53 results
An Evaluation of the Prescribing of High Dose Antipsychotic Therapy and Combination Antipsychotic Therapy to Inpatients on the General Adult Wards of Mersey Care NHS Foundation Trust
- Louise Campbell, Harry Holmes, Declan Hyland
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S135-S136
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Aims
High dose antipsychotic therapy (HDAT) is defined as “a total daily dose of a single antipsychotic which exceeds the upper limit stated in the SPC or BNF or a total daily dose of two or more antipsychotics exceeding the SPC or BNF maximum using the percentage method. Previous audits have looked at HDAT on both a national level (the Prescribing Observatory for Mental Health) and within Mersey Care NHS Foundation Trust. This audit aimed to identify the proportion of patients subject to HDAT and review combination antipsychotic strategies and consideration of Clozapine in patients subject to HDAT.
MethodsIn August 2021, data were collected from the eight inpatient wards in Mersey Care NHS Foundation Trust. This involved using the Electronic Prescription and Administration system to identify those prescribed antipsychotics. Following this, the patient's electronic record was scrutinised for documentation of the rationale for HDAT, combination antipsychotics and consideration of Clozapine.
Results129 inpatients were identified as being prescribed antipsychotic medication. 21 (16.3%) patients were prescribed combination antipsychotic therapy, with four of these patients (3.1%) being prescribed HDAT. For these four HDAT patients, there was no recorded documentation of discussion of the option of Clozapine. The most common antipsychotic combination was Paliperidone depot with oral Risperidone. 38 out of 129 (29.5%) patients had been considered for Clozapine. Reasons for Clozapine being refused included the patient declining, concerns about non-concordance with oral medication, patients having had a neutropenia on an FBC, the patient being reluctant to have regular blood tests and a patient's comorbidities.
ConclusionWhen comparing the proportion of patients subject to HDAT (3.1%) to the previous Trust audit in December 2020 (9.1%), there is a recurrent theme that antipsychotic prescribing practice in Mersey Care is safe, with minimal HDAT. Of note, the figure is significantly lower than the proportion of HDAT patients identified in the 2012 national study (28%). In this audit, none of the patients on HDAT had documented consideration of Clozapine. Three of the four patients were soon to be no longer subject to HDAT which may explain this result. Compared to the Trust's HDAT audit in 2020, the percentage of patients on combination antipsychotic therapy has stayed largely the same - 16.3% compared to 17.4%. The Trust needs to strive to continue minimal HDAT prescriptions and ensure that, in those patients subject to HDAT, there is consideration of and documentation of Clozapine being considered.
Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic
- M Shrivastava, C Harris, S Holmes, S Brady, S Winter
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- Journal:
- The Journal of Laryngology & Otology / Volume 137 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 02 March 2022, pp. 213-218
- Print publication:
- February 2023
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Objective
This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies.
MethodA retrospective review of electronic patient records was performed between 2016 and 2020.
ResultsTwenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy.
ConclusionThis study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.
Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single-centre study
- T Layton, R Thomas, C Harris, S Holmes, L Fraser, P Silva, S C Winter
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- Journal:
- The Journal of Laryngology & Otology / Volume 136 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 10 January 2022, pp. 1105-1112
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- November 2022
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Background
Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions.
MethodsThis paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre.
ResultsAnalysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture.
ConclusionPharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.
