Predictors of response to CBT and IPT for depression; the contribution of therapy process

Little is known about the factors that contribute to a positive psychotherapy outcome. There is still considerable debate as to whether specific factors (e.g. severity of symptoms, comorbidity) or nonspecific factors (e.g. alliance, therapy process) are most important in influencing outcome. This study examined the additional contribution that therapeutic process and alliance made to previously identified specific predictors of response to CBT and IPT for depression over the course of therapy. The previously identified specific factors were belief that childhood reasons caused the depression, recurrent depression, perceptions about how logical therapy was and comorbid personality disorder symptoms. One hundred and sixty five adult outpatients with major depression were treated for depression in a randomised clinical trial examining predictors of response to Cognitive Behavior Therapy and Interpersonal Psychotherapy. All therapy sessions were audiorecorded to enable objective ratings of therapeutic process and alliance. Process factors - patient psychic distress, patient participation and patient alliance had the strongest associations with outcome. The early and middle stage of therapy process did not account for any additional variance other than that previously identified by the patient predictors, however, at the end stage of therapy process contributed a further 14%.

Drying process strongly affects probiotics viability and functionalities

Probiotic formulations are widely used and are proposed to have a variety of beneficial effects, depending on the probiotic strains present in the product. The impact of drying processes on the viability of probiotics is well documented. However, the impact of these processes on probiotics functionality remains unclear. In this work, we investigated variations in seven different bacterial markers after various desiccation processes. Markers were composed of four different viability evaluation (combining two growth abilities and two cytometric measurements) and in three in vitro functionalities: stimulation of IL-10 and IL-12 production by PBMCs (immunomodulation) and bacterial adhesion to hexadecane. We measured the impact of three drying processes (air-drying, freeze-drying and spray-drying), without the use of protective agents, on three types of probiotic bacteria: Bifidobacterium bifidum, Lactobacillus plantarum and Lactobacillus zeae. Our results show that the bacteria respond differently to the three different drying processes, in terms of viability and functionality. Drying methods produce important variations in bacterial immunomodulation and hydrophobicity, which are correlated. We also show that adherence can be stimulated (air-drying) or inhibited (spray-drying) by drying processes. Results of a multivariate analysis show no direct correlation between bacterial survival and functionality, but do show a correlation between probiotic responses to desiccation-rewetting and the process used to dry the bacteria.

Enzymo-chemical preparation, physico-chemical characterization and hypolipidemic activity of granular corn bran dietary fibre

Corn bran dietary fibre (CF) was paid more attention for its anticancer and hypolipidemic activities. In this paper, corn bran was firstly decomposed to the threadlike fibre (CF1) by multiple enzymes and then further modified to the granular fibre (CF2) by alkali under high pressure and high temperature (APT). The two types of fibres were characterized by scanning electron microscope (SEM) and near-infrared spectrophotometer (IR), and investigated by hydration measurements and nitrite adsorption assays. The results showed that CF2 had more much specific surface area, and displayed 4.7, 6.3 and 30-fold increases in water retention (WR), swelling capacity (SC) and nitrite absorption (NA), compared with CF1, respectively. The rat feeding trials showed that the granular fibre could decrease total cholesterol (TC), triglyceride (TG) and low density lipoprotein-cholesterol (LDLC) by 41.4 %, 20.7 % and 56.5 %, respectively. These excellent physiological activities indicate that CF2 will be a potentially available dietary ingredient in functional food industries, and meanwile imply that the enzymochemical method is a desired strategy for CF processing.

Preventable deaths in patients with traumatic brain injury

OBJECTIVE

The objective of this study is to evaluate the rate of and etiology for preventable deaths in patients with traumatic brain injuries (TBIs).

METHODS

We conducted a retrospective, multicenter review of patients with TBIs who died within 7 days of their traumatic event from June 2008 to May 2009. Three board certified emergency physicians independently reviewed every case using a structured survey format. Cases were considered preventable deaths only if all physicians independently agreed the death was preventable. Management errors contributing to the preventable death were determined.

