The impact of integrating emotion focused components into psychological therapy: A randomized controlled trial

OBJECTIVES

This paper presents a randomized controlled trial on assimilative integration, which is aimed at integrating elements from other orientations within one approach to enrich its conceptual and practical repertoire. Elements from Emotion-Focused Therapy (EFT) were integrated into a form of cognitive behavior therapy: Psychological Therapy (PT). In one treatment condition, EFT was added to PT (+EFT) with the intent to enhance therapists' working with emotions. In the other condition, concepts and interventions based on the socialpsychological self-regulation approach were added to PT (+SR). Our assumption was that the +EFT would lead to greater and deeper change, particularly in the follow-up assessments.

METHOD

Patients (n = 104) with anxiety, depression, or adjustment disorders were randomized to the two conditions and treated by 38 therapists who self-selected between the conditions. Primary outcome was symptom severity at 12-month follow-up; secondary outcomes included several measures such as interpersonal problems and quality of life. Variables were assessed at baseline, after 8 and 16 sessions, at posttreatment, and at 6- and 12-month follow-up.

RESULTS

Contrary to our hypothesis, no significant between-group effects were found.

CONCLUSION

The findings first suggest the difficulty of topping an already very effective approach to psychotherapy. Alternative interpretations were that the EFT training, while corresponding to regular practice in AI, was not sufficient to make a difference in outcome, or that while profiting from the enhancement of abilities for working with emotions, this was outbalanced by negative effects of difficulties related to the implementation of the new elements.

Development and Demonstration of Low-Impact IPM Strategy to Control Argentine Ants (Hymenoptera: Formicidae) in Urban Residential Settings

Argentine ants are one of the most common nuisance pest ants treated by pest management professionals (PMPs) in southern and western urban residential areas of the United States. Two new technologies (spraying with a pheromone adjuvant and using a biodegradable hydrogel bait delivery method) were used to develop a unique low-impact integrated pest management (IPM) protocol for Argentine ants in urban residential settings. The IPM protocol included a one-time perimeter spray treatment with 0.03% fipronil (mixed with a pheromone adjuvant) at the beginning of the ant season to achieve a quick knockdown. The initial spray application was followed by a biodegradable hydrogel baiting with 1% boric acid as a maintenance treatment. This low-impact IPM protocol was compared with two other conventional methods: (1) one initial fipronil application and one pyrethroid spray application for maintenance, or (2) one initial fipronil application and one essential oil insecticide spray application for maintenance. Based on Argentine ant foraging activity, the protocols were compared for their control efficacy. Insecticide use information and treatment time were also recorded and compared among different treatment protocols. Our results provided empirical data to support the effectiveness and economic feasibility of the low-impact IPM protocol for managing Argentine ants in urban residential settings.

Working with emotion predicts sudden gains during experiential therapy for depression

Objective: This study involves the first attempt to identify sudden gains in a sample of clients undergoing experiential therapy for depression while also investigating client and therapist change processes related to sudden gains.Method: Pre- and post-session Beck Depression Inventory, short form (BDI-SF) questionnaires were used to identify sudden gains and differentiate between in-session and between-session symptom changes in thirty-six client-therapist dyads. Archival videotape data of a sub-sample were coded using the Experiencing Scale, Classification of Affective Meaning States, and the Coding System for Therapist Focus.Results: The study revealed that 63.9% of clients experienced a sudden gain and the bulk of the total mean symptom decrease (74.9%) was found to occur within the session preceding the sudden gain. During this critical session, clients were more likely to display deepened experiencing (p < .01, η² = .34), clients were more likely to express "primary adaptive emotions" (p < .05, r = .38), and therapists were found to be more likely to focus on unmet client needs (p < .01, d = .75).Conclusion: The majority of the sudden gain change occurs within session in experiential therapy, and primary adaptive emotions as well as addressing unmet needs are possible processes of sudden gains.

Oncology Training in Rwanda: Challenges and Opportunities for Undergraduate Medical Students (The EDUCAN Project)

A critical shortage of trained cancer specialists is one of the major challenges in addressing the increasing cancer burden in low- and middle-income countries. Inadequate undergraduate cancer education in oncology remains a major obstacle for both task shifting to general practitioners and for training of specialists. We provide the first report of cancer education in Rwanda's undergraduate program to survey how new graduates are prepared to provide care for cancer patients. Anonymous online survey was sent January to June 2017 to medical students in their senior clinical years (years 5 and 6). Questions related to the demographics, medical curriculum, and general oncology exposure were included in the survey. Of 192 eligible students, 42% (n = 80) completed the survey and were analyzed. The majority were 25 to 29 years of age and 41% were female. Internal medicine was cited to provide the most exposure to cancer patients (50%) and cancer bedside teaching (55%). Close to a half (46%) have been taught oncology formally in addition to bedside teaching. A tenth (11%) of the participants felt comfortable in attending a cancer patient, and a fifth (21%) of the students felt comfortable while addressing multimodality treatment approach. The majority (99%) of the participants preferred having a formal oncology rotation. Of particular interest, 61% of the students are interested in pursuing an oncology career path. There is a need to modify the current oncology undergraduate curriculum to prepare future physicians for delivering cancer care in Rwanda. Raising the profile of oncology in undergraduate medical education will complement the on-going efforts to increase the country's capacity in task shifting and in training of cancer specialists.