Cancer Incidence and Mortality in 260,000 Nordic Twins With 30,000 Prospective Cancers
- Axel Skytthe, Jennifer R. Harris, Kamila Czene, Lorelei Mucci, Hans-Olov Adami, Kaare Christensen, Jacob Hjelmborg, Niels V. Holm, Thomas S. Nilsen, Jaakko Kaprio, Eero Pukkala
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- Journal:
- Twin Research and Human Genetics / Volume 22 / Issue 2 / April 2019
- Published online by Cambridge University Press:
- 25 April 2019, pp. 99-107
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The Nordic countries have comprehensive, population-based health and medical registries linkable on individually unique personal identity codes, enabling complete long-term follow-up. The aims of this study were to describe the NorTwinCan cohort established in 2010 and assess whether the cancer mortality and incidence rates among Nordic twins are similar to those in the general population. We analyzed approximately 260,000 same-sexed twins in the nationwide twin registers in Denmark, Finland, Norway and Sweden. Cancer incidence was determined using follow-up through the national cancer registries. We estimated standardized incidence (SIR) and mortality (SMR) ratios with 95% confidence intervals (CI) across country, age, period, follow-up time, sex and zygosity. More than 30,000 malignant neoplasms have occurred among the twins through 2010. Mortality rates among twins were slightly lower than in the general population (SMR 0.96; CI 95% [0.95, 0.97]), but this depends on information about zygosity. Twins have slightly lower cancer incidence rates than the general population, with SIRs of 0.97 (95% CI [0.96, 0.99]) in men and 0.96 (95% CI [0.94, 0.97]) in women. Testicular cancer occurs more often among male twins than singletons (SIR 1.15; 95% CI [1.02, 1.30]), while cancers of the kidney (SIR 0.82; 95% CI [0.76, 0.89]), lung (SIR 0.89; 95% CI [0.85, 0.92]) and colon (SIR 0.90; 95% CI [0.87, 0.94]) occur less often in twins than in the background population. Our findings indicate that the risk of cancer among twins is so similar to the general population that cancer risk factors and estimates of heritability derived from the Nordic twin registers are generalizable to the background populations.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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How heritable is individual susceptibility to death? The results of an analysis of survival data on Danish, Swedish and Finnish twins
- Ivan A Iachine, Niels V Holm, Jennifer R Harris, Alexander Z Begun, Maria K Iachina, Markku Laitinen, Jaakko Kaprio, Anatoli I Yashin
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- Twin Research / Volume 1 / Issue 4 / 01 August 1998
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- 21 February 2012, pp. 196-205
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Molecular epidemiological studies confirm a substantial contribution of individual genes to variability in susceptibility to disease and death for humans. To evaluate the contribution of all genes to susceptibility and to estimate individual survival characteristics, survival data on related individuals (eg twins or other relatives) are needed. Correlated gamma-frailty models of bivariate survival are used in a joint analysis of survival data on more than 31 000 pairs of Danish, Swedish and Finnish male and female twins using the maximum likelihood method. Additive decomposition of frailty into genetic and environmental components is used to estimate heritability in frailty. The estimate of the standard deviation of frailty from the pooled data is about 1.5. The hypothesis that variance in frailty and correlations of frailty for twins are similar in the data from all three countries is accepted. The estimate of narrow-sense heritability in frailty is about 0.5. The age trajectories of individual hazards are evaluated for all three populations of twins and both sexes. The results of our analysis confirm the presence of genetic infiuences on individual frailty and longevity. They also suggest that the mechanism of these genetic infiuences may be similar for the three Scandinavian countries. Furthermore, results indicate that the increase in individual hazard with age is more rapid than predicted by traditional demographic life tables.
Entry #12 - Iterated Prisoner's Dilemma: United We Stand, Divided We Fall
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 271-284
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Summary
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The single-trial Prisoner's Dilemma, discussed in Entry #5, is defined by the conflict between self-interest (“me”) and joint interest (“we”). An individual is always better off choosing a noncooperative option, irrespective of the partner's behavior, even though the cooperative choice is preferable from a dyadic standpoint. Choices in the “classic” case of the single-trial Prisoner's Dilemma, involving simultaneous and irrevocable choice (as in the story from which the situation takes its name), are unlikely to be influenced by past interactions or future goals. In contrast, in Iterated Prisoner's Dilemmas, behavior is likely to be affected by prior interactions and considerations regarding future interactions with the partner. This is true even when the choices at each point are simultaneous and irrevocable. The persons become able to react contingently to each other's prior behaviors and, therefore, to develop strategies for influencing each other's behavior. For example, a person is unlikely to prepare extensively for a joint working meeting if she knows that her colleague has repeatedly slacked off before in past meetings. On the other hand, a person may devote greater time and effort preparing for a joint task when anticipating future shared endeavors in order to motivate the other to enhance her performance in the future.
