ISTDP and Its Contribution to the Understanding and Treatment of Psychotic Disorders.

In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.

Factors affecting household adoption of an evacuation plan in American Samoa after the 2009 earthquake and tsunami.

American Samoa is still recovering from the debilitating consequences of the September 29, 2009 tsunami. Little is known about current household preparedness in American Samoa for future earthquakes and tsunamis. Thus, this study sought to enumerate the number of households with an earthquake and tsunami evacuation plan and to identify predictors of having a household evacuation plan through a post-tsunami survey conducted in July 2011. Members of 300 households were interviewed in twelve villages spread across regions of the principle island of Tutuila. Multiple logistic regression showed that being male, having lived in one's home for < 30 years, and having a friend who suffered damage to his or her home during the 2009 tsunami event increased the likelihood of having a household evacuation plan. The prevalence of tsunami evacuation planning was 35% indicating that survivors might feel that preparation is not necessary given effective adaptive responses during the 2009 event. Results suggest that emergency planners and public health officials should continue with educational outreach to families to spread awareness around the importance of developing plans for future earthquakes and tsunamis to help mitigate human and structural loss from such natural disasters. Additional research is needed to better understand the linkages between pre-event planning and effective evacuation responses as were observed in the 2009 events.

From simulations to automated tutoring.

Training medical personnel to maintain readiness for medical emergencies and combat-related operations is a critical problem. Distance learning solutions are required for enabling effective training while minimizing time away from the important on-the-job duties of providing quality medical care. Simulation-based training can significantly benefit learners by providing opportunities for hands on training. A simulation by itself, however, is not sufficient to enable learning. It must be accompanied by opportunities for reflection and a chance for learners to try their skills under different conditions. This means a simulation-based training course should include several scenarios. The high cost of developing and administering training scenarios renders this infeasible. We have developed a simulation-based training framework called SimCore that incorporates intelligent, automated assessment and coaching in support of self-paced learning. This reduces the need for human facilitators. A key feature of this framework is an authoring tool that supports rapid scenario development and customization and is designed for use by subject matter experts and course developers. This brings down the cost of scenario development. The system has been designed to interface easily with third-party simulators, with minimal effort. It also includes a Flash-based simulator that can be played on a web-browser. A beta version of SimCore is currently being distributed for evaluation.