A-71 Comparing College Athletes and Non-Athlete Controls on the ImPACT Validity Indices at Baseline

Objective

In the context of sports-related concussion (SRC) evaluations, athletes have been shown to “sandbag” their baseline testing in order to improve their chances of return-to-play post-concussion. To circumvent this problem, performance validity tests are often administered. The ImPACT, a widely used computerized program in SRC evaluations, has five embedded validity indices (VIs); however, indications of their use as measures of effort have not been well established. With this in mind, we aimed to compare performance on the ImPACT VIs between athletes and non-athlete controls at baseline. Given the incentive to “sandbag” by at least some players, it was hypothesized that athletes would demonstrate poorer performance on all VIs than controls.

Method

Participants included 1,254 college students (70% male; 77.3% Caucasian) divided into two groups: athletes (n = 929) and non-athlete controls (n = 325). All participants completed the ImPACT individually. Primary outcomes of interest included the five ImPACT VIs: Impulse Control Composite, X’s and O’s Total Incorrect, Word Memory Learning Percent Correct, Design Memory Learning Percent Correct, and Three Letters Total Letters Correct.

Results

Independent samples t-tests revealed that athletes performed worse than controls on 4 of the 5 VIs (p = < .001 to .028; d = 0.13 to 0.23). The only VI that was not significantly different between groups was Three Letters (p>.05, d = 0.11).

Conclusion

Consistent with our hypotheses, findings generally showed that athletes demonstrated worse performance on the ImPACT VIs compared to non-athlete controls. Although future research is needed to validate the utility of the VIs, our results suggest that these scores may be useful in detecting suboptimal baseline performance.

Fiproles in urban surface runoff: Understanding sources and causes of contamination

Urban-use pesticides present a unique risk to non-target organisms in surface aquatic systems because impervious pavement facilitates runoff that may lead to serious contamination and ensuing aquatic toxicity. Fipronil is an insecticide used at high rates in urban environments, especially in regions such as California. This compound and its biologically active degradation products have been detected in urban runoff drainage and downstream surface water bodies at concentrations exceeding toxicity thresholds for sensitive aquatic invertebrates, necessitating a better understanding of the runoff sources and causes of this contamination at sites of application. In this study, we evaluated sorption of fipronil, fipronil desulfinyl, fipronil sulfide, and fipronil sulfone in urban dust, soil, and concrete, matrices commonly associated with the perimeter of a residential home. Samples were also collected from five single family homes treated with fipronil in Riverside, California, for five months to determine the occurrence of fipronil and its degradates in runoff water, urban dust, soil, and on concrete surfaces. Statistical analysis was performed to determine which urban matrices contributed more significantly to the contaminant levels in runoff water. Freundlich sorption coefficients for fipronil and its degradation products in dust were 3- to 9-fold greater than their values in soil. Fipronil and its degradates were detected in 100% of runoff samples and their presence was observed in dust, soil, and concrete wipe samples for 153 d after the treatment. Linear regression analysis showed that concrete surfaces were a primary source of all four compounds to runoff, and loose dust on concrete pavement also served as an important contributor. This study represents the first comprehensive investigation of the sources and causes for surface runoff contamination by fipronil and its degradation products. Findings highlight the importance to reduce fipronil residues on concrete surfaces through improved application methods and other mitigation practices.

The Design and Implementation of Cancer Patient Support Groups in Rural Haiti

Background: In Haiti, cancer is associated with myths that have traumatic effects on patients and families. Cancer diagnoses are drivers of socioeconomic change, with psychological repercussions for an impoverished population. Aware of this reality, the Oncology Service at University Hospital of Mirebalais (HUM) created a dedicated psychosocial team, composed of a social worker, her assistant and a psychologist. Care is provided to patients and families through: individual counseling, support groups, outreach activities, home visits, and mental health consults. This abstract focuses on patient support groups (SG). SGs act as vectors of information and training that are capable of breaking myths, and accompanying patients on their cancer journey. Aim: The primary aim of SGs is to create a space for patients to participate in education and peer counseling. During sessions, the team encourages expressions of emotions and experiences in relation to the disease and its repercussions on patients and caregivers. These discussions encourage participant solidarity and strengthen compliance to treatments. SGs, however, are not static and services are continuously improved by collecting feedback. Methods: To address the psychosocial needs of each cancer patient, SGs were developed with specificity. Patients are categorized in SGs according to the medical treatment they are receiving. Other SGs offered, focus on caregiver experience. SGs have about 12 participants, last 120 minutes and are held in a private space in HUM. In general, discussions relate to patient experience, side effects, relationship implications, and socio-economic impacts. Across all SGs, principles for speaking are negotiated and are always at discretion of participants. Results: The HUM team has provided SG services since 2013. SGs are held often and the majority of oncology patients participate. In 2017, we held 30 SGs with over 380 participants. Therapeutic alliances have improved relationships: patient–patient, family–patient, and patient-clinician - fostering interdisciplinary collaboration. However, all SGs must be performed the same day as the medical appointment due to socio-economic difficulties that can create logistical challenges. Patient needs are also fluid and flexibility is key as SGs evolve. Conclusion: SGs play a critical role in comprehensive cancer care, particularly in Haiti where there are severe social implications for patients. Mental health of cancer patients is critical and SGs are an impactful way to address this need. Arranging SGs by medical treatment, the model used at HUM, is adaptable to other low-income settings. Every SG is different and facilitators approach each session without preconceptions, yet diligent to gather feedback. SGs provide critical information to clinicians about social determinants and implications of cancer diagnoses in Haiti. In the future, we hope to do robust qualitative analysis of SGs, using feedback from cancer patients at HUM.