Iterated Prisoner's Dilemmas are common in everyday life (and are considerably more common than the single-trial Prisoner's Dilemma).
Incomplete Information Situations
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 323-324
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2 - Outcome Interdependence
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 17-50
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Summary
A “situation” is defined in the dictionary as “a position with respect to conditions and circumstances,” or, more generally, as a “site” or “problem.” These introductory chapters describe how, in keeping with that definition, we describe and distinguish among situations involving several persons, that is, interpersonal situations. In this chapter, we give concrete examples of a simple yet useful method for characterizing such situations, namely, the “outcome matrix,” and explain the rationale for its use. We then show the implications of that method as well as some of its limitations. Chapter 3 describes our remedies for those limitations.
This Atlas is based on a particular theory known as “interdependence theory.” It was first presented by Thibaut and Kelley (1959) and then elaborated in Kelley and Thibaut (1978) and Kelley (1984b). It derives from Kurt Lewin's emphasis on interdependence as “the essence of a group” (1948, p. 84), and it implements that view by borrowing payoff matrices from game theory (Luce & Raiffa, 1957) and adapting them to the broader purposes of an interpersonal psychology. Other, newer elaborations of the theory, concerning situational conditions affecting the timing and sequencing of behavior and the availability of information, are less well developed but deserve and receive attention in our Atlas.
The theory aspires to provide a means for drawing systematic and logical distinctions among situations which make it possible to imagine laying them out on a “map” or “globe” of the situational “world” – hence our metaphor of an “atlas.”
Two- and Three-Component Patterns
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 175-176
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Frontmatter
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp i-vi
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Entry #20 - N-Person Prisoner's Dilemma: Tragedy of the Commons
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 415-428
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This situation is a generalization of the two-person Prisoner's Dilemma situation to more than two persons (hence, it is sometimes called an N-person PD or NPD situation; its other most common label is a social dilemma). As in the Prisoner's Dilemma Game (PDG), each person's concern is whether she or he should make a choice which advantages the self but disadvantages others – in this situation, several others (e.g., all members of a group). For example, the police might give each member of a captured N-person criminal gang the same basic choices offered to the two prisoners in the classic PD (e.g., confess and thereby knock 1 year off your own sentence but also thereby add 2 years to every other gang member's sentence). Or, members of a fishing village might choose between maximizing their individual catches (and, hence, profits) versus limiting their catches/profits (but thereby helping to preserve the long-term viability of the fishing grounds upon which this and future generations of the village depend); Hardin's (1968) famous example of the “Tragedy of the Commons” is a very similar social dilemma. Or, members of a group performing some task might choose between working hard (and thereby improving the chances of the group performing well and quickly) or hardly working (and saving themselves effort while still profiting from any group success). In each case, noncooperative behavior brings better outcomes for oneself; but cooperative behavior brings better outcomes to the group as a whole.
Entry #7 - Chicken: Death before Dishonor
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 203-215
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The name of this situation is based on a deadly game. In one version, the two contestants – invariably males – drive their cars at high speed, headlong toward each other. The essence of this high-stakes game is to see which contestant has the stronger nerves. The first one to veer off course to avoid a collision loses the test of courage and is branded a “chicken” (i.e., a coward). If both drivers (in a simultaneous moment of sanity) veer off, the contest ends in a draw – somewhat embarrassing but giving neither a justification for accusing the other of less courage. Of course, if neither driver “chickens out,” the result is a fatal – and hence, rather hollow – “victory” for both. Another variation on this game – in which the contestants simultaneously drive toward a cliff's edge – was depicted in the film Rebel without a Cause.
A similar situation occurs when neighboring countries, seeking something valuable possessed by the other, issue ultimatums threatening war if the other will not yield. If one's neighbor yields, one may gain something of real value, but if neither yields and both carry through on their threats, the resulting war is likely to cost both far more than what was sought through the initial threats.
