Case Example (case + example)

Distribution by Scientific Domains

Selected Abstracts


BIOETHICS, Issue 8 2008
ABSTRACT The current ethical structure for collaborative international health research stems largely from developed countries' standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country. [source]

The Role of Surface Water Drainage in Environmental Change: a Case Example of the Upper South East of South Australia; an Historical Review

Kathryn H. Taffs
The role of surface water drainage in environmental change in Australia is rarely appreciated. Drains can modify surface water hydrology, not only altering flow regimes but also rapidly dispersing contaminants and altering the natural hydrological balance of associated flora and fauna. Yet drainage continues to be considered a viable management strategy rather than as a cause of land degradation. The impact of surface water drainage in an inherently saline area of South Australia, the Upper South East, is investigated. Surface water drains were constructed by developers in an attempt to increase the area of land available and viable for agricultural land use. Drainage strategies altered the natural direction, magnitude and frequency of surface water flow. The Upper South East has experienced periods of both increased surface water and flooding, and surface water deficit, in the past one hundred years. The region now receives less surface water than under pre-European conditions, but local runoff is channelled into and through the wetlands more rapidly than before European settlement. Future management strategies are likely to continue this trend, to the detriment of remnant natural wetlands. [source]

Multisystemic Therapy (MST) for Youth Offending, Psychiatric Disorder and Substance Abuse: Case Examples from a UK MST Team

Charles Wells
Background:, The paper illustrates the MST treatment model with three types of presenting problem in young people aged 14,15. Method:, The MST model is described and then illustrated with detailed case material from a violent young person convicted of robbery, a young person with a history of serious self-harming behaviour and hospitalisation, and a young person persistently smoking cannabis. Results:, All three cases improved after the MST intervention despite disparate presenting problems that included re-offending, the elimination of self-harming behaviour and a significant reduction in the use of cannabis. The three young people were re-integrated into the education system. Conclusion:, This case series illustrates the potential uses of the MST model in CAMHS although RCT data are needed to replicate the effectiveness of MST in the British context. [source]

What Does It Mean to Be Relational?

FAMILY PROCESS, Issue 4 2006
A Framework for Assessment, Practice
The authors begin with a question regarding how to better draw upon relational thinking in making case assessments and treatment plans. They first address issues regarding the cultural construction of self and relationships, integrating women's psychology, family systems, and collectivist culture literatures within a discussion of power. Then they present a heuristic framework for how individuals orient themselves within relationships that includes two dimensions,focus and power,and evolves out of the social context. From these two dimensions, a typology of four basic relational orientations is presented: position directed, rule directed, independence directed, and relationship directed. Case examples from couple's therapy and suggestions for practice are provided. [source]

A Modeling Framework for Supply Chain Simulation: Opportunities for Improved Decision Making,

D. J. Van Der Zee
ABSTRACT Owing to its inherent modeling flexibility, simulation is often regarded as the proper means for supporting decision making on supply chain design. The ultimate success of supply chain simulation, however, is determined by a combination of the analyst's skills, the chain members' involvement, and the modeling capabilities of the simulation tool. This combination should provide the basis for a realistic simulation model, which is both transparent and complete. The need for transparency is especially strong for supply chains as they involve (semi)autonomous parties each having their own objectives. Mutual trust and model effectiveness are strongly influenced by the degree of completeness of each party's insight into the key decision variables. Ideally, visual interactive simulation models present an important communicative means for realizing the required overview and insight. Unfortunately, most models strongly focus on physical transactions, leaving key decision variables implicit for some or all of the parties involved. This especially applies to control structures, that is, the managers or systems responsible for control, their activities and their mutual attuning of these activities. Control elements are, for example, dispersed over the model, are not visualized, or form part of the time-indexed scheduling of events. In this article, we propose an alternative approach that explicitly addresses the modeling of control structures. First, we will conduct a literature survey with the aim of listing simulation model qualities essential for supporting successful decision making on supply chain design. Next, we use this insight to define an object-oriented modeling framework that facilitates supply chain simulation in a more realistic manner. This framework is meant to contribute to improved decision making in terms of recognizing and understanding opportunities for improved supply chain design. Finally, the use of the framework is illustrated by a case example concerning a supply chain for chilled salads. [source]

