Detecting
pain in infants and children | understanding a matriarchy
|
treating severe depression
| preparing
troops to train with simulated situations.
New Pain Scale "Fifth Vital
Sign" for Babies
Not
all babies--or children--cry when they're hurt, so how can you be
sure an infant is not in pain? Particularly if they have an undetected
ailment or undergo routine but uncomfortable hospital procedures
such as drawing blood or circumcision.
Penn
researchers are investigating the usefulness of a pain scale which
they now consider "the fifth vital sign" with newborns
in hospital nurseries, said nursing professor Dr. Marilyn Stringer.
The
assessment tool, Neonatal Infant Pain Scale (NIPS), looks at factors
including facial expression, crying, altered breathing (is it quickened
or shallow), arm movement (flailing), leg movement (twitching, kicking),
and state of arousal (can they be awakened).
"Historically,
we haven't known how to assess pain in our tiniest patients,"
Dr. Stringer said. "With this tool, we are collecting data
on how to better detect and manage the pain of infants because they
can't tell us what hurts. By doing so, we expect to catch some potentially
serious conditions earlier with better outcomes for babies-and their
families."
Parents,
too, can look for these same signs in their children. "By careful
observation of subtle changes in patient appearances, nurses are
often the first care provider to assess that something isn't right
with this baby," Dr. Stringer said. "By looking at these
same factors, parents can become astute observers of their babies'
symptoms in order to report them in a meaningful way to their family
physician if they become concerned."
Detecting
pain in infants and children | understanding a matriarchy
|
treating severe depression
| preparing
troops to train with simulated situations.
Minangkabau of Indonesia: Alternative
Social System
For
the last century, historians, anthropologists and other scholars
have searched both human history and the continents to find a matriarchy--a
society where the power was in the hands of women, not men. Most
have concluded that a genuine matriarchy does not exist, perhaps
may never have existed.
Anthropologist
Dr. Peggy Reeves Sanday disagrees. After years of research among
the Minangkabau people of West Sumatra, Indonesia, she has accepted
that group's own self-labeling, as a "matriarchate," or
matriarchy. The problem, she asserts, lies in Western cultural notions
of what a matriarchy "should" look like--patriarchy's
female-twin.
"Too
many anthropologists have been looking for a society where women
rule the affairs of everyday life, including government," she
said. "That template--and a singular, Western perspective on
power--doesn't fit very well when you're looking at non-Western
cultures like the Minangkabau. In West Sumatra, males and females
relate more like partners for the common good than like competitors
ruled by egocentric self-interest. Social prestige accrues to those
who promote good relations by following the dictates of custom and
religion."
Dr.
Sanday decided to propose a new definition of matriarchy after living
for an extended period with the Minangkabau. The R. Jean Brownlee
Endowed Term Professor of Anthropology at Penn, and Consulting Curator
at the University of Pennsylvania Museum of Archaeology and Anthropology
(UPM), she has spent most of the last 21 summers and some sabbaticals
living in a Minangkabau village, conducting research supported in
part by the Museum.
Today,
four million Minangkabau, one of the largest ethnic groups in Indonesia,
live in the highlands of the province of West Sumatra. Their society,
Dr. Sanday discovered, is founded on the coexistence of matrilineal
custom and a nature-based philosophy called adat.
The
key to Minangkabau matriarchy, according to Dr. Sanday, is found
in the ever-present adat idea expressed in the proverb "growth
in nature must be a teacher." "One must nurture growth
in humans, animals, and plants so that society will be strong,"
people told her.
The
power of Minangkabau women extends to the economic and social realms.
Women control land inheritance and husbands move into the households
of their wives. Unlike many other societies in which anthropologists
say women are exchanged between families at marriage, in this society
men are exchanged. During the wedding ceremony the wife collects
her husband from his household and, with her female relatives, brings
him back to her household to live. In the event of a divorce the
husband collects his clothes and leaves.
Yet, despite the special position women are accorded in the
society, the Minangkabau matriarchy is not the equivalent
of female rule.
"Neither
male nor female rule is possible because of the Minangkabau belief
that decision-making should be by consensus," Dr. Sanday said.
"In answer to my persistent questions about who rules,'
I was often told that I was asking the wrong question. Neither sex
rules, it was explained to me, because males and females complement
one another. As with everything else, the Minangkabau have a proverb
to describe the partnership relationship between the sexes: Like
the skin and nail of the fingertip.'"
Detecting
pain in infants and children | understanding a matriarchy
|
treating severe depression
| preparing
troops to train with simulated situations.
