The MATRIX: A deliberate practice approach for clinical supervision in the public sector

Clinical supervision is an essential component of psychotherapeutic practice. However, the literature suggests that the provision of supervision in the public sector has been declining significantly over the past two decades, suggesting that many health care professionals are receiving neither the guidance nor support needed to deliver safe and effective care. Identifying the distinct challenges of supervision in the public sector and proposing prospective solutions is, therefore, a burning issue. In this article, we introduce a novel analytical framework for clinical supervision-the MATRIX-striving to address the unique demands of psychotherapy in the public sector. Various applications of this framework are thoroughly presented and further exemplified using a case illustration. We conclude by discussing the contribution of MATRIX-aided supervision to the acquisition of expert performance in psychotherapy, while also addressing its limitations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patient-therapist congruent exchanges engaged with the potential-to-experience is associated with better outcome of psychotherapy

BACKGROUND

The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. However, as this assumption has never been empirically tested, the relationship between such interventions and treatment outcome is unclear. The aim of this pilot study is to explore the relationship between patient-therapist congruence of potential-to-experience engaged statements and the outcome of psychodynamic treatments.

METHODS

Transcripts of 90 sessions from good- and poor-outcome treatments (N = 18) were encoded using the MATRIX - a novel content analysis tool of psychodynamic psychotherapy. Based on fixed algorithms, this observer-coding system is designed to identify different types of clinical interventions, including those which focus on the potential-to-experience. Total number of MATRIX codes analysed was 11,125. We compared the total congruence/incongruence ratio of such statements in good and poor treatments. The importance of the congruence/incongruence ratio of the potential-to-experience statements was measured by applying general linear models to classify treatment outcome.

RESULTS

The congruence/incongruence ratio of the potential-to-experience engaged statements was significantly higher in good treatments. In the best model for classifying treatment outcome based on the congruence/incongruence ratios of several parameters, the congruence/incongruence ratio of the potential-to-experience engaged statements was the single most important predictor.

DISCUSSION

Maintaining the congruence of potential-to-experience engaged statements within the therapeutic session is associated with better clinical outcome. This provides an initial empirical indication to the importance of the potential-to-experience discourse in psychotherapy praxis.

PRACTITIONER POINTS

The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. The current results suggest that the ability of both patient and therapist to maintain the congruence of potential-to-experience statements within the session may improve clinical outcomes. These findings suggest a practical approach for a better management of the therapeutic process. Mainly, it recommends therapists to implement a very careful, active listening to potential-to-experience-related content throughout the session, while highlighting the patient's associations for their potential to become new modus operandi. Moreover, the current study presents an integrative, micro-level tool that enables the translation of complex theoretical concepts in psychotherapy into measurable constructs, aiming at the creation of a bridge between clinical theory and evidence-based practice.

SlPRA1A/RAB attenuate EIX immune responses via degradation of LeEIX2 pattern recognition receptor

Pattern recognition receptors (PRR) are plasma membrane (PM) proteins that recognize microbe-associated molecular patterns (MAMPs), triggering an immune response. PRR are classified as receptor like kinases (RLKs) or receptor like proteins (RLPs). The PM localization of PRRs, which is crucial for their availability to sense MAMPs, depends on their appropriate trafficking through the endomembrane system. Recently, we have identified SlPRA1A, a prenylated RAB acceptor type-1 (PRA1) from S. lycopersicum, as a regulator of RLP-PRR localization and protein levels. SlPRA1A overexpression strongly decreases RLP-PRR protein levels, particularly those of LeEIX2, redirecting it to the vacuole for degradation. Interestingly, SlPRA1A does not affect RLK-PRRs, indicating its activity to be specific to RLP-PRR systems. As PRA1 proteins stabilize RABs on membranes, promoting RABs activity, we aimed to identify a RAB target of SlPRA1A. Screening of a set of A. thaliana RABs revealed that AtRABA1e is able to mimic SlPRA1A activity. Through live cell imaging, we observed that SlPRA1A enhances AtRABA1e localization on SlPRA1A positive punctuated structures. These results indicate that AtRABA1e is a putative target of SlPRA1, and a co-regulator of LeEIX2 trafficking and degradation.