The causes, consequences and detection of publication bias in psychiatry

Simon M. Gilbody
Objective: Publication bias threatens the validity of published research, although this topic has received little attention in psychiatry. The purpose of this article is to produce a systematic overview of the causes and consequences of publication bias and to summarize the available methods with which it is detected and corrected. Method: Empirical evidence for the existence of publication bias is reviewed and the following methods are applied to an illustrative case example from psychiatry: funnel plot analysis; the ,file drawer method'; linear regression techniques; rank correlation; ,trim and fill'. Results: Small studies are particularly susceptible to publication and related bias. All methods to detect publication bias depend upon the availability of a number of individual studies with a range of sample sizes. Unfortunately, large numbers of studies of varying sample size are not always available in many areas of psychiatric research. Conclusion: Where possible researchers should always test for the presence of publication bias. The problem of publication bias will not be solved by anything other than a prospective trials register. [source]

Development of an Intelligent Data-Mining System for a Dispersed Manufacturing Network

EXPERT SYSTEMS, Issue 4 2001
H.C.W. Lau
Recent advances related to on-line analytical processing (OLAP) have resulted in a significant improvement in data analysis efficiency by virtue of its multidimensional database structure and pre-computing operations of measuring data. However, the research related to the design and implementation of OLAP, particularly in the support of dispersed manufacturing networks in terms of ,intelligent decision making', has yet to be considered as remarkable. Research studies indicate that the level of intelligence of decision support systems can be enhanced with the incorporation of computational intelligence techniques such as case-based reasoning or rule-based reasoning. This paper describes the development of an intelligent data-mining system using a rule-based OLAP approach which can be adopted to support dispersed manufacturing networks in terms of performance enhancement. In this paper, the techniques, methods and infrastructure for the development of such a data-mining system, which possesses certain intelligent features, are presented. To validate the feasibility of this approach, a case example related to the testing of the approach in an emulated industrial environment is covered. [source]

A fuzzy analytic hierarchy process approach in modular product design

EXPERT SYSTEMS, Issue 1 2001
W.B Lee
Product development stages. The analytic hierarchy process (AHP), which breaks down a complex problem into simple hierarchical decision-making processes, can be incorporated with fuzzy logic to suggest the relative strength of the factors in the corresponding criteria, thereby enabling the construction of a fuzzy judgement matrix to facilitate decision-making. This paper proposes a fuzzy AHP approach in modular product design complemented with a case example to validate its feasibility in a real company. Test findings indicate that the approach is helpful for providing key decision support information in terms of product module selection during product development stages. The significance of the contribution of this paper is the suggestion of a novel approach in modular product design, embracing a combination of computational intelligence and traditional techniques, thereby providing more alternatives and ideas for those researchers who are interested in this field of study. [source]

Clinical use of the adult attachment interview in parent,infant psychotherapy

Miriam Steele
This article provides an illustration of how the use of the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) can be extended beyond the research arena to its use as a clinical instrument in parent,infant psychotherapy. The article is based on the ongoing work of the Parent,Infant Project team at the Anna Freud Centre, London, where psychoanalytically trained therapists routinely administer the AAI early in the therapeutic process. In the first part of the article, we introduce the thinking behind the use of the AAI as a clinical tool and its particular relevance to the field of parent,infant psychotherapy. In the second part, we track the accruing clinical picture built up from a case example of the initial clinical sessions with a father who attended the Parent,Infant Project with his partner and two young children, and from the father's AAI. The discussion of the AAI material illustrates the distinct, yet related, interpretations of the parent,infant psychotherapist and the independent AAI coder as each made sense of the father's interview transcript. The resulting dialogue, between the psychodynamic-clinical and the attachment-research based approaches to the AAI, aims to highlight the added value the interview provides to the clinical understanding and process in parent,infant psychotherapy, which may ultimately help bridge the gap between the research and clinical domains. [source]

Practical use of the International Olympic Committee Medical Commission position stand on the female athlete triad: A case example

Roberta Trattner Sherman PhD
Abstract The female athlete triad consists of the interrelated problems of disordered eating, amenorrhea, and osteoporosis, and it is believed to affect female athletes in all sports and at all levels of competition. Objective: The current article highlights the Position Stand on the Female Athlete Triad of the International Olympic Committee's Medical Commission (IOCMC). Method: The literature related to disordered eating, energy availability, amenorrhea, and bone loss in athletes is briefly reviewed. A hypothetical case is presented to illustrate some of the common issues and problems encountered when working with athletes affected by the triad, such as the effect of weight on performance in "thin" sports, coach involvement, sport participation by symptomatic athletes, and treatment resistance/motivation. Results: Strategies recommended by the position stand for managing those issues and problems are presented regarding the referral, evaluation, and treatment phases of the management process. Conclusion: Implications of the position stand are discussed in terms of the IOCMC's endorsement of the athlete's health being primary to her performance. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006 [source]