Struggles for dominance in a group can also create a Chicken situation.
Introduction to the Entries for the Situations
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 113-126
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Summary
The following section of the Atlas devotes a chapter to each of 21 abstract interpersonal situations that we have chosen to describe in detail. We will use the term “entry” for each of these situations, parallel to usage in listings for maps in a geographical atlas, topics in an encyclopedia, or locations in a table of basic elements. In this introduction, we first describe the structure and contents of each entry. Then we describe our reasons for selecting these particular situations, the criteria used for including or excluding potential entries. Finally, we discuss the issue of the adequacy of our coverage of situations and the potential strengths and weaknesses of our reasoning.
The Structure of Individual Entries
Each situation is first described through concrete, everyday examples from interpersonal life, with the goal of illustrating the more abstract features of each entry in a nontechnical fashion. A conceptual description follows, using the various analytical tools developed in the earlier chapters. Each situation is characterized in terms of the basic control components that influence individuals' outcomes in the situation, as well as the response and informational conditions that are typically part of the social problem. Then, the relation of this entry to other “family” members or “neighbors” is discussed, in order to help the reader gain perspective on the conceptual “location” of the situation, the region of the interpersonal situation map that it occupies.
Entry #13 - Investment: Building for the Future
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 285-303
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Summary
Examples
Investment situations are extended situations in which each person, at each of a series of preliminary steps, must make an “investment” in order to move toward a desirable goal. For example, in seeking to establish a successful business, the owners proceed through a series of preliminary steps at which they invest time and effort in order to reach their goal. They work evenings and weekends, forgo short-term financial profits, and reinvest early earnings in development activities, including employee training and construction projects. In the situations considered here, those of mutual investment, both owners must engage in these activities. If either loses heart and backs out of the venture, their investments are lost and the company fails. If both persist and jointly work their way through the early steps, making suitable choices and effective investments of time, effort, and resources, they may achieve a desirable goal – a company that will earn substantial profits.
In like manner, the partners in an emerging romantic relationship must work together, making their way through preliminary steps at which they invest a variety of resources in their involvement. They disclose private thoughts and feelings to each other, purchase joint possessions, develop a shared friendship network, spend time becoming acquainted with one another's family members, and exert effort to resolve conflicts involving incompatible preferences. If both partners successfully surmount the preliminary hurdles of their involvement, they may achieve a desirable goal – a committed, trusting relationship in which each partner gratifies the other's needs.
4 - Exploring the Geography of the Outcome Patterns
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 82-110
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Summary
In this chapter, we examine in some detail the 2 × 2 outcome matrices which, as explained in chapter 2, define the problems that interdependent persons may encounter. This requires further explanation of how the basic patterns of interdependence (see Table 2.7) may be combined to produce more complex patterns. Our general point is that many complex situations can be understood more clearly when considered as a combination of certain basic elements. We then take a closer look at the three dimensions of symmetric interdependence shown in chapter 2 (Figure 2.2) and see how various common patterns are distributed through those dimensions. The distribution enables us to gain further understanding of each situation by examining its location relative to other situations. For example, as will be explained in this chapter, the distribution of the situations has implications for the developmental course of a dyadic relationship as, through changes in the individuals and the problems they encounter, a pair moves from one kind of situation to another. Readers who are less interested in the full implications of our combinatorial system may prefer to skip this chapter and go directly to the following “Introduction to the Entries” and to the entries themselves.
Exploring the Possible 2 × 2 Matrices by Combining the Basic Components
All possible patterns of 2 × 2 interdependence can be constructed by combining the patterns of control represented in Table 2.7: Bilateral Actor Control (BAC), Mutual Partner Control (MPC), and Corresponding or Conflicting Mutual Joint Control (MJC).
