Psychological Factors in Evaluation and Treatment of Diabetes

Both type 1 and type 2 diabetes are increasing in incidence world-wide and being diagnosed at earlier ages. Despite advances in medical treatments and technologies, most patients do not attain optimal glycemic control, many are not on intensified insulin regimens, regimen adherence problems are common, and significant diabetes-related morbidity contributes to reduced quality of life, early mortality, and substantial heath care costs to society. This presentation summarizes research on psychological problems among adults with diabetes. Studies indicate that depression, anxiety, and eating disorders are common and associated with increased risk for metabolic control problems. Research also indicates that neurocognitive problems may develop in older adults with chronic poor glycemic control. Cognitive behavior therapy has been shown to improve outcomes for patients with psychological problems, and intervention research to increase patient empowerment has also demonstrated improved patient outcomes in terms of both quality of life and glycemic control. Future research needs and recommendations for clinical care are discussed. The patient-centered chronic care model is described as a skillful approach to increase the probability of successful management of psychological problems in adults with diabetes.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

The Use of Procalcitonin Monitoring in Critically Ill Adults for Early Identification and Treatment of Sepsis

Sepsis is the leading cause of death in critically ill and rapidness of identification is crucial to prevent circulatory collapse, multisystem organ failure, and death. The International Surviving Sepsis Guidelines supports the early implementation of empiric antimicrobial therapy. The inappropriate use or overuse of antimicrobials results in increased antibiotic resistance, increased healthcare costs, adverse drug events, and antibiotic-induced colitis. The use of a biomarker specific to bacterial sepsis would allow the clinician to diagnose sepsis early and monitor response to antimicrobial therapy, understanding the need to escalate, descalate, or discontinue therapy. Procalcitonin has been proposed as such specific biomarker; able to differentiate sepsis syndrome from systemic inflammatory response. Studies to date show mixed results regarding the effectiveness of procalcitonin to identify, stage, and monitor response to treatment of sepsis. Procalcitonin is not a gold standard in the diagnosis of sepsis; however, it is an important adjunct to other physiological clinical markers

Civil Procedure—Summary Judgment Granted Where Issues, Although Formal, Were Not Substantial And Fairly Arguable

Senrow Concessions, Inc. v. Shelton Properties, Inc., 10 N.Y.2d 320, 178 N.E.2d 726, 222 N.Y.S.2d 329 (1961)

Civil Procedure—Rules Of Civil Practice—Automatic Dismissal Of Action Marked Off Calendar and Not Restored Within One Year, Ineffective Where Litigation Was Actually In Progress

Marco v. Sacks, 10 N.Y.2d 542, 181 N.E.2d 392, 226 N.Y.S.2d 353 (1962)

The Girl That I\u27ve Had In Mind

https://digitalcommons.library.umaine.edu/mmb-vp/5400/thumbnail.jp

Associative mechanisms involved in specific Pavlovian-to-instrumental transfer (PIT) in human learning tasks

Four experiments compared the effect of forward and backward conditioning procedures on the ability of conditioned stimuli (CSs) to elevate instrumental responding in a Pavlovian-to-instrumental transfer (PIT) task. Two responses were each trained with one distinct outcome (R1->O1, R2->O2), either concurrently (Experiment 1) or separately (Experiments 2, 3 and 4). Then, in Experiments 1 and 2, four CSs were either followed or preceded by one outcome (A->O1, B->O2, O1->C, O2->D). In Experiment 3 each CS was preceded and followed by an outcome: for one group of participants both outcomes were identical (e.g., O1->A->O1, O2->B->O2), but for the other they were different (e.g., O1->A->O2, O2->B->O1). In Experiment 4 two CSs were preceded and followed by identical outcomes, and two CSs by different outcomes. In the PIT tests participants performed R1 and R2 in the presence and absence of the CSs. In Experiments 1 and 2 only the CSs followed by outcomes in Pavlovian training elevated responding. In Experiments 3 and 4 all the CSs elevated responding but based on the outcome that followed them in training. These results support the stimulusoutcome-response (S-O-R) mechanism of specific PIT, according to which CSs elevate responding via activation of its associated outcome representation

Rats distinguish between absence of events and lack of evidence in contingency learning.

The goal of three experiments was to study whether rats are aware of the difference between absence of events and lack of evidence. We used a Pavlovian extinction paradigm in which lights consistently signaling sucrose were suddenly paired with the absence of sucrose. The crucial manipulation involved the absent outcomes in the extinction phase. Whereas in the Cover conditions, access to the drinking receptacle was blocked by a metal plate, in the No Cover conditions, the drinking receptacle was accessible. The Test phase showed that in the Cover conditions, the measured expectancies of sucrose were clearly at a higher level than in the No Cover conditions. We compare two competing theories potentially explaining the findings. A cognitive theory interprets the observed effect as evidence that the rats were able to understand that the cover blocked informational access to the outcome information, and therefore the changed learning input did not necessarily signify a change of the underlying contingency in the world. An alternative associationist account, renewal theory, might instead explain the relative sparing of extinction in the Cover condition as a consequence of context change. We discuss the merits of both theories as accounts of our data and conclude that the cognitive explanation is in this case preferred