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Research Roundup

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


May 28, 2002
Volume 48 Number 35

The Law School awards teaching awards, including some new ones.
Two SAS faculty members will be appointed Annenberg Professors.
As the weather warms up outside, the cooling season energy conservation measures are planned for inside campus buildings.
A search committee is formed for the School of Social Work Dean position.
The Alumni Reunion Gifts will provide funds for scholarships and campus enhancements.
It is almost time for the annual Faculty and Staff Appreciation Picnic.
This call is for you….is your entry in the Telephone Directory correct? How to update records if they are incorrect and out-of-date.
City Year, an AmeriCorps program, will have its annual convention at Penn in early June, with a day of service that the Penn community is invited to participate in along with the 1,000 young people from across the U.S.
New Border Security Legislation, Changes in Student Visa Processing and Bioterrorism Legislation are some of the topics in the The Government Affairs Update.
Penn Perspective is a perfect place to ponder this complex place.
Detecting pain in infants and children; understanding a matriarchy; treating severe depression and preparing troops to train with simulated situations.