PART ONE - INTRODUCTION AND THEORY
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 1-2
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Entry #10 - Disjunctive Problems: Either of Us Can Do It
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 239-248
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Summary
Examples
This situation is one in which the actions of a single person provide a benefit for all (including himself or herself). Such situations arise routinely both in dyadic and group settings. For example, in marriages or business partnerships, joint obligations (e.g., responding to invitations, paying bills) can be fulfilled equally well by either partner. Likewise, either marriage partner can simultaneously benefit self and the spouse by making a particular “right” choice – for example, both benefit when either cleans the house, quiets the children, or prepares a meal. As Steiner (1972) has observed, performance groups face this situation in group tasks where a single member can effectively do the work of the entire group. For example, a group of students in a chemistry lab may have a single lab assignment requiring a single written report, for which all the students will receive the same grade. In such a case, any single lab-group member could (in principle) complete, write up, and turn in the assignment. Many bystander intervention settings (cf. Latané & Darley, 1970) also have this structure. Often only one bystander needs to act (e.g., give or seek help) in order to “solve” the problem confronting the group of bystanders (i.e., deal with the emergency).
Conceptual Description
The essential feature of the situation of disjunctive interdependence is that an act or choice of any single group member is sufficient to determine a desired outcome for all.
Entry #4 - Conflicting Mutual Joint Control: Match or Mismatch
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
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- 21 October 2009
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- 03 February 2003, pp 162-174
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Summary
Examples
A younger brother wants to “hang out” with his older brother and be at the same place as the older one, but the older brother finds that the younger one “cramps his style” and prefers not to have the younger one around. So the situation is one of hide and seek, with the older brother doing the hiding and the younger, the seeking. In marriages, situations of this type are sometimes reflected in a general conflict over closeness. One member of the couple wants a close relationship while the partner wants more independence. (Christensen and Heavey report that in heterosexual pairs, it is usually the woman who wants closeness.)
Athletic competitions, whether they be individual or team contests, involve one situation of this sort after another. The concepts of “offense” and “defense” are based on the distinction between different preferences about being “with” or being “separate from” another person or team: The offense wants to go to a location different from where the defense is located but the defense wants to be where the offense is. The preferences can shift rapidly. For example, in baseball the batter wants to swing where the ball “is” but then wants the ball to travel to where the fielders “aren't.” In other words, the batter “defends” the plate (as the coach often instructs the Little Leaguer) but acts offensively in relation to the other team's defense. In boxing, each man shifts from defensive dodging to offensive striking on a moment-by-moment basis.
Entry #14 - Delay of Gratification: Resisting Temptation
- Harold H. Kelley, University of California, Los Angeles, John G. Holmes, University of Waterloo, Ontario, Norbert L. Kerr, Michigan State University, Harry T. Reis, University of Rochester, New York, Caryl E. Rusbult, University of North Carolina, Chapel Hill, Paul A. M. Van Lange, Vrije Universiteit, Amsterdam
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- An Atlas of Interpersonal Situations
- Published online:
- 21 October 2009
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- 03 February 2003, pp 304-322
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Summary
Examples
Mary's father offers her a trip to Disneyland if she earns good grades during the coming year. To earn the prize, Mary must exercise self-control, forgoing activities that she otherwise would love and engaging in activities that are not necessarily fun but will help her do well in school. She may need to cut back on soccer practice in order to spend more time on homework, and may find it necessary to spend some afternoons studying rather than playing with friends. This self-control problem will be less difficult if she places considerably greater value on the trip to Disneyland than on the alternative activities that she must forgo, and to the degree that she can count on her father to deliver on his promise if she indeed earns good grades.
John's cholesterol level is dangerously high. His wife promises to buy him a Jaguar if he radically changes his eating habits and lowers his cholesterol level. To obtain the Jaguar (and avoid the risk of serious health problems), John must carefully plan and prepare meals, forgo the convenience of fast food, and inhibit the impulse to eat many of his favorite foods. He is more likely to be successful if he develops strong intentions to engage in health-related behaviors and identifies strategies to forgo temptation. He may find it helpful to distract himself, bringing to mind “cool” thoughts about high cholesterol foods (“french fries look like a stack of lumber”) and inhibiting “hot” thoughts (“french fries are crispy, salty, and delicious”).
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