The Revised Kingston Standardized Cognitive Assessment

Robert W. Hopkins
Abstract The original Kingston Standardized Cognitive Assessment (KSCA) was designed to assess cognitive functioning in the elderly with suspected organic brain damage (i.e. dementia). It was specifically designed to be a relatively quickly administered assessment tool available to mental health professionals who were not trained in specialized cognitive assessment techniques. It was introduced over a decade ago to bridge a gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. Recently, a revision of the KSCA was completed. This revision includes the addition of a word-list memory task with immediate recall, delayed recall and recognition formats, as well as new norms for patients with Alzheimer's disease (AD). The updated norms reflect the abilities of higher-functioning (community-dwelling) patients. In order to facilitate the Revised KSCAs use we have developed a new scoring and analysis form as well as a more comprehensive scoring and administration manual. These changes have resulted in better detection of earlier Alzheimer's disease and use of comparison groups that reflect the changing referral base. The structure of the revised scale and updated normative data are described. An illustrative clinical case example is also provided. Copyright © 2004 John Wiley & Sons, Ltd. [source]

The struggle for methodological orthodoxy in nursing research: The case of mental health

Edward White
ABSTRACT: This paper is not intended as an exhaustive review of contemporary mental health nursing research. Rather, the intention is to explore some of the competing arguments for different methodological approaches in social research, using mental health nursing as a case example. The paper questions the extent to which the artificially dichotomized debate over quantitative versus qualitative research impacts upon the working lives of practitioners, managers and policy makers. In particular, the paper traces the development of survey method, during this its centennial anniversary year. It also traces its subsequent decline, in favour of what will be referred to as the new methodological orthodoxy in nursing research. It is also interwoven with occasional accounts of personal experience, drawn from an international perspective. The paper calls for a rapprochement between different wings of methodological opinion, in deference to a publicly unified position for nursing research in which the achievement of quality becomes the over-arching concern. [source]

Prescription Duration After Drug Copay Changes in Older People: Methodological Aspects

Sebastian Schneeweiss MD
OBJECTIVES: Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to healthcare planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization measures after drug policy changes when relying on pharmacy dispensing data. Reference pricing, a copayment for expensive medications above a fixed limit, for angiotensin-converting enzyme (ACE) inhibitors in older British Columbia residents, is used as a case example. DESIGN: Time series of 36 months of individual claims data. Longitudinal data analysis, adjusting for autoregressive data. SETTING: Pharmacare, the drug benefits program covering all patients aged 65 and older in the province of British Columbia, Canada. PARTICIPANTS: All noninstitutionalized Pharmacare beneficiaries aged 65 and older who used ACE inhibitors between 1995 and 1997 (N = 119,074). INTERVENTION: The introduction of reference drug pricing for ACE inhibitors for patients aged 65 and older. MEASUREMENTS: Timing and quantity of drug use from a claims database. RESULTS: We observed a transitional sharp decline of 11%± a standard error of 3% (P = .02) in the overall utilization rate of all ACE inhibitors after the policy implementation; five months later, utilization rates had increased, but remained under the predicted prepolicy trend. Coinciding with the sharp decrease, we observed a reduction in prescription duration by 31% in patients switching to no-cost drugs. This reduction may be attributed to increased monitoring for intolerance or treatment failure in switchers, which in turn led to a spurious reduction in total drug utilization. We ruled out the extension of medication use over the prescribed duration through reduced daily doses (prescription stretching) by a quantity-adjusted analysis of prescription duration. CONCLUSION: The analysis of prescription duration after drug policy interventions may provide alternative explanations to apparent short-term reductions in drug utilization and adds important insights to time trend analyses of drug utilization data in the evaluation of drug benefit policy changes. J Am Geriatr Soc 50:521,525, 2002. [source]

