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A modern assessment of Freud's conceptualization of the creative process focusing on drives, ego psychology, and object relation theory is presented. 40 artists and musicians were interviewed employing 13 open-ended questions to provoke responses historically associated with the theoretical conceptualizations of Freud and post-Freudian theory related to the creative process. Creative process was defined as internal object relations that motivate the external connection between artist and the creative work. Measured responses concerning purpose and understanding; motivation before, during, and after performance; obstacles in performance; and needs through the creative process were assessed. Cluster analysis segregated the participants into high, medium, and low agreement groups based on similarity of responses. A multivariate stepwise regression revealed four questions (enlightenment, drives, obstacles, and ought self discrepancies) accounted for 83.9% of the variance. A post hoc discriminant function analysis identified 82.5% of the population to their correct groups. The findings support Spitz's (2005) suggestion that we regard “drives, ego psychology, and object relation theory not as separate approaches but as parts of a whole with varying stresses or accents” (p. 503).

The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70-89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity - 1,555 counts/minute for men and 1,237 counts/minute for women - was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes “moderate” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

A methodological discrepancy exists in the hydration assessment literature regarding the establishment of euhydration, as some investigations utilize a prehydration technique, while others do not (overnight fluid/food fast). However, the degree that plasma osmolality (Posm) dilutes when using the pre-hydration method and how body mass/composition might influence the results is not known. Thirty subjects (22 M, 8 F; 20 ± 2 years (mean ± SD); 1.8 ± 0.1 m; 75.8 ± 13.5 kg) had P osm measured after an 8-h food and fluid fast (overnight fast) and 90 min after a 500-mL (4-9 mL/kg) water bolus (prehydration). From pre- to post-bolus, participants' P osm declined from 297 ± 3.5 to 295 ± 3.8 mmol/kg (p<0.05; Δ -1.7 ± 3.5 mmol/kg). One-third of the sample diluted to more than -3 mmol/kg. The effect of body mass on P osm dilution was investigated by comparing dilution in the ten lightest (62.8 ± 3.4 kg) and heaviest (92.0 ± 9.8 kg) participants; however, the change between the light (Δ -1.9 ± 3.8 mmol/kg) versus heavy groups (Δ -1.1 ± 3.0 mmol/kg) was not different (p>0.05). The correlation between body mass or total body water and change in P osm was weak (p>0.05), as was the correlation between relative fluid intake based on mass and change in P osm (p>0.05). The two methodologies appear to produce similar P osm values when measured in most individuals. However, the potential for significant dilution (>3 mmol/kg) should be considered when choosing the pre-hydration methodology. © Springer-Verlag (outside the USA) 2011.

Purpose To evaluate baroreflex sensitivity and autonomic control in a cohort of normotensive obese (OB) children. Method A cross-sectional investigation, in which, baroreflex sensitivity and autonomic control were evaluated using transfer function and power spectral density analysis (PSDA) of the electrocardiogram and beat-to-beat blood pressures in normotensive OB children and normal weight normotensive controls. All methods used were noninvasive and data were captured while seated and at rest. Results The OB and control subjects non-obese (NO) were of similar age (OB 9.1 ± 1.9 years vs.NO9.2 ± 1.4 years). The OB group was classified as having a BMI greater than the 95th percentile adjusted for age and gender, and a NO group with a BMI at or less than the 95th percentile (BMI percentile OB. 97.5 ± 1.3 vs. NO 58.5 ± 24.1). Both groups had similar normotensive blood pressures. T tests revealed that baroreflex sensitivity and HFRR were significantly reduced in the OB 9.2 ± 2.7 vs. 15.2 ± 4.7 (ms/mmHg) and 6.7 ± 1.1 vs. 8.2 ± 1.1 ms 2, respectively, while LF SBP and LF/HF ratio were significantly increased in the OB 11.9 ± 5.6 vs. 8.2 ± 4.7 mmHg 2 and 1.2 ± 0.7 vs. 0.54 ± 0.3, respectively. Conclusions Normotensive OB children exhibited significantly reduced baroreflex sensitivity, parasympathetic control as well as increased sympathetic control when compared with healthy, NO controls. Findings in this investigation raise the awareness that autonomic dysfunction is present in young OB normotensive children. © Springer-Verlag 2011.

Using eye-tracking methodology, gaze to a speaking face was compared in a group of children with autism spectrum disorders (ASD) and a group with typical development (TD). Patterns of gaze were observed under three conditions: audiovisual (AV) speech in auditory noise, visual only speech and an AV non-face, non-speech control. Children with ASD looked less to the face of the speaker and fixated less on the speakers' mouth than TD controls. No differences in gaze were reported for the non-face, non-speech control task. Since the mouth holds much of the articulatory information available on the face, these findings suggest that children with ASD may have reduced access to critical linguistic information. This reduced access to visible articulatory information could be a contributor to the communication and language problems exhibited by children with ASD.