RESULTS

Forty-one patients who died from TBI were eligible. Preventable deaths were identified in nine (22%; 95% confidence interval [CI], 11 to 28) cases. Fifty-six management errors were identified including 36 (64%; 95% CI, 50 to 77) in the emergency department and 13 (23%; 95% CI, 13 to 36) in the prehospital phase. Thirty (54%; 95% CI, 40 to 67) management errors were process-related, and 26 (46%; 95% CI, 33 to 60) were structure-related.

CONCLUSION

An important and measurable rate of preventable mortality occurs in the initial care of TBI patients. Errors were common and most occurred in the emergency department. In addition, errors were common in the prehospital phase but did not always lead to mortality. When analyzed by type of problem, both process-related and structure-related errors occurred in similar proportions.

Better together: the "M" word

Collaborative work between institutions of higher education is highly supported by legislators, administrators, and students. To address the need for enrollment of students, regulatory demands, and cost containment a school of nursing that spanned two institutions was undertaken by the faculty and staff at a university and technical college. This article outlines the process of alignment with faculty, students and administration which includes five stages: dreaming, developing, championing, launching, and stabilizing.

Effects of the Deslagging Process on some Physicochemical Parameters of Honey

Some physicochemical parameters of honey have been introduced by the International Honey Commission to evaluate its quality and origin but processes such as heating and filtering can affect these parameters. In traditional Iranian medicine, deslagging process involves boiling honey in an equal volume of water and removing the slag formed during process. The aim of this study was to determine the effects of deslagging process on parameters of color intensity, diastase evaluation, electrical conductivity, pH, free acidity, refractive index, hydroxy methyl furfural (HMF), proline and water contents according to the International Honey Committee (IHC) standards. The results showed that deslagged honey was significantly different from control honey in terms of color intensity, pH, diastase number, HMF and proline content. It can be concluded that the new standards are needed to regulate deslagged honey.

The experience of freedom in decisions - Questioning philosophical beliefs in favor of psychological determinants

Six experiments tested two competing models of subjective freedom during decision-making. The process model is mainly based on philosophical conceptions of free will and assumes that features of the process of choosing affect subjective feelings of freedom. In contrast, the outcome model predicts that subjective freedom is due to positive outcomes that can be expected or are achieved by a decision. Results heavily favored the outcome model over the process model. For example, participants felt freer when choosing between two equally good than two equally bad options. Process features including number of options, complexity of decision, uncertainty, having the option to defer the decision, conflict among reasons, and investing high effort in choosing generally had no or even negative effects on subjective freedom. In contrast, participants reported high freedom with good outcomes and low freedom with bad outcomes, and ease of deciding increased subjective freedom, consistent with the outcome model.

Why functions are not special dispositions: an improved classification of realizables for top-level ontologies

Background

The concept of function is central to both biology and technology, but neither in philosophy nor in formal ontology is there a generally accepted theory of functions. In particular, there is no consensus how to include functions into a top-level ontology or whether to include them at all.

Methods

We first review current conceptions of functions in philosophy and formal ontology and evaluate them against a set of criteria. These evaluation criteria are derived from a synopsis of theoretical and practical requirements that have been suggested for formal accounts of functions. In a second step, we elucidate in particular the relation between functions and dispositions.

Results

We argue that functions should not be taken as a subtype of dispositions. The strongest reason for this is that any view that identifies functions with certain dispositions cannot account for malfunctioning, which is having a function but lacking the matching disposition. As a result, we suggest a cross-classification of realizables with dispositions supervening on the physical structure of their bearer, whereas both functions and roles also have some external grounding. While bearers can survive the gain, loss and change of roles, functions are rigid properties that are essentially connected to their particular bearers. Therefore, Function should not be regarded as a subtype of Disposition; rather, the classes of functions and dispositions are disjoint siblings of Realizable.