Spontaneous improvement in both obstructive sleep apnea and cognitive impairment after stroke

BACKGROUND

Knowledge available about the relationship between obstructive sleep apnea (OSA) and cognitive impairment after stroke is limited. The evolution of OSA and cognitive performance after stroke is not sufficiently described.

METHODS

We prospectively enrolled and examined acute stroke patients without previously diagnosed OSA. The following information was collected: (1) demographics, (2) sleep cardio-respiratory polygraphy (PG) at 72 h, day seven, month three, and month 12 after stroke, (3) post-stroke functional disability tests at entry and at months three and 12, and (4) cognition (attention and orientation, memory, verbal fluency, language, and visual-spatial abilities) using the revised Addenbrooke's Cognitive Examination (ACE-R) at months three and 12.

RESULTS

Of 68 patients completing the study, OSA was diagnosed in 42 (61.8%) patients. The mean apnea/hypopnea index (AHI) at study entry of 21.0 ± 13.7 spontaneously declined to 11.6 ± 11.2 at month 12 in the OSA group (p < 0.0005). The total ACE-R score was significantly reduced at months three (p = 0.005) and 12 (p = 0.004) in the OSA group. Poorer performance on the subtests of memory at months 3 (p = 0.039) and 12 (p = 0.040) and verbal fluency at months 3 (p < 0.005) and 12 (p < 0.005) were observed in the OSA group compared to non-OSA group. Visual-spatial abilities in both the OSA (p = 0.001) and non-OSA (p = 0.046) groups and the total ACE-R score in the OSA (p = 0.005) and non-OSA (p = 0.002) groups improved.

CONCLUSIONS

A high prevalence of OSA and cognitive decline were present in patients after an acute stroke. Spontaneous improvements in both OSA and cognitive impairment were observed.

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for patients with hematological malignancies. However, is associated with substantial rates of morbidity and mortality. We and others have shown that malglycemia is associated with adverse transplant outcome. Therefore, improving glycemic control may improve transplant outcome. In this prospective study we evaluated the feasibility of using Glucommander (a Computer-Guided Glucose Management System; CGGM) in order to achieve improved glucose control in hospitalized HCT patients. Nineteen adult patients contributed 21 separate instances on CGGM. Patients were on CGGM for a median of 43 h. Median initial blood glucose (BG) on CGGM was 244 mg/dL, and patients on 20 study instances reached the study BG target of 100-140 mg/dL after a median of 6 h. After BG reached the target range, the median average BG level per patient was 124 mg/dL. Six patients had a total of 10 events of BG <70 mg/dL (0.9% of BG measurements), and no patients experienced BG level <40 mg/dL. The total estimated duration of BG <70 mg/dL was 3 h (0.2% of the total CGGM time). In conclusion, our study demonstrates that stringent BG control in HCT patients using CGGM is feasible.

Quality of life of adult daughters of women with schizophrenia: Associations with psychological resource losses and gains

OBJECTIVE

This study examined the relationship between perceived losses and gains of psychological resources and quality of life of adult daughters of women with schizophrenia.

METHOD

Thirty one adult daughters of mothers with schizophrenia (age range 30 to 50years) and thirty women of similar socio-demographic characteristics whose mothers were mentally healthy (the control group) participated in this study.

RESULTS

(a) Resource loss was higher and resource gains were lower among daughters of women with schizophrenia, compared to the control group; (b) despite resource gains total score of quality of life was significantly lower among daughters of mothers with schizophrenia compared to the controls; (c) daughters of mothers with schizophrenia had lower levels of family functioning, a higher level of negative emotions and a lower level of positive emotions; (d) resource gains moderated the negative relationship between resource loss and quality of life; (e) the most significant predictor of quality of life was the group (i.e. daughters of women with schizophrenia compared with controls); (f) quality of life was more strongly associated with resource loss than with resource gain.