Behavioral treatment of substance abuse in schizophrenia

Wendy N. Tenhula
Abstract Co-occurring substance use disorders are highly prevalent among individuals with schizophrenia and other serious and persistent mental illnesses (SPMI) and are associated with clinically significant consequences. A multifaceted behavioral treatment called Behavioral Treatment for Substance Abuse in Serious and Persistent Mental Illness (BTSAS) can reduce substance abuse in persons with SPMI. The key treatment strategies in BTSAS include a urinalysis contingency, short-term goal setting, training in drug refusal skills, psychoeducation about the impact of drug use, and relapse prevention training. A case example illustrating the application of BTSAS is presented and relevant clinical issues are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1,11, 2009. [source]

Clinical assessment of self-injury: A practical guide

Barent Walsh
In this article, the author provides a practice-friendly guide to the psychological assessment of self-injury, such as self-inflicted cutting, burning, hitting, and excoriation of wounds. The crucial distinction between self-injury and suicide is emphasized. The author presents a structure for the assessment of self-injury that focuses first on the therapeutic relationship, and thereafter on the history and specifics of the behavior, its intrapersonal and interpersonal functions, and its antecedents and consequences. Types of self-injury that are atypical, and especially alarming, are identified. A case example illustrates both the style and content of a thorough assessment. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1057,1068, 2007. [source]

Novel tools and resources for evidence-based practice in psychology

Barbara B. Walker
Given the vast proliferation of scientific research in the behavioral and social sciences, there is a growing need for psychologists to be able to access the most current, clinically relevant research quickly and efficiently and integrate this information into patient care. In response to a similar need within the field of medicine, evidence-based medicine took hold in the early 1990s to provide both a framework and set of skills for translating research into practice. Since then, this method has been adopted by every major health care profession including psychology, and is now widely known as evidence-based practice (EBP). In this article, the authors present a general overview of the skills required for EBP along with an introduction to some of the tools and resources that have been developed in other health care professions to support EBP. Using a case example, we illustrate how these tools and resources can be applied in psychological settings. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 633,642, 2007. [source]

Tailoring cognitive-behavioral therapy for chronic pain: A case example

Alicia A. Heapy
Cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for chronic pain. However, many patients who might benefit from this treatment either refuse treatment, fail to adhere to treatment recommendations, or drop out prematurely. Adherence to and engagement in CBT for chronic pain might be improved by tailoring a limited number of its components to individual preferences. Motivational interviewing, in which the therapist facilitates the patient's motivation for changing behavior, might also promote CBT engagement and adherence. We describe components of a tailored CBT treatment for chronic pain in the context of ongoing research and illustrate the process of tailoring CBT with a case study. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 1345,1354, 2006. [source]

Using the Conformity to Masculine Norms Inventory to work with men in a clinical setting

James R. Mahalik
Given that gender roles are increasingly viewed as salient in clinical work with men, this article describes a process of exploring masculine gender roles with male clients in therapy by using the Conformity to Masculine Norms Inventory (CMNI). Specifically, this article (a) discusses how men's degree of conformity to masculine norms may be connected to a variety of benefits and costs, (b) describes the CMNI as a tool that can be used to explore men's degree of conformity to masculine norms, (c) describes a process by which to use the CMNI to explore the relevance of men's masculine selves to their presenting concerns, and (d) illustrates the process with a case example. As such, the paper is intended to provide a systematic procedure for clinicians working with men who want to explore the benefits and costs that both conformity, and nonconformity, to specific masculinity norms brings for male clients. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 661,674, 2005. [source]

Treatment of obsessive-compulsive disorder in patients who have comorbid major depression

Jonathan S. Abramowitz
Many patients who have obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses such as mood, anxiety, and personality disorders. The presence of severe depression, and major depressive disorder per se, impedes response to treatment for OCD that uses the best available treatments. In this article, the comorbidity data in OCD are reviewed, then the relationship between depression and OCD treatment outcome is reviewed. Next, the derivation and implementation of a treatment program specifically for depressed OCD patients are illustrated with a case example. The article closes with a discussion of implications and directions gleaned from this single case study. © 2004 Wiley Periodicals, Inc. J Clin Psychol/In Session. [source]

Chronic illness as a family process: A social-developmental approach to promoting resilience