Establishing a Childhood Cancer Survivorship Program in Rwanda

Background: Over 80% of children diagnosed with cancer survive in high-income countries (HICs). While the survival rate remains poor in low- and middle-income countries (LMICs) such as Rwanda, a growing number of children with cancer are surviving to adulthood. These children and young adults will face an increased risk of secondary cancers and late complications from their curative treatment. Cancer centers in HICs have established Long Term Survivorship (LTS) programs to cater for childhood cancer survivors and to capture these complications and/or recurrences at an early stage. They also address the more complex psychological and social aspects of surviving cancer in childhood. Aims: To develop an LTS program in Rwanda, initial training will take place in Botswana where a pediatric hematology-oncology (PHO) program was established at the national referral hospital, Princess Marina Hospital (PMH), in 2007. This training program will allow successful methods and lessons learned from the development of an LTS program in Botswana to establish a similar program in Rwanda with ongoing bidirectional collaboration. Methods: The Texas Children's Cancer and Hematology Centers (TXCH) Global Hematology-Oncology Pediatric Excellence (HOPE) program in Botswana is the only provider of PHO care in the country, provided at PMH, through a partnership with the Botswana government. The program has over 130 childhood cancer survivors in active follow-up. A one-month bench-marking visit will be conducted. During this period, Dr. Rubagumya will spend time with the medical director of the program learning how the LTS program was established and current operations. He will spend time with clinicians during consultations to understand the scope of tests requested, frequently asked questions across all parties: clinicians, survivors and/or caretakers and use of technology to aid in the management of LTS patients. Focused interviews of clinicians, patients, caregiver and administration will be conducted to further understand the challenges of the pediatric cancer survivors and the development of an LTS program in an LMIC face. Results: After this month visit, critical areas of knowledge transfer will include: how to set up a childhood cancer survivorship programs; methods for sustainable operation of a childhood cancer LTS program, and how to help childhood cancer survivors navigate health care systems. A similar model will be established in Rwanda. Long-term mentorship with Botswana colleagues will help to build Rwanda's first LTS. Conclusion: Survivors involved in dedicated LTS follow-up care have better health outcomes. This indicates the need for life long survivorship care. There is a dearth of data on how to establish and operate a childhood cancer LTS program in LMIC settings. Lessons learned through this program will guide us on how to set up such program in Rwanda.

Patterns of Treatment Noninitiation and Early Loss to Follow-Up in Breast Cancer Care in Haiti

Background: Loss to follow-up after treatment initiation is a recognized and well-studied problem in cancer care programs in low- and low-middle income countries (LMIC). However, there is less literature on causes of treatment noninitiation in LMIC breast cancer programs. Hôpital Universitaire de Mirebalais (HUM) in Haiti established the main public comprehensive cancer center in the country in 2013. The facility is located in the Centre Department but serves patients from all the other nine departments (regions) of the country. Care provided within the facility is free after an initial nominal deposit, as a result of a multi-institutional collaboration with Zanmi Lasante, a local arm of Partners In Health, an international nonprofit organization, and US academic institutions. Aim: To determine the causes of treatment noninitiation and early loss to follow-up (LTFU) among a retrospective cohort of patients seen in the HUM breast cancer program. Methods: We evaluated 1371 women who had their first visit between July 1, 2013 and December 31, 2016. The list of breast cancer patients was generated from electronic medical record diagnosis codes. We identified individuals who were followed for less than 90 days (Under-90). We reviewed the patient's record to determine reason for care noninitiation and early losses. We used logistic regression analysis to determine if distance from HUM contributed to being Under-90, while controlling for demographic factors. Results: 339 (24.6%) patients in the breast cancer program were seen for less than 90-days. The two most common periods of early LTFU were prior to obtaining diagnostic biopsy (113 patients- 33%), and after referral for staging diagnostic imaging (83 patients- 24%). 49 patients (14%) had confirmed diagnosis and completed staging but never initiated treatment, while only 23 (7%) did not initiate treatment due to confirmed advanced metastatic disease or death. Majority of the patients 1254 (91.5%) came from outside the Centre region; early LTFU was more common among these patients (25.6%) compared with Centre region patients (16.2%). Using logistic regression analysis, controlling for age and rural/urban home classification, we found that the odds of Under-90 was 2.05 (95% CI: 1.22-3.45), P = 0.007, for those living outside the Centre region, compared with living in hospital's region. We repeated the analysis comparing the Centre region to the immediately adjacent regions, and more distant regions; we found the odds of Under-90 was 1.88 (95% CI: 1.12-3.18) for the adjacent regions, and 2.92 (95% CI: 1.61-5.31) for the distant regions. Conclusion: Treatment noninitiation and early losses are a significant problem in the HUM breast cancer program. As anticipated, living farther from HUM increased the odds of early LTFU. Effective interventions are needed to reduce the number of patients failing to initiate therapy, and these interventions must begin at the first contact with the oncology program.