DISCUSSION

The findings of this research underscore the importance of raising awareness of caregivers and healthcare authorities to the needs of the unique population of daughters of women diagnosed with schizophrenia for support and even treatment.

Forming first impressions of others in schizophrenia: impairments in fast processing and in use of spatial frequency information

Individuals form first impressions of others all the time, which affects their social functioning. Typical adults form threat impressions in faces with neutral expressions quickly, requiring less than 40 ms. These impressions appear to be mediated by low spatial frequency (LSF) content in the images. Little is known, however, about mechanisms of first impression formation in schizophrenia. The current study investigated how quickly individuals with schizophrenia can form consistent impressions of threat compared with controls and explored the mechanisms involved. Patients and controls were presented intact, LSF- or high spatial frequency (HSF)-filtered faces with durations that varied from 39 to 1703 ms and were asked to rate how threatening each face was on a scale from 1 to 5. In order to assess the speed of impression formation for intact faces, correlations were calculated for ratings made at each duration compared to a reference duration of 1703 ms for each group. Controls demonstrated a significant relation for intact faces presented for 39 ms, whereas patients required 390 ms to demonstrate a significant relation with the reference duration. For controls, LSFs primarily contributed to the formation of consistent threat impressions at 39 ms, whereas patients showed a trend for utilizing both LSF and HSF information to form consistent threat impressions at 390 ms. Results indicate that individuals with schizophrenia require a greater integration time to form a stable "first impression" of threat, which may be related to the need to utilize compensatory mechanisms such as HSF, as well as LSF, information.

Transferred WT1-reactive CD8+ T cells can mediate antileukemic activity and persist in post-transplant patients

Relapse remains a leading cause of death after allogeneic hematopoietic cell transplantation (HCT) for patients with high-risk leukemias. The potentially beneficial donor T cell-mediated graft-versus-leukemia (GVL) effect is often mitigated by concurrent graft-versus-host disease (GVHD). Providing T cells that can selectively target Wilms tumor antigen 1 (WT1), a transcription factor overexpressed in leukemias that contributes to the malignant phenotype, represents an opportunity to promote antileukemic activity without inducing GVHD. HLA-A*0201-restricted WT1-specific donor-derived CD8 cytotoxic T cell (CTL) clones were administered after HCT to 11 relapsed or high-risk leukemia patients without evidence of on-target toxicity. The last four treated patients received CTL clones generated with exposure to interleukin-21 (IL-21) to prolong in vivo CTL survival, because IL-21 can limit terminal differentiation of antigen-specific T cells generated in vitro. Transferred cells exhibited direct evidence of antileukemic activity in two patients: a transient response in one patient with advanced progressive disease and the induction of a prolonged remission in a patient with minimal residual disease (MRD). Additionally, three treated patients at high risk for relapse after HCT survive without leukemia relapse, GVHD, or additional antileukemic treatment. CTLs generated in the presence of IL-21, which were transferred in these latter three patients and the patient with MRD, all remained detectable long-term and maintained or acquired in vivo phenotypic and functional characteristics associated with long-lived memory CD8 T cells. This study supports expanding efforts to immunologically target WT1 and provides insights into the requirements necessary to establish potent persistent T cell responses.

Perampanel Study 207: long-term open-label evaluation in patients with epilepsy

OBJECTIVES

Evaluate interim long-term tolerability, safety and efficacy of adjunctive perampanel, a novel α-amino-3-hydroxy-5-methyl-5-isoxazolepropionic acid (AMPA)-receptor antagonist, in patients with refractory partial-onset seizures.