Optimization of algorithms for diagnosis and treatment of small bowel obstruction

AIM: To investigate the role of multi-slice CT three-dimensional reconstruction combined with meglumine diatrizoate in the diagnosis and treatment of intestinal obstruction and to optimize the algorithms for diagnosis and treatment of small bowel obstruction.

METHODS: Clinical data for 89 patients with small bowel obstruction were prospectively collected from January 2011 to January 2012 at the First Hospital of Wuhan City. All patients were randomly divided into either a conventional therapy group or a conventional therapy plus meglumine diatrizoate group (two doses of meglumine diatrizoate via a gastric tube with a 24 h interval). The time to first flatus, indwelling time of the stomach tube, and hospitalization time were compared between the two groups. After injection of meglumine diatrizoate via the tube, the patients received gastrointestinal radiographic examination every 24 h to observe whether the contrast agent went into the colon. The therapeutic effect of meglumine diatrizoate on small bowel obstruction, and the association between whether meglumine diatrizoate could enter the colon within 24 h and surgery necessity were evaluated.

RESULTS: In patients of the conventional therapy plus meglumine diatrizoate group, the indwelling time of gastric tube was 3.0 d ± 1.1 d, the time to first flatus was 26.0 h ± 19.1 h, and the length of hospital stay was 7 d ± 2.5 d. These parameters were significantly shorter compared with those for the conventional treatment group (P < 0.05 for all). There was a significant correlation between the observation that meglumine diatrizoate could not enter the colon within 24 h and surgery necessity. Preoperative multi-slice CT three-dimensional reconstruction could help to investigate the cause and sites of obstruction and to evaluate the local conditions to ensure the surgical safety.

CONCLUSION: Meglumine diatrizoate via the gastric tube can effectively alleviate adhesive intestinal obstruction, reduce the rate of operation and provide an important reference for the timing of surgery. Preoperative multi-slice CT three-dimensional reconstruction can provide effective protection for patients undergoing operation. Sequential application of meglumine diatrizoate and multi-slice CT three-dimensional reconstruction in small bowel obstruction can greatly improve the accuracy of diagnosis and treatment effectiveness and thus can be used as the optimized algorithm for clinical diagnosis and treatment.

Internal Representations of the Therapeutic Relationship Among Adolescents in Psychodynamic Psychotherapy

This study examined changes in adolescents' internal representations of their relationship with their therapist and the extent to which these changes were related to changes in their representations of their relationship with their parents and to treatment outcomes.

METHOD

Thirty adolescents (aged 15-18 years, 70% women) undergoing psychodynamic psychotherapy participated in relationship anecdote paradigms interviews based on the core conflictual relationship theme method and completed outcome measures at the beginning of treatment and a year later.

RESULTS

Adolescents' positive representations of their therapists increased throughout the year of treatment, whereas their negative representations did not change. There was an association between the development of the therapeutic relationship and improvement in the perception of the relationship with parents over the course of therapy. Increases in the level of positive representations and decreases in the level of negative representations of the therapist were associated with greater satisfaction with treatment but not with the other outcome measures. These results support the centrality of the therapeutic relationship in the process of change during adolescents' psychodynamic psychotherapy.

KEY PRACTITIONER MESSAGE

The finding that positive representations of the therapist increased throughout treatment but that negative representations remained steady suggests that therapists who treat adolescents should expect and be able to hear adolescent clients' positive and negative internal representations of themselves. Therapists need to realize that although adolescents often experience negative emotions and perceptions in therapy as in other significant relationships, this does not necessarily block the development of positive emotions. The finding that changes in the representations of the therapist are associated with changes in the representations of parents is in line with psychodynamic theory, which posits that psychotherapy facilitates new interpersonal experiences and new insights through the exploration of the therapeutic relationship. Working in the 'here and now' may eventually impact the nature of other significant relationships, particularly with parents in the case of adolescents.