Ester R. Shapiro
This paper describes a social-developmental approach to interventions in chronic illness using naturally occurring processes of change during family life-cycle transitions to promote more positive developmental outcomes. Clinical interventions can help build resilience by creating a therapeutic collaboration designed to help patients improve their use of existing and new resources in multiple systems. They can then better meet demands of the illness as it impacts on shared development. A case example of a 13-year-old daughter with complex, chronic health problems and developmental disabilities illustrates clinical interventions designed to promote family resilience during the entry into adolescence and a transition in schooling. This approach involves focusing on the family's own definition of the current problem and relevant history, constructing a multidimensional, coherent story of the illness and its impact that recognizes stressors yet highlights strengths, and normalizing their strategies for stability under circumstances of developmental stress. These interventions with mother, daughter, and family helped improve health efficacy, communication toward mutual understanding and shared problem solving, and better use of existing and new resources to enhance current and future developmental adaptation. © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 1375,1384, 2002. [source]

Treating chronic-pain patients in psychotherapy

Timothy R. Tumlin
This article provides an overview of the breadth of issues a therapist may face in treating a person with chronic pain. Questions such as the relative contributions of biological and psychosocial influences on the patient's reported condition must be addressed. In addition, the counselor often must help the patient deal with psychopathology that occurs in reaction to the pain, which is likely to be contributing to it. Other financial, medical, and legal circumstances also may impinge on the therapeutic framework to limit or influence the course of treatment. Two examples of treatment lessons are offered, and a case example illustrates the lengthy and multidimensional course some treatments can take. © 2001 John Wiley & Sons, Inc. J Clin Psychol/In Sess 57: 1277,1288, 2001. [source]

The challenges forensic nurses face when their patient is comatose: Addressing the needs of our most vulnerable patient population

Jennifer Pierce-Weeks RN, SANE-A, SANE-P
Abstract Since 1996, the American Nurses Association has recognized forensic nursing as a formal specialty. Despite this recognition, Sexual Assault Nurse Examiners and Emergency Department nurses struggle with incorporating evidence collection into the care they give the unconscious or comatose patient they suspect has been sexually assaulted. Through case example, this article provides an abbreviated review of the circumstances under which these patients present for care, current challenges, and barriers in upholding the standard of forensic nursing care, as well as proposed interventions for the practicing forensic nurse. [source]


Brian Jory
This article describes development of the Intimate Justice Scale (IJS) and reports on a clinical study of the validity, reliability, and clinical usefulness of the instrument. Rather than measuring specific acts of abuse, the IJS measures ethical dynamics of couple relationships, which areevident in patterns of action and attitude expressed over the course of the relationship. Ethical dynamics appear to correlate with partner abuse. The study suggests that the IJS may reliably identify victims of abuse and may discriminate between minor and severe levels of abuse. The IJS can be completed and scored in less than 10 min and may be useful for screening in mental health, medical, and social service agencies. Clinical guidelines and a case example are presented. [source]

Clinical formulation for mental health nursing practice

M. Crowe rn phd
There are problems for mental health nurses in using psychiatric diagnoses as outcomes of their nursing assessments and nursing diagnoses present similar issues. However, there is a need in practice to link the assessment to nursing interventions in a meaningful way. This paper proposes that the clinical formulation can be regarded as central to providing this cohesion. The formulation does not merely organize the assessment findings but is also an interpretation or explanation, made in consultation with the client, of what meaning can be attributed to the issues explored in the assessment process. Because this interpretation is dependent on both the client's and the nurse's explanatory frameworks, there are multiple ways of developing the formulation. It is also an evolving and dynamic statement of understanding. A case example is provided in the paper to illustrate how the same case can be interpreted in different ways and the implications this has for the nursing interventions provided. [source]

Stepping out of the box: broadening the dialogue around the organizational implementation of cognitive behavioural psychotherapy

J. POOLE ba dip nursing (mh)
The dissemination and uptake of cognitive behavioural interventions is central to the evidence-based mental health agenda in Britain. However, some policy and related literature, in and of itself social constructed, tends to display discursive naïvety in assuming a rational basis for the dissemination and organizational integration of cognitive behavioural approaches. Rational constructions fail to acknowledge that the practice settings of key stakeholders in the process are likely to be socially constructed fields of multiple meanings. Within these, the importance of evidence-based interventions may be variously contested or reworked. To illustrate this, a case example from the first author will discuss the hypothetical introduction of a cognitive behavioural group for voice hearers in a forensic mental health unit. This will highlight contradictions and local organizational problems around the effective utilization of postgraduate cognitive behavioural knowledge and skills. A synthesis of social constructionist with organizational theory will be used to make better sense of these actual and anticipated difficulties. From this basis, specific ways in which nurses and supportive stakeholders could move the implementation of cognitive behavioural psychotherapy agenda forward within a postmodern leadership context will be proposed. [source]