Association Between Living in Urban Areas and Obesity in Haitian Breast Cancer Patients

Background: Obesity and metabolic syndrome (MS) have been linked to increased risk of breast cancer recurrence and mortality in prospective cohorts. These studies have mostly occurred in high-income countries. Little is known about rates of obesity and what factors predict obesity in breast cancer patients from low- and low-middle income countries (LMIC). However, there are increasing rates of obesity in the general population of LMICs. Hôpital Universitaire de Mirebalais (HUM) in Haiti established the main public comprehensive cancer center in the country in 2013. The facility serves patients from all around the country. Aim: To establish the prevalence of obesity in a retrospective cohort of breast cancer patients at HUM, and evaluate the association between living in urban areas and obesity in this population. Methods: We evaluated 1035 women who had their first visit between July 1, 2013 and December 31, 2016, with a coded diagnosis of breast cancer, and who had been followed in the HUM program for ≥ 90 days. We abstracted their first recorded height, weight and blood pressure (BP). We identified individuals who met criteria for obesity (body mass index [BMI] ≥ 30 kg/m2), systolic hypertension (systolic BP [SBP] ≥ 135 mmHg), and diastolic hypertension (diastolic BP [DBP] ≥ 90 mmHg). After exclusion of missing data in the variables of interest, the final analysis cohort was 678. We classified home commune location as rural or urban based on World Bank and UN standards. We used logistic regression analysis to determine the odds of being obese for individuals living in urban areas compared with rural dwellers. Results: 179 breast cancer patients (26.4%) had BMI ≥ 30, of which 58 (8.5%) were morbidly obese (BMI ≥ 35). 309 (45.6%) patients had systolic hypertension (HTN) and 180 (26.6%) had diastolic HTN. 417 (61.5%) lived in urban areas; 125 (30%) of urban dwellers were obese while only 20.7% of rural dwellers were obese. The crude OR for obesity in urban versus rural areas was 1.64 (95% CI: 1.16-2.36). Using logistic regression analysis and controlling for age the OR for obesity in urban areas was 1.67 (95% CI: 1.15-2.40), P = 0.0162. We did a similar analysis for morbid obesity, while controlling for age, the OR in urban compared with rural patients was 2.16 (95% CI: 1.15-4.03), P = 0.0162. There were no statistically significant differences in SBP and DBP comparing rural and urban patients. Conclusion: HUM breast cancer patients from urban areas were more likely to be obese than rural dwellers. Urban patients were twice as likely to be morbidly obese. There were no differences in HTN between the groups. Higher rates of obesity in the HUM breast cancer population is partly driven by the higher proportion of urban patients. Further studies need to be done to evaluate the causes and mediators of obesity as well as its effect on patient cancer outcome in Haiti.

Cancer Education in Rwanda: Challenges and Opportunities for Undergraduate Medical Students (The EDUCAN Project)

Background: Shortage and lack of trained cancer specialists is one of the major challenges in addressing the increasing cancer burden in low and middle income countries. Inadequate undergraduate cancer education in oncology remains a major obstacle for both task shifting to general practitioners and for training of specialists. We provide the first report of cancer education in Rwanda's undergraduate program to survey how fresh graduates are prepared to provide care for cancer patients. Aim: - Identify the current status of cancer education in one of Rwanda's two medical schools; - Provide a basis for educational reforms that target improvements of cancer knowledge and management. Methods: Anonymous online survey was sent January to June 2017 to medical students in their senior clinical years (year 5 and 6). Questions related to the demographics, medical curriculum and general oncology exposure were included in the survey. Results: Of 192 eligible students, 42% (n=80) completed the survey and were analyzed. The majority were 25 to 29 years of age and 41% were female. Internal medicine was cited to provide the most exposure to cancer patients (50%) and cancer bedside teaching (55%). Close to a half (46%) have been taught oncology formally in addition to bedside teaching. A tenth (11%) of the participants felt comfortable in attending a cancer patient, and a fifth (21%) of the students felt comfortable while addressing multimodality treatment approach. The majority (99%) of the participants preferred having a formal oncology rotation. Of particular interest, 61% of the students are interested in pursuing an oncology career path. Conclusion: There is a need to modify the current oncology undergraduate curriculum to prepare future physicians for delivering cancer care in Rwanda. Raising the profile of oncology in undergraduate medical education will complement the on-going efforts to increase the country's capacity in task shifting an in training of cancer specialists.

Attrition in trials evaluating complex interventions for schizophrenia: Systematic review and meta-analysis

Essential criteria for the methodological quality and validity of randomized controlled trials are the drop-out rates from both the experimental intervention and the study as a whole. This systematic review and meta-analysis assessed these drop-out rates in non-pharmacological schizophrenia trials. A systematic literature search was used to identify relevant trials with ≥100 sample size and to extract the drop-out data. The rates of drop-out from the experimental intervention and study were calculated with meta-analysis of proportions. Meta-regression was applied to explore the association between the study and sample characteristics and the drop-out rates. 43 RCTs were found, with drop-out from intervention ranging from 0% to 63% and study drop-out ranging from 4% to 71%. Meta-analyses of proportions showed an overall drop-out rate of 14% (95% CI: 13-15%) at the experimental intervention level and 20% (95% CI: 17-24%) at the study level. Meta-regression showed that the active intervention drop-out rates were predicted by the number of intervention sessions. In non-pharmacological schizophrenia trials, drop-out rates of less than 20% can be achieved for both the study and the experimental intervention. A high heterogeneity of drop-out rates across studies shows that even lower rates are achievable.