From refrigerator to arm: issues in vaccination delivery

This report summarizes the first meeting of a panel of immunization experts who met in Washington, DC, on May 4-5, 2012. The panel consisted of experts from national immunization policy organizations; state, regional, and local immunization programs; and vaccinating health care practices. The primary objective of this meeting was to identify issues in the vaccine delivery process as a critical first step in the determination of where and how improvements can be made. Vaccines are one of the greatest achievements in public health. However, in order to maintain the integrity of vaccines and the success of vaccination programs, proper handling of vaccines from the receipt of shipment through administration to the patient is critical. Continuous improvement of the vaccine delivery process is important to ensure appropriate vaccine handling by all vaccine providers. The overarching consensus of the participants of this meeting was that the major challenge in vaccine delivery is the complexity throughout all areas of the vaccine delivery process, which is often underestimated, particularly in the areas of vaccine preparation and administration. The lack of detailed, consistent standards encompassing all areas of the vaccine delivery process, and the gaps in oversight, education, and training of vaccine providers, particularly providers of adult vaccines, were also identified as major issues. The next step for this panel is to reconvene to explore potential solutions to address the identified issues.

Combining fMRI and behavioral measures to examine the process of human learning

Prior to the advent of fMRI, the primary means of examining the mechanisms underlying learning were restricted to studying human behavior and non-human neural systems. However, recent advances in neuroimaging technology have enabled the concurrent study of human behavior and neural activity. We propose that the integration of behavioral response with brain activity provides a powerful method of investigating the process through which internal representations are formed or changed. Nevertheless, a review of the literature reveals that many fMRI studies of learning either (1) focus on outcome rather than process or (2) are built on the untested assumption that learning unfolds uniformly over time. We discuss here various challenges faced by the field and highlight studies that have begun to address them. In doing so, we aim to encourage more research that examines the process of learning by considering the interrelation of behavioral measures and fMRI recording during learning.

Mechanisms of folate losses during processing: diffusion vs. heat degradation

Though folates are sensitive to heat treatments, leaching appears to be a major mechanism involved in folate losses in vegetables during processing. The aim of our study was to study folate diffusivity and degradation from spinach and green beans, in order to determine the proportion of each mechanism involved in folate losses. Folate diffusivity constant, calculated according to Fick's second law (Crank, 1975), was 7.4×10(-12) m(2)/s for spinach and 5.8×10(-10) m(2)/s for green beans, which is the same order of magnitude as for sugars and acids for each vegetable considered. Folate thermal degradation kinetics was not monotonous in spinach and green beans especially at 45 °C and did not follow a first order reaction. The proportion of vitamers changed markedly after thermal treatment, with a better retention of formyl derivatives. For spinach, folate losses were mainly due to diffusion while for green beans thermal degradation seemed to be preponderant.

Effects of microwave rendering on the yield and characteristics of chicken fat from broiler abdominal fat tissue

Microwave rendering process and effects of rendering conditions on yields and characteristics of chicken fat from broiler abdominal fat tissue were studied. Microwave rendering process could be divided into three phases: warming-up, constant temperature and heating-up phases. Increasing microwave power increased the rate of temperature rise and final temperature of chicken fat, shortened the duration of warming-up and constant temperature phase, and decreased the moisture content of chicken fat. Longer irradiation time resulted in higher final temperature, lower moisture content and darker, browner color of chicken fat. The chicken fat rendered at power level of 2.75 W/g for 10 min had the highest yield (70.55%) with the lowest peroxide value, acid value and thiobarbituric acid value (p < 0.05). The major fatty acids in chicken fat obtained at optimum conditions were oleic acid (45.73%), palmitic acid (26.13%), linoleic acid (15.12%), palmitoleic acid (6.07%), and stearic acid (5.81%).