MATERIALS AND METHODS

Study 207, an open-label extension (OLE) study (ClinicalTrials.gov identifier: NCT00368472), enrolled patients (18-70 years) who completed one of two randomized, placebo-controlled, dose-escalation Phase II studies. The OLE Treatment Phase comprised a 12-week Titration Period (2 mg increments of perampanel every 2 weeks to 12 mg/day, maximum) and a Maintenance Period, during which patients continued treatment up to a planned maximum of 424 weeks (~8 years). Interim analysis data cut-off date was 1 December, 2010.

RESULTS

Of 180 patients completing the Phase II studies, 138 enrolled in study 207. At the time of interim analyses (approximately 4 years after study start), over a third (n = 53, 38.4%) remained on perampanel; 41.3% (n = 57) of patients had >3 years of exposure; and 13.0% (n = 18) had at least 4 years' exposure. Mean ± standard deviation (SD) duration of exposure was 116 ± 75 weeks and mean ± SD dose during the OLE Maintenance Period was 7.3 ± 3.3 mg. No new safety signals emerged with long-term treatment. Consistent with previous studies, the most common treatment-emergent adverse events were as follows: dizziness, headache and somnolence. Overall median (range) per cent change from baseline in seizure frequency per 28 days during open-label treatment was -31.5% (-99.2 to 512.2).

CONCLUSIONS

Long-term - up to 4 years - adjunctive perampanel had a favourable tolerability profile in patients with refractory partial-onset seizures. Improvements in seizure control were maintained with long-term treatment.

Diagnosis of recanalization of the intracranial artery has poor inter-rater reliability

BACKGROUND AND PURPOSE

Recanalization is the important outcome measure for acute stroke therapy. Several methods of recanalization assessment are used in clinical practice, but few studies have addressed their reliability. We, therefore, sought to assess interobserver reliability of the diagnosis of intracranial artery recanalization following intervention by using TIMI criteria.

MATERIALS AND METHODS

The digital angiography scans of all patients with acute ischemic stroke during 2009 undergoing DSA and endovascular procedures at Ostrava University Hospital were assessed in the study. Images were retrospectively evaluated for intracranial artery recanalization on the TIMI scale by 2 experienced neuroradiologists who were blinded to clinical findings and to each other.

RESULTS

The angiography scans of 43 patients (16 females; age, 70.5 ± 14 years; median baseline NIHSS score, 15 [IQR, 11-18]) were retrospectively evaluated in our study. At 3 months, 27% of patients had mRS scores ≤ 2 and mortality was 18%. Two radiologists diagnosed TIMI grades as follows: TIMI 0, 16%, and 16%; TIMI 1, 21%, and 8%; TIMI 2a, 32% and 29%; TIMI 2b, 13% and 16%; TIMI 3, 18, and 31%. Interobserver agreement for recanalization was weighted κ = 0.4 (95% CI, 0.2-0.6).

CONCLUSIONS

The diagnosis of recanalization after interventional procedures was found to have poor interobserver agreement between 2 experienced neuroradiologists. TIMI criteria, therefore, do not permit reliable comparison of the efficacy of recanalization therapy among different studies.

Tolerability and safety of perampanel: two randomized dose-escalation studies

OBJECTIVES

To evaluate, for the first time in patients with epilepsy, the tolerability and safety of escalating doses of oral perampanel, a novel, selective, non-competitive AMPA antagonist, as adjunctive therapy for refractory partial-onset seizures.

MATERIALS AND METHODS

Two consecutive, randomized, double-blind, dose-escalation studies recruited adults (18-70 years) with uncontrolled partial-onset seizures receiving one to three concomitant antiepileptic drugs. In study 206, patients were treated for 12 weeks (8-week dose-titration, 4-week dose-maintenance) with placebo or perampanel (up to 4 mg/day, dosed once- or twice-daily). In study 208, patients received placebo or perampanel once-daily (up to 12 mg) for 16 weeks (12-week titration, 4-week maintenance).