Laboratory and Field Evaluations of Polyacrylamide Hydrogel Baits Against Argentine Ants (Hymenoptera: Formicidae)

The development of effective baits to control the Argentine ant, Linepithema humile (Mayr), has been problematic because foragers prefer sweet liquids, while many toxicants are insoluble in water and liquid baits are generally difficult to deliver. The incorporation of thiamethoxam and sucrose solutions into a water-absorbing polyacrylamide hydrogel provides a unique and novel carrier and method of application for liquid baits. Formulations of thiamethoxam affected the size of the hydrogels, and sucrose solutions containing 0.0003% technical thiamethoxam provided hydrogels as large as those made with 25% sucrose solution or deionized water. Concentrations of thiamethoxam as low as 0.000075% in the hydrogels provided 50% kill of workers within 3 d in a laboratory setting. In small colony studies, baiting with 0.00015 and 0.000075% thiamethoxam hydrogels provided 100% mortality of workers and queens within 8 d. An enzyme-linked immunosorbent assay indicated that thiamethoxam was absorbed into the interior of the polyacrylamide matrix. The water loss rates of the hydrogels were dependent upon the relative humidity. Polyacrylamide hydrogels with >50% water loss were less attractive to ants. Field studies in highly infested areas indicated that concentrations of 0.0006 or 0.0018% thiamethoxam were more effective than 0.00015%. Hydrogels may provide a cost-effective alternative to providing aqueous baits to control Argentine ants.

Emotion-focused group therapy for women with symptoms of bulimia nervosa

This study provides outcome pilot data for an outpatient emotion-focused therapy group for 12 women with DSM-IV diagnoses of binge-eating disorder, bulimia nervosa, or eating disorder not otherwise specified. The emotion-focused therapy group involved 16 weekly sessions that targeted problematic emotions connected to eating disorder symptoms. Semi-structured clinical interviews were conducted pre- and post-treatment and self-report questionnaires were administered. From pre- to post-treatment, changes in binge eating and scores on self-report measures were statistically significant. Participants reported a decrease in the frequency of binge episodes, improvements in mood, and improvements in emotion regulation and self-efficacy.

Practical Pest Management Strategies to Reduce Pesticide Runoff for Argentine Ant (Hymenoptera: Formicidae) Control

The purpose of this study was to involve pest management professionals in the design of application techniques and strategies that would be efficacious and also reduce insecticide runoff. Our study involved measuring both the efficacy of treatments for the Argentine ant, Linepithema humile (Mayr), and the concurrent runoff of fipronil and pyrethroids. Two collaborating companies used low-impact protocols for controlling ants while minimizing runoff. Protocol 1 involved bimonthly treatments, while Protocol 2 was monthly. Both protocols involved an initial treatment with a fipronil spray around the foundation. At the garage door-driveway interface, the fipronil application was done as a pin stream for Protocol 1, and as a crack and crevice application in the expansion joint near the garage for Protocol 2. Protocol 1 replaced most pyrethroid sprays with bifenthrin granules placed around bushes and away from the driveway. For the next treatment on day 63, Protocol 1 also included cyfluthrin spray treatments around the house foundation and crack and crevice applications around the edge of the driveway. For the first treatment in Protocol 2, the fipronil spray was supplemented with spot treatments of cyfluthrin. For subsequent Protocol 2 treatments, botanical insecticides were applied. For weeks 1 and 2 posttreatment combined, Protocol 1 had significantly higher reductions in ant numbers compared with Protocol 2. Thereafter there were no significant differences between the protocols. Runoff of bifenthrin from the granules used with Protocol 1 was much lower than in previous trials involving bifenthrin sprays. Day 1 fipronil runoff for Protocol 2 was significantly lower than that for Protocol 1. This difference may be because of the crack and crevice application applied in Protocol 2. Cyfluthrin runoff was minimal for Protocol 2, which involved spot treatments to supplement the fipronil on day 1, or the botanical insecticides for subsequent treatments. Protocol 1 had a large peak of cyfluthrin runoff at day 63 corresponding to their house and driveway treatments.

Protection of non-human primates against rabies with an adenovirus recombinant vaccine

Rabies remains a major neglected global zoonosis. New vaccine strategies are needed for human rabies prophylaxis. A single intramuscular immunization with a moderate dose of an experimental chimpanzee adenovirus (Ad) vector serotype SAd-V24, also termed AdC68, expressing the rabies virus glycoprotein, resulted in sustained titers of rabies virus neutralizing antibodies and protection against a lethal rabies virus challenge infection in a non-human primate model. Taken together, these data demonstrate the safety, immunogenicity, and efficacy of the recombinant Ad-rabies vector for further consideration in human clinical trials.

Narrative Processes Coding System: A Dialectical Constructivist Approach to Assessing Client Change Processes in Emotion-Focused Therapy of Depression

Drawing on a Dialectical Constructivist model of therapeutic change, this paper addresses the fundamental contributions of client narrative disclosure, emotional differentiation and reflexive meaning-making processes in emotion-focused treatments of depression. An overview of the multi-methodological steps undertaken to empirically investigate the contributions of client storytelling, emotional differentiation, and meaning-making processes, using the Narrative Processes Coding System (NPCS; Angus et al., 1999) are provided, followed by a summary of key research findings that informed the development of a narrative-informed approach to emotion-focused therapy of depression (Angus & Greenberg, 2011). Finally, therapy practice implications for the adoption of a research-informed approach to working with narrative and emotion processes in emotion-focused therapy are described and future research directions discussed.