Marine protected area networks in California, USA

California responded to concerns about overfishing in the 1990s by implementing a network of marine protected areas (MPAs) through two science-based decision-making processes. The first process focused on the Channel Islands, and the second addressed California's entire coastline, pursuant to the state's Marine Life Protection Act (MLPA). We review the interaction between science and policy in both processes, and lessons learned. For the Channel Islands, scientists controversially recommended setting aside 30-50% of coastline to protect marine ecosystems. For the MLPA, MPAs were intended to be ecologically connected in a network, so design guidelines included minimum size and maximum spacing of MPAs (based roughly on fish movement rates), an approach that also implicitly specified a minimum fraction of the coastline to be protected. As MPA science developed during the California processes, spatial population models were constructed to quantify how MPAs were affected by adult fish movement and larval dispersal, i.e., how population persistence within MPA networks depended on fishing outside the MPAs, and how fishery yields could either increase or decrease with MPA implementation, depending on fishery management. These newer quantitative methods added to, but did not supplant, the initial rule-of-thumb guidelines. In the future, similar spatial population models will allow more comprehensive evaluation of the integrated effects of MPAs and conventional fisheries management. By 2011, California had implemented 132 MPAs covering more than 15% of its coastline, and now stands on the threshold of the most challenging step in this effort: monitoring and adaptive management to ensure ecosystem sustainability.

Production of adeno-associated virus (AAV) serotypes by transient transfection of HEK293 cell suspension cultures for gene delivery

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Transient transfection of HEK293 suspension cells efficiently produce AAV vectors.

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Nine different AAV serotypes were produced with yields of 1E+13 Vg/L.

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AAV2 and AAV6 produced in 3-L bioreactors gave yields comparable to shake-flasks.

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The process is cGMP compatible using serum-free media and HEK293 master cell bank.

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Industrialization of the process is possible for manufacturing AAV serotypes.

Adeno-associated virus (AAV) is being used successfully in gene therapy. Different serotypes of AAV target specific organs and tissues with high efficiency. There exists an increasing demand to manufacture various AAV serotypes in large quantities for pre-clinical and clinical trials. A generic and scalable method has been described in this study to efficiently produce AAV serotypes (AAV1-9) by transfection of a fully characterized cGMP HEK293SF cell line grown in suspension and serum-free medium. First, the production parameters were evaluated using AAV2 as a model serotype. Second, all nine AAV serotypes were produced successfully with yields of 10¹³ Vg/L cell culture. Subsequently, AAV2 and AAV6 serotypes were produced in 3-L controlled bioreactors where productions yielded up to 10¹³ Vg/L similar to the yields obtained in shake-flasks. For example, for AAV2 10¹³ Vg/L cell culture (6.8 × 10¹¹ IVP/L) were measured between 48 and 64 h post transfection (hpt). During this period, the average cell specific AAV2 yields of 6800 Vg per cell and 460 IVP per cell were obtained with a Vg to IVP ratio of less than 20. Successful operations in bioreactors demonstrated the potential for scale-up and industrialization of this generic process for manufacturing AAV serotypes efficiently.

Process of in situ forming well-aligned zinc oxide nanorod arrays on wood substrate using a two-step bottom-up method

A good nanocrystal covering layer on wood can serve as a protective coating and present some new surface properties. In this study, well-aligned ZnO nanorods (NRs) arrays were successfully grown on wood surface through a two-step bottom-up growth process. The process involved pre-sow seeds and subsequently their growing into NRs under hydrothermal environment. The interface incorporation between wood and ZnO colloid particles in the precursor solution during the seeding process was analyzed and demonstrated through a schematic. The growth process of forming well-aligned ZnO NRs was analyzed by field-emission scanning electron microscopy and X-ray diffraction, which showed that the NRs elongated with increased reaction time. The effects of ZnO crystal form and capping agent on the growth process were studied through different viewpoints.

The process of cognitive behaviour therapy for chronic fatigue syndrome: which changes in perpetuating cognitions and behaviour are related to a reduction in fatigue?

OBJECTIVE

Cognitive behaviour therapy (CBT) can significantly reduce fatigue in chronic fatigue syndrome (CFS), but little is known about the process of change taking place during CBT. Based on a recent treatment model (Wiborg et al. J Psych Res 2012), we examined how (changes in) cognitions and behaviour are related to the decrease in fatigue.