Background: The rates of annual visits for adult Medicaid enrollees to the emergency department (ED) are increasing. Many programs throughout the country are focused on engaging patients in the use of their primary care providers (PCP) rather than the ED for low acuity conditions. It is unclear, however, the proportion of patients who are willing to use primary care services rather than the ED if they are given the choice. Methods: Cross-sectional study of adult Medicaid enrollees (18 y and older) presenting to a large, urban, academic ED from June to August 2012 with a low acuity condition was performed. We excluded patients who did not have a PCP or active Medicaid insurance. Our primary goal was to determine the proportion of patients who prefer to use the ED, rather than their PCP clinic, if an appointment was immediately available. Our second goal was to understand why patients would prefer ED over PCP care. Results: A total of 150 patients agreed to complete the survey, and 95 (63.3%) met our inclusion criteria. Forty-three patients (45.3%) stated preferring to use their PCPs rather than the ED if an appointment was available at that time. Thirteen (48.1%) cited that the ED had more technology or specialty care services available when compared with their PCP's clinic, 8 (15.4%) were in significant pain, and 6 (11.5%) felt the care they received in the ED was better than what they would receive in their PCP clinic. Conclusions: Our study shows that a little less than half of adult Medicaid enrollees presenting to the ED with low acuity conditions would have preferred to use their PCP rather than the ED, if an appointment had been immediately available.

Despite prevention efforts of colleges and universities across the nation, there have been no substantial decreases in heavy episodic drinking among undergraduates over the past 2 decades.This study provides an update on correlates of heavy episodic drinking for a recent cohort of undergraduate college students.A cross-sectional survey design was utilized. Participants were randomly selected undergraduate students from a public 4-year university located in the Northeast.Heavy episodic drinking was associated with male gender, white race, having a family history of drug or alcohol abuse, smoking cigarettes, and using marijuana. Age, athlete status, completion of an alcohol education program, condom use, depression, anxiety, and financial stress were not associated. After controlling for gender and race, marijuana use and smoking cigarettes were found to increase predictability of heavy episodic drinking.Rates of heavy episodic drinking remain high but correlates may be shifting for this cohort of college students. Opportunities to address heavy episodic drinking concurrently with cigarette smoking and marijuana use should be explored.Qualitative research methods are needed to gain insight into reasons for heavy episodic drinking; information that could inform the creation of more effective programming. © 2014 Copyright © SHAPE America.

Empirical data support the benefits of physical activity for women who have been diagnosed with breast cancer. However, the experience of exercising during or after breast cancer treatment has not been fully documented. The purpose of the researchers in this study was to provide an in-depth description of women's experiences with exercising during or after their breast cancer treatments, specifically, their perceptions of the benefits they experienced as a result of participation in an individualized exercise program that included cardiovascular and resistance activities. Forty-five women who had been diagnosed with breast cancer within the previous two years were recruited from two oncology practices after electing to enroll in an exercise program. Data were collected between September 2006 and August 2007 through in-depth interviews at various stages in the exercise program and analyzed simultaneously using thematic analysis methods. Whether in treatment or post-treatment, women attributed psychological, physical, and social benefits to their participation in the exercise program. Participants credited the program with helping them to feel better, regain control over their bodies and their lives, manage their emotions, and prepare them to live healthfully going forward. These results provide insight into the specific ways women experience exercise during and after their breast cancer treatments.

Objective: To explore the psychosocial effects of living with polycystic ovary syndrome (PCOS) through the experiences of young women diagnosed with this endocrine disorder. Design: A qualitative, phenomenological methodology was used. Data were obtained through personal, semistructured interviews. Setting: College campuses in New England. Participants: A purposive sample of 12 young women with PCOS age 18 to 23 years. Results: The following themes emerged from analysis of participants' responses: concerns for older self, feeling physically inferior, coping with symptoms, patient-provider relationship, seeking useable information and support, and coming to terms with a chronic condition. Conclusions: Participants in this study faced numerous physical, social, and emotional challenges on a daily basis. As these young women gathered information relevant to their needs, sought and received social support, and maintained their daily routines to improve their health and appearance, they came to terms with this chronic condition. Based on participants' relayed experiences, it became evident that a need exists for health care practitioners to include psychosocial support in a comprehensive holistic plan for the treatment of PCOS in adolescents and young women in their early twenties. JOGNN, 40, 709-718; 2011. DOI: 10.1111/j.1552-6909.2011.01299.x