Temperature-dependent prey capture efficiency and foraging modes of brown trout Salmo trutta

Prey capture success and foraging mode were studied in brown trout Salmo trutta at temperatures ranging from 5.7 to 14.0° C. At low temperatures, there was a positive correlation between prey capture success and the proportion of time that the fish spent holding feeding stations. This correlation was not found at temperatures >10° C.

Impact of ant control technologies on insecticide runoff and efficacy

BACKGROUND

Insecticides are commonly used for ant control around residential homes, but post-treatment runoff may contribute to contamination of surface water in urban watersheds. This study represents the first instance where runoff of insecticides was directly measured after applications around single family residences. During 2007, houses were treated with bifenthrin or fipronil sprays following standard practices. During 2008, pin stream applicators, spray-free zones and restricting sprays to the house foundation were considered as management options.

RESULTS

During 2007, the resulting runoff from the bifenthrin spray in the irrigation water had a mean concentration of 14.9 microg L(-1) at 1 week post-treatment and 2.5 microg L(-1) at 8 weeks, both high enough to be toxic to sensitive aquatic organisms. In comparison, treatments with bifenthrin granules resulted in no detectable concentrations in the runoff water after 8 weeks. The mean concentration for fipronil used as a perimeter spray was 4.2 microg L(-1) at 1 week post-treatment and 0.01 microg L(-1) at 8 weeks, with the first value also suggesting a potential for causing acute aquatic toxicity to sensitive organisms. During 2008, insecticide runoff was reduced by using spray-free zones and pin stream perimeter applications.

CONCLUSIONS

It is shown that insecticide runoff from individual home treatments for ants can be measured and used to improve techniques that minimize runoff. The pin stream application and applications limited to the house foundation should be further evaluated for their potential to reduce pesticide runoff from residential homes.

Genetic component of bee odor in kin recognition

The primitively social sweat bee, Lasioglossum zephyrum, blocks the entry into its nest of most conspecifics from other colonies. Laboratory inbreeding of these bees produced lines which showed a positive linear relationship between the coefficient of relationship of bees tested and how often they permitted non-nestmates to pass them. The most probable mechanism is a genetically determined odor coupled with a learned component by which guard bees discriminate between odors of close kin and other bees.

Efficacy and cardiac safety of adjuvant trastuzumab-based chemotherapy regimens for HER2-positive early breast cancer

BACKGROUND

Trastuzumab-based adjuvant therapy has become the standard of care for human epidermal growth factor receptor-2 (HER2)-positive early breast cancer (EBC). Both anthracycline- and non-anthracycline-containing trastuzumab regimens are approved in the United States, but cardiotoxicity is increased with anthracycline-containing regimens.

DESIGN

This paper reviews published and reported efficacy and cardiac safety data from the adjuvant trastuzumab trials [National Surgical Adjuvant Breast and Bowel Project (NSABP) B-31/North Central Cancer Treatment Group (NCCTG) N9831, Breast Cancer International Research Group (BCIRG) 006, Herceptin Adjuvant (HERA), FinHer, and Programme Adjuvant Cancer Sein (PACS) 04].

RESULTS

The addition of trastuzumab to adjuvant chemotherapy significantly improved disease-free survival (from 24% to 58%) in five of the six trials. Overall survival was significantly improved (23%-35%) in the large trials. In NSABP B-31/ NCCTG N9831, 5.0%-6.6% of patients who received doxorubicin and cyclophosphamide (AC) were unable to receive trastuzumab. Cardiac event rate was highest in the anthracycline-containing trastuzumab arms (1.9%-3.8%) and lowest with the regimen of docetaxel, carboplatin, and trastuzumab (TCH) (0.4%).

CONCLUSIONS

Incorporation of trastuzumab into anthracycline and non-anthracycline adjuvant chemotherapy regimens has substantially improved outcomes in HER2-postive EBC. The TCH regimen has the lowest rates of cardiac dysfunction, but uncertainty exists regarding the relative efficacy of TCH compared with anthracycline-containing trastuzumab regimens. Cardiac risk factor assessment can aid in selection of trastuzumab-based adjuvant therapy regimens.

Queen sex pheromone of the slave-making ant, Polyergus breviceps

Workers of the slave-making ant, Polyergus breviceps, raid nests of Formica ants and return with Formica pupae that mature into worker ants in the slave-makers' colony. These Formica workers then tend the Polyergus brood, workers, and reproductives. During raids in the mating season, winged virgin Polyergus queens accompany the workers in the raiding columns. During the raid, the virgin queens release a pheromone that attracts males that quickly mate with the queens. We report the identification, synthesis, and bioassay of the sex attractant pheromone of the queens as an approximately 1:6 ratio of (R)-3-ethyl-4-methylpentan-1-ol and methyl 6-methylsalicylate. The ants produce exclusively the (R)-enantiomer of the alcohol, and the (S)-enantiomer has no biological activity, neither inhibiting nor increasing attraction to blends of methyl 6-methylsalicylate with the (R)-enantiomer.