Cognitive Therapy as Effective
as Drugs
A
new study indicates that cognitive therapy is at least as effective
as medication for long-term treatment of severe depression, and
it is less expensive. The findings, by researchers at Penn and Vanderbilt
University, undercut opinions now held by many in the psychiatric
profession.
Principal
investigators, Dr. Robert J. DeRubeis of Penn and Dr. Steven D.
Hollon of Vanderbilt and their colleagues presented the work at
the annual conference of the American Psychiatric Association in
Philadelphia.
"This
will be a surprising, controversial finding for many psychiatric
professionals," said Dr. DeRubeis, professor and chair of psychology
at Penn. "Most believe quite strongly in the efficacy of medication,
and psychiatric treatment guidelines call unequivocally for medication
in cases of severe depression."
Compared
to past research on severely depressed patients--those depressed
nearly enough to require hospitalization--Dr. DeRubeis and Dr. Hollon's
study was unusually comprehensive in its size, 240 patients in Philadelphia
and Nashville, and in its duration, 16 months.
The
study involved a four-month period of acute treatment followed by
an additional year of treatment for those who showed improvement
in the initial phase. Among those who continued into the second
phase of the study, 75 percent of patients who underwent cognitive
therapy avoided a relapse, compared to 60 percent of patients on
medication and 19 percent of those receiving a placebo pill.
"Statistically,
both cognitive therapy and medication were more effective than a
placebo, and a brief course of cognitive therapy was better than
a similarly brief course of medication in the yearlong continuation
phase," Dr. DeRubeis said. "These results suggest that
even after termination, a brief course of cognitive therapy may
offer enduring protection comparable to that provided by ongoing
medication."
Drs.
DeRubeis, Hollon and colleagues also found that cognitive therapy
enjoys a long-term cost benefit compared to drugs. During the 16
months, treatment with medication cost an average of $2,590, compared
with $2,250 for cognitive therapy. This gap grew with time, since
antidepressants must be administered continually to be effective.
Dr.
DeRubeis and Dr. Hollon's colleagues in the study include Jay D.
Amsterdam and John P. O'Reardon of the Department of Psychiatry
in Penn's School of Medicine; Paula R. Young, formerly of Penn's
Department of Psychiatry; and Richard C. Shelton, Ronald M. Solomon
and Margaret L. Lovett of Vanderbilt's Department of Psychiatry.
The study was funded by the National Institute of Mental Health
and GlaxoSmithKline.
Detecting
pain in infants and children | understanding a matriarchy
|
treating severe depression
| preparing
troops to train with simulated situations.
Next-Generation Training: Part
Technology, Psychology
American
troops may soon prepare for their assignments by pitting themselves
against virtual "mobs" and "terrorists" developed
by computer scientists at Penn.
The
goal of the project, rooted in studies by social scientists, is
computer-generated figures that mimic the complex behavior of real-life
adversaries. Dr. Barry G. Silverman, professor of systems engineering
and computer and information science at Penn, and lead researcher
on the three-year effort, presented a behavioral framework for the
training system at the annual Computer-Generated Forces and Behavioral
Representation Conference in Orlando, Florida.
Dr.
Silverman's crowd-modeling work will offer detail to the level of
single provocateurs within a crowd, taking into account, for instance,
young agitators' frequent desire to assert themselves, dominate
conflicts and avenge wrongs. The simulation can model terrorist
behavior based upon observations of extremists' sense of commitment,
feelings of competence and need to right perceived injustices.
Dr.
Silverman's work will permit troops to face a host of virtual opponents
before deploying. Recruits could find themselves facing mobs of
women and children throwing rocks, rogue armies of disaffected teens
tormenting ethnic minorities or protesters cowed into submission
by nothing more than planes whizzing overhead. With news crews infiltrating
zones of conflict around the world, peacekeepers-in-training may
even have to make decisions as photographers record their behavior.
The
simulation will steer trainees away from behaviors that research
has shown to contribute to crowd aggression, such as the flaunting
of weapons, authoritarian governance, the use of barricades and
the exaggeration of differences between groups.
Dr.
Silverman's work is supported by a three-year, $1.4 million grant
from the Pentagon's Defense Modeling and Simulation Office. At Penn,
his group includes Michael Johns of the Human Modeling and Simulation
Lab, Kevin O'Brien and Jason Cornwell of the Ackoff Center for Advancement
of Systems Approaches and Ransom Weaver of the Department of Asian
and Middle Eastern Studies.
Detecting
pain in infants and children | understanding a matriarchy
|
treating severe depression
| preparing
troops to train with simulated situations.
Almanac, Vol. 48, No. 35, May 28, 2002
|