RESULTS

Overall, 153 patients were randomized into study 206 (perampanel twice-daily, n = 51; perampanel once-daily, n = 51; placebo, n = 51). Study 208 included 48 patients (perampanel once-daily, n = 38; placebo, n = 10). The highest dose in study 206 - 4 mg/day - was well tolerated, with similar proportions of patients tolerating once-daily (82.4%) and twice-daily (82.4%) perampanel and placebo (82.4%) treatments. In study 208 most patients tolerated doses of ≥ 6 mg perampanel once-daily in a Kaplan-Meier analysis. In both studies, the most common adverse events were CNS-related; most were of mild/moderate severity.

CONCLUSIONS

Perampanel was well tolerated across doses of 4-12 mg/day. The studies showed preliminary evidence of efficacy and identified doses to be evaluated in larger clinical studies.

Growth without growth hormone and similar dysmorphic features in three patients with sporadic combined pituitary hormone deficiencies

BACKGROUND/AIMS

Mutations in the HESX1 gene are associated with a broad spectrum of phenotypes: septo-optic dysplasia, midline defects, pituitary abnormalities with consequent hypopituitarism, isolated growth hormone (GH) deficiency or combined pituitary hormone deficiencies (CPHD). This study examined the prevalence of mutations in the HESX1 gene in patients with CPHD.

PATIENTS/METHODS

Sixty patients with sporadic CPHD without septo-optic dysplasia were screened for mutations in HESX1.

RESULTS

Three patients were found to be heterozygous for the same Asn125Ser variant in the HESX1 gene. In all 3, panhypopituitarism was presented in the neonatal period, manifested by severe hypoglycemia and neonatal jaundice in 2 patients and respiratory distress in 1. Remarkable findings from physical examination included coarse face; prominent, large, low-set ears; and skeletal abnormalities. Magnetic resonance imaging, performed in 2 patients, revealed a hypoplastic anterior and ectopic posterior pituitary without other midline anomalies. Despite persistent GH deficiency and undetectable levels of insulin-like growth factor 1, all patients had normal linear growth along the 10-25th percentile without GH therapy.

CONCLUSION

The present study expands the clinical picture of HESX1 mutations by demonstrating that patients heterozygous for Asn125Ser may have a severe endocrinologic and neuroradiologic phenotype and similar dysmorphic features appearing very early in life.

The Parahippocampal Cortex Mediates Spatial and Nonspatial Associations

The parahippocampal cortex (PHC) has been implicated in the processing of place-related information. It has also been implicated in episodic memory, even for items that are not related to unique places. How could the same cortical region mediate such seemingly different cognitive processes? Both processes rely on contextual associations, and we therefore propose that the PHC should be viewed not as exclusively dedicated for analyzing place-related information, or as solely processing episodic memories, but instead as more generally playing a central role in contextual associative processing. To test this proposal, we created a novel learning paradigm to form new associations among meaningless visual patterns. These new associations were created to emulate either spatial or nonspatial contexts. Both spatial and nonspatial associations activated the PHC more than noncontextual items. Moreover, items from spatial contexts activated the posterior part of the PHC, whereas items from nonspatial contexts activated the anterior PHC. Therefore, we show that the PHC plays a role of processing contextual associations in general, and that these associations are not restricted to spatial information. By modifying the existing view of the PHC function accordingly, the seemingly contradicting processes that activate it can be reconciled under one overarching framework.