Aggressive interactions between Solenopsis invicta and Linepithema humile (Hymenoptera: Formicidae) under laboratory conditions

The Argentine ant, Linepithema humile (Mayr), and the red imported fire ant, Solenopsis invicta Buren, are natural agonists in their country of origin. Since the first report of L. humile in California in 1907 its range expanded statewide, displacing native ant species wherever it spread. Since the discovery of established populations of S. invicta in southern California in 1998, it has been restricted to discrete areas of southern California. However, as these discrete populations expand, they are encountering large populations of L. humile, which are effective competitors for available resources and are particularly aggressive in their encounters with other ant species such as S. invicta. Most Dolichoderine ants such as L. humile do not prefer to forage on baits made with defatted corn grit and soybean oil typically used in red imported fire ant control programs. Applications of these baits in areas where distributions of these species overlap might selectively affect populations of S. invicta and give L. humile a competitive advantage. Three laboratory experiments were conducted to determine the competitive outcomes between S. invicta pitted against L. humile: 1) agonistic behavior of workers in small arenas, 2) colony interactions with different population ratios, and 3) the effects of pyriproxyfen on the competitiveness of S. invicta against L. humile. Populations of S. invicta consisting of major workers killed more L. humile than did minors or a mixture of majors and minors. When paired against L. humile colonies consisting of 1,100 workers, colonies consisting of 38 S. invicta workers were easily defeated by L. humile. Colonies consisting of 450 S. invicta workers plugged their nest entrances, but they were ultimately defeated by L. humile after 13 d. The S. invicta colonies consisting of 1,100 workers took control of the bridge connecting the colonies, invaded the L. humile colony, killed the Argentine ant queens, and removed their brood. Pyriproxyfen-treated fire ant workers took significantly longer to chase the Argentine ants from a connecting bridge than did untreated fire ants. Thus, fire ant baits may have long-term effects on intercolonial aggression between S. invicta and L. humile, especially when Argentine ant populations are high in the summer.

Response of Argentine ants and red imported fire ants to permethrin-impregnated plastic strips: foraging rates, colonization of potted soil, and differential mortality

This study investigated the effects of the permethrin-impregnated plastic on ant mortality and foraging rates, and tested its potential for preventing ants from colonizing potted soil. Direct exposure to the plastic for as short as 1 min caused significant mortality of both red imported fire ants, Solenopsis invicta Buren, and Argentine ants, Linepithema humile (Mayr); however, red imported fire ants were more susceptible than Argentine ants. Knockdown of virtually all ants initially occurred within 15 min after exposure. However, some moribund ants recovered from the effects within 24 h. For example, after 1 min of direct exposure to the permethrin-impregnated plastic, 70% of Argentine ants and 5% of red imported fire ants recovered from the treatment. In established colonies of Argentine ants, significantly fewer ants foraged for food up posts treated with the plastic compared with untreated posts. In addition, colonies responded to introduction of the treatment by significantly reducing their overall foraging rates, even on untreated posts. When pots filled with moistened soil were introduced into established ant colonies, 82% of Argentine ants and 99% of red imported fire ants moved into the soil. In contrast, when a 1-cm-wide coil of the plastic was placed under the pot, no ants moved into the soil. The potential for use of these materials in nursery production is discussed.

Sex Pheromone of Queens of the Slave-Making Ant, Polyergus breviceps

The sex attractant pheromone produced in mandibular glands of queens of the slave-making ant Polyergus breviceps has been identified as a blend of methyl 6-methylsalicylate and 3-ethyl-4-methylpentanol. In field trials, each compound alone was completely unattractive to males, whereas blends of the two compounds attracted hundreds of males within a couple of hours.

Assessing an educational intervention to improve physician violence screening skills

OBJECTIVES

Health professionals play an integral role in assessing the risk of violence in their patients. However, there have been few evaluations of violence prevention education programs for health care personnel. The objective of this study was to evaluate the effects of a violence-screening education program on pediatric residents' and medical students' comfort level and skills in the identification and management of violence risks.

SETTING

Adolescent clinic of a tertiary care pediatric hospital.

PARTICIPANTS

Fifty-six second-year residents and third-year medical students assigned to a 4-week adolescent clinic rotation.

DESIGN

Randomized, controlled comparison study conducted over a 1-year period.

INTERVENTION

On alternate months, medical students and residents in the intervention group participated in a 3-hour workshop on violence prevention. The workshop included a didactic session with an overview of firearm, media, and sexual violence; a discussion of risk factors for adolescent violence; and training on the approach to the adolescent interview. Participants also discussed violence risks in the community with a panel of teen health educators, engaged in one-on-one role play with the youth educators, and received feedback on their violence screening skills. The control group received the standard ambulatory clinic manual with articles on violence prevention.

EVALUATION METHODS

All participants completed prerotation and postrotation questionnaires assessing their self-reported screening practices, as well as perceived importance and confidence in violence screening. Participants also interviewed and examined an adolescent standardized patient (SP) in the clinic. SPs completed evaluations on the content of the residents' and students' screening, their interpersonal skills, and their skill in the identification and management of the violence-related problem.

RESULTS

Over 12 months, 30 control and 26 intervention participants were recruited. There were no differences in prerotation questionnaire scores for intervention and control groups in screening practices, perceived importance and confidence in violence screening. Postrotation intervention participants reported more screening compared with controls on violence in school/neighborhood and fighting history. There was also greater perceived importance in asking about access/use of weapons and violence in school/neighborhood. Intervention participants also had improved performance compared with controls on SP evaluations of screening for violence, identification and management of the violence-related scenario, and interpersonal skills.