A case example of assessment and evaluation: Building capability in a corporate university

Shawn Overcast
One corporate university makes measurement a priority by dedicating resources and assigning responsibilities to a centralized analytics function: the assessment, measurement, and evaluation team. As more measurement became a focus for learning and business leaders alike, the more the team became motivated to take a critical look at how it was approaching assessment, measurement, and evaluation activities and how it could leverage its capabilities, technology, and processes to have a greater reach across the organization. [source]

Managing information sharing within an organizational setting: A social network perspective

John-Paul Hatala
Information sharing is critical to an organization's competitiveness and requires a free flow of information among members if the organization is to remain competitive. A review of the literature on organizational structure and information sharing was conducted to examine the research in this area. A case example illustrates how a social network approach was used to explore the process of measuring the social structure of an organization and the implementation of change interventions to increase connectivity and manage information sharing. The process of conducting social network analysis is described using the case example. Interventions for increasing information flow are discussed. The authors provide an information-sharing model that demonstrates the various domains of connectivity within an organization at any given state. The benefits of using social network analysis for information sharing and the implications for further research and practice are discussed. [source]

Considerations in the identification, assessment, and intervention process for deaf and hard of hearing students with reading difficulties

Donna Gilbertson
Problematic assessment and intervention issues present substantial challenges when making educational decisions for deaf or hard of hearing (D/HH) students who are experiencing reading difficulties. These students present a diverse set of language acquisition skills, hearing ability, and orientation to early school learning activities that are different from the hearing student population. Given the importance of selecting assessment approaches that lead to effective interventions for D/HH students, three assessment procedures for identification of at-risk children and learning disabilities within the D/HH population are examined. Assessments reviewed are teacher referral, norm-referenced testing, and student response to intervention. Challenges to each process and the need for additional assessment and empirically validated treatment options are discussed. Finally, a case example is presented to illustrate a framework that may help school psychologists promote early identification of learning problems and outline interventions that meets a D/HH child's unique needs by focusing on reading outcomes in the curriculum. © 2008 Wiley Periodicals, Inc. [source]

Statistical basis for positive identification in forensic anthropology

Dawnie Wolfe Steadman
Abstract Forensic scientists are often expected to present the likelihood of DNA identifications in US courts based on comparative population data, yet forensic anthropologists tend not to quantify the strength of an osteological identification. Because forensic anthropologists are trained first and foremost as physical anthropologists, they emphasize estimation problems at the expense of evidentiary problems, but this approach must be reexamined. In this paper, the statistical bases for presenting osteological and dental evidence are outlined, using a forensic case as a motivating example. A brief overview of Bayesian statistics is provided, and methods to calculate likelihood ratios for five aspects of the biological profile are demonstrated. This paper emphasizes the definition of appropriate reference samples and of the "population at large," and points out the conceptual differences between them. Several databases are introduced for both reference information and to characterize the "population at large," and new data are compiled to calculate the frequency of specific characters, such as age or fractures, within the "population at large." Despite small individual likelihood ratios for age, sex, and stature in the case example, the power of this approach is that, assuming each likelihood ratio is independent, the product rule can be applied. In this particular example, it is over three million times more likely to obtain the observed osteological and dental data if the identification is correct than if the identification is incorrect. This likelihood ratio is a convincing statistic that can support the forensic anthropologist's opinion on personal identity in court. Am J Phys Anthropol, 2006. © 2006 Wiley-Liss, Inc. [source]

Daimonic elements in early trauma

Donald E. Kalsched
Abstract: This paper explores some of the ,daimonic' elements of unconscious mentation that emerge both in dreams and in the transference/countertransference field with early-trauma patients and illustrates these with an extended clinical example. An archaic and typical (archetypal) ,trauma complex' is articulated (with diagram) as a bi-polar structure consisting of divine child protected and/or persecuted by an inner ,guardian angel'. Sources of this structure and its mythological inner objects are traced to trauma at the stage of what Winnicott calls ,unintegration' and to flooding by dis­integration anxiety at a time before nascent ego-structure has formed. In an extended case example, the author shows how the patient's traumatized innocence and desire for a new start, thwarted by self-attacking defences, pulls him into playing the inflated role of her guardian angel, leading to re-traumatization in the transference. Working through is seen as the necessary disillusionment and humanization of these daimonic structures as they are projected, suffered, and transmuted by the analytic partners in the stormy process of psychotherapy. [source]