premanifest HD, we predicted visuomotor integration would be adversely affected, with greater impairment under conditions of indirect visual feedback. METHODS: 239 subjects with the HD CAG expansion, ranging from more than a decade before predicted clinical onset until early stage disease, and 122 controls, completed a circle-tracing task, which included both direct and indirect visual feedback conditions. Measures included accuracy, speed, and speed of error detection and correction. Using brain images acquired with 3T magnetic resonance imaging (MRI), we generated grey and white matter volumes with voxel-based morphometry, and analyzed correlations with circle-tracing performance. RESULTS: Compared with controls, early HD was associated with lower accuracy and slower performance in both circle-tracing conditions. Premanifest HD was associated with lower accuracy in both conditions and fewer rotations in the direct condition. Comparing performance in the indirect condition with the direct condition, HD gene expansion-carriers exhibited a disproportionate increase in errors relative to controls. Premanifest and early HD groups required longer to detect and correct errors, especially in the indirect condition. Slower performance in the indirect condition was associated with lower grey matter volumes in the left somatosensory cortex in VBM analyses. CONCLUSIONS: Visuomotor integration deficits are evident many years before the clinical onset of HD, with deficits in speed, accuracy, and speed of error detection and correction. The visuomotor transformation demands of the indirect condition result in a disproportionate decrease in accuracy in the HD groups. Slower performance under indirect visual feedback was associated with atrophy of the left-hemisphere somatosensory cortex, which may reflect the proprioceptive demands of the task