CONCLUSION

A violence prevention education program with teen health educators improved participants' self-reported violence questioning, as well as increased perceived comfort and importance in violence screening. Participants in the program also improved their identification and management of a standardized violence-related scenario presented in an adolescent clinic setting. adolescent violence, physician education, violence risk screening.

Considerations in choosing a primary endpoint that measures durability of virological suppression in an antiretroviral trial

OBJECTIVES

At present, many clinical trials of anti-HIV-1 therapies compare treatments by a primary endpoint that measures the durability of suppression of HIV-1 replication. Several durability endpoints are compared.

DESIGN

Endpoints are compared by their implicit assumptions regarding surrogacy for clinical outcomes, sample size requirements, and accommodations for inter-patient differences in baseline plasma HIV-1-RNA levels and in initial treatment response.

METHODS

Virological failure is defined by the non-suppression of virus levels at a prespecified follow-up time T(early virological failure), or by relapse. A binary virological failure endpoint is compared with three time-to-virological failure endpoints: time from (i) randomization that assigns early failures a failure time of T weeks; (ii) randomization that extends the early failure time T for slowly responding subjects; and (iii) virological response that assigns non-responders a failure time of 0 weeks. Endpoint differences are illustrated with Agouron's trial 511.

RESULTS

In comparing high with low-dose nelfinavir (NFV) regimens in Agouron 511, the difference in Kaplan-Meier estimates of the proportion not failing by 24 weeks is 16.7% (P = 0.048), 6.5% (P = 0.29) and 22.9% (P = 0.0030) for endpoints (i), (ii) and (iii), respectively. The results differ because NFV suppresses virus more quickly at the higher dose, and the endpoints weigh this treatment difference differently. This illustrates that careful consideration needs to be given to choosing a primary endpoint that will detect treatment differences of interest.

CONCLUSION

A time from randomization endpoint is usually recommended because of its advantages in flexibility and sample size, especially at interim analyses, and for its interpretation for patient management.

Toxicity and repellency of borate-sucrose water baits to Argentine ants (Hymenoptera: Formicidae)

The oral toxicity of boron compounds to the Argentine ant, Linepithema humile (Mayr), was evaluated in laboratory tests. The ants were provided 25% sucrose water containing 0.5 and 1% boric acid, disodium octaborate tetrahydrate, and borax. Lethal times of these solutions were a function of the concentration of boron. In field tests, the ants showed no discrimination between disodium octaborate tetrahydrate and boric acid. There was a significant reduction in consumption of sucrose water with > 1% boric acid.

Teaching prevention in pediatrics

Pediatrics has attempted to inculcate the "culture of prevention" into practice, both through anticipatory guidance in well-child care and through behavioral interventions in sick care. The effectivenesses of many components of well-child care have not been conclusively demonstrated, particularly in health education, counseling, and anticipatory guidance, nor has teaching prevention in pediatrics been thoroughly evaluated. This article reviews methods of teaching prevention in pediatrics and highlights innovative programs. Teaching programs use the wide range of approaches now common in medical education, in a variety of inpatient and outpatient sites. Programs across the country are trying new approaches to teaching traditional topics or are introducing new topics into their curricula. Examples of specific programs are given, organized by the themes of the programs. The field needs to develop in three major directions. First, there is a need to develop competencies and curricula in prevention issues of contemporary importance, including the new morbidities, cross-cultural issues, cost-effectiveness, quality of care, and practice in managed care and other community settings. Second, further work is needed to evaluate programs and measure educational outcomes. This feedback must in turn be used to redefine competencies, curricula, and programs, Third, there needs to be an accessible clearinghouse, and educational tools need to be disseminated. To be effective, a curriculum for prevention in pediatrics cannot stand alone, but must be part of a vertically and horizontally integrated curriculum. Further, creating horizontally and vertically integrated curricula in prevention teaching across disciplines should be the standard.

Argentine ant (Hymenoptera: Formicidae) trail pheromone enhances consumption of liquid sucrose solution

We investigated whether the Argentine ant, Linepithema humile (Mayr), trail pheromone, Z9-16:Ald, could enhance recruitment to and consumption of liquid sucrose solutions. All tests were done as paired comparisons with a 10% sucrose solution as food. In the laboratory, mixing 20 microl of a 10-microg/ml solution of the pheromone with 50 microl of the 10% sucrose solution increased the number of ants feeding by >150%. In a field test, we combined the trail pheromone with a 10% sucrose solution in 50-ml vials. These vials were covered with a plastic membrane that has 1.5-mm-diameter holes punched uniformly across its surface. Ants could drink from the holes after the vials were inverted. For half of the vials, 1 microg of the pheromone was put onto the plastic membrane before the vials were filled with a 10% sucrose solution. The remaining vials had no pheromone on the plastic membrane. After 4 h we measured the consumption in each vial. Bait consumption with the pheromone was enhanced by 29%. In a 2nd series of tests, vials were left outside for 24 h. The consumption rate was 33% higher with the pheromone compared with the controls that didn't have pheromone.

Calf augmentation using free TRAM flap

Augmentation of the calf for correction of contour deformities has been most frequently performed utilizing silicone implants. Results of such implants have often been unsatisfactory. We report the case of a 27-year-old woman who chose the use of a transverse rectus abdominis myocutaneous (TRAM) free flap for correction of a left calf contour deformity from childhood polio. This is the first report of calf augmentation with the use of a TRAM free flap and excellent results were obtained.