METHODS

We included 183 patients meeting the US Centers for Disease Control criteria for CFS, aged 18 to 65 years, starting CBT. We measured fatigue and possible process variables before treatment; after 6, 12 and 18 weeks; and after treatment. Possible process variables were sense of control over fatigue, focusing on symptoms, self-reported physical functioning, perceived physical activity and objective (actigraphic) physical activity. We built multiple regression models, explaining levels of fatigue during therapy by (changes in) proposed process variables.

RESULTS

We observed large individual variation in the patterns of change in fatigue and process variables during CBT for CFS. Increases in the sense of control over fatigue, perceived activity and self-reported physical functioning, and decreases in focusing on symptoms explained 20 to 46% of the variance in fatigue. An increase in objective activity was not a process variable.

CONCLUSION

A change in cognitive factors seems to be related to the decrease in fatigue during CBT for CFS. The pattern of change varies considerably between patients, but changes in process variables and fatigue occur mostly in the same period.

Comparing predicted and actual affective responses to process versus outcome: an emotion-as-feedback perspective

One of the conjectures in affective forecasting literature is that people are advised to discount their anticipated emotions because their forecasts are often inaccurate. The present research distinguishes between emotional reactions to process versus those to outcome, and highlights an alternative view that affective misforecasts could indeed be adaptive to goal pursuit. Using an ultimatum game, Study 1 showed that people overpredicted how much they would regret and be disappointed by the amount of effort they exerted, should the outcomes turned out worse than expected; nonetheless, people could accurately predict their emotional responses to unfavorable outcomes per se. In a natural setting of a university examination, Study 2 demonstrated that actual regret and disappointment toward favorable outcomes were more intense than the level people expected, but this discrepancy was not observed in their emotional responses to efforts they had invested. These two distinct patterns of results substantiate the argument that the deviation between predicted and actual emotions is dependent on the referents of the emotional reactions.

Beyond Components of Wellbeing: The Effects of Relational and Situated Assemblage

Despite multiple axes of variation in defining wellbeing, the paper argues for the dominance of a 'components approach' in current research and practice. This approach builds on a well-established tradition within the social sciences of attending to categories whether for their identification, their value or their meanings and political resonance. The paper critiques the components approach and explores how to move beyond it towards conceptually integrating the various categories and dimensions through a relational and situated account of wellbeing. Drawing on more fluid social sciences, wellbeing is framed as an effect, dependent on the mobilisation of resources from everyday encounters with complex assemblages of people, things and places. Through such a framing, wellbeing can be conceived of as stable and amenable to change, as individual and collective and as subjective and objective. Policy interventions then need to attend to the relationalities of particular social and spatial contexts.

Osteochondroma arising from the thoracic transverse process

The incidence of osteochondroma is rare and only 2% of such tumors are found in the spine area. When they are found in the vertebral column, less than 1% of all osteochondromas and few tumors occur in the thoracic vertebrae. An osteochondroma arising from the transverse process of the vertebra is even rarer, especially following from the thoracic transverse process. Here we report a giant solitary osteochondroma arising from the thoracic transverse process of T8 vertebra and involving the corresponding transverse process and rib.

A 28-year-old man presented with a progressive thoracic node, and neuroradiological evaluation of the spine showed a giant mass lesion involving the transverse process of T8 vertebra and concomitant corresponding facet joint and rib on the left side. At surgery, a firm and cartilaginous tumor originating from the transverse process was radically excised and surgical curettage of the lesion was performed.

It is concluded that accurate and prompt diagnosis requires a high index of suspicion followed by surgical treatment to prevent severe morbidity in cases of primary spinal column tumors. The histological examination of this patient revealed the lesion was osteochondroma.

The best choice of treatment for spinal osteochondromas is surgical excision or curettage and spinal stabilization, if necessary.