Top-down facilitation of visual recognition

Cortical analysis related to visual object recognition is traditionally thought to propagate serially along a bottom-up hierarchy of ventral areas. Recent proposals gradually promote the role of top-down processing in recognition, but how such facilitation is triggered remains a puzzle. We tested a specific model, proposing that low spatial frequencies facilitate visual object recognition by initiating top-down processes projected from orbitofrontal to visual cortex. The present study combined magnetoencephalography, which has superior temporal resolution, functional magnetic resonance imaging, and a behavioral task that yields successful recognition with stimulus repetitions. Object recognition elicited differential activity that developed in the left orbitofrontal cortex 50 ms earlier than it did in recognition-related areas in the temporal cortex. This early orbitofrontal activity was directly modulated by the presence of low spatial frequencies in the image. Taken together, the dynamics we revealed provide strong support for the proposal of how top-down facilitation of object recognition is initiated, and our observations are used to derive predictions for future research.

Viewpoint dependency in visual object recognition does not necessarily imply viewer-centered representation

The nature of visual object representation in the brain is the subject of a prolonged debate. One set of theories asserts that objects are represented by their structural description and the representation is "object-centered." Theories from the other side of the debate suggest that humans store multiple "snapshots" for each object, depicting it as seen under various conditions, and the representation is therefore "viewer-centered." The principal tool that has been used to support and criticize each of these hypotheses is subjects' performance in recognizing objects under novel viewing conditions. For example, if subjects take more time in recognizing an object from an unfamiliar viewpoint, it is common to claim that the representation of that object is viewpoint-dependent and therefore viewer-centered. It is suggested here, however, that performance cost in recognition of objects under novel conditions may be misleading when studying the nature of object representation. Specifically, it is argued that viewpoint-dependent performance is not necessarily an indication of viewer-centered representation. An account for the neural basis of perceptual priming is first provided. In light of this account, it is conceivable that viewpoint dependency reflects the utilization of neural paths with different levels of sensitivity en route to the same representation, rather than the existence of viewpoint-specific representations. New experimental paradigms are required to study the validity of the viewer-centered approach.

FLP/FRT-mediated restoration of normal phenotypes and clonal sectors formation in rolC transgenic tobacco

Site-specific recombination systems have been shown to excise transgene DNA sequences positioned between their cognate target sites, and thus be used to generate clonal sectors in transgenic plants. Here we characterized clonal sectors derived from genetic reversion of rolC (A. rhizogenes)--induced vegetative and reproductive phenotypes, mediated by FLP recombinase from S. cerevisiae, in tobacco. The constitutive expression of rolC induces pleiotropic effects including reduced apical dominance and plant height, lanceolate and pale green leaves and small, male-sterile flowers. Two transgenic male-sterile tobacco lines (N. tabacum, Samsun NN) expressing a 35sP-rolC gene construct flanked by two FRT (FLP recombinase target) sites, were cross-pollinated with pollen from a constitutive 35sP-FLP expressing line. Three main phenotypes were generated in result of recombinase-mediated excision of the 35sP-rolC locus in the F1 (FLP x FRT-35sP-rolC-FRT) hybrid progenies: (a) restoration of male fertility, associated with reversion to normal leaf phenotypes prior to flower bud formation, (b) development of normal and fertile lateral shoot sectors on the background of rolC-type plants, (c) restoration of partially fertile flowers, associated with display of peripheral normal leaf sectors surrounding rolC-type inner-leaf tissues, consistent with periclinal chimeras. These results, supported by DNA molecular analysis, indicate that site-specific recombination might be used as a relatively efficient tool for generation of transgenic periclinal chimeric plants.

Inferior temporal neurons show greater sensitivity to nonaccidental than to metric shape differences

It has long been known that macaque inferior temporal (IT) neurons tend to fire more strongly to some shapes than to others, and that different IT neurons can show markedly different shape preferences. Beyond the discovery that these preferences can be elicited by features of moderate complexity, no general principle of (nonface) object recognition had emerged by which this enormous variation in selectivity could be understood. Psychophysical, as well as computational work, suggests that one such principle is the difference between viewpoint-invariant, nonaccidental (NAP) and view-dependent, metric shape properties (MPs). We measured the responses of single IT neurons to objects differing in either a NAP (namely, a change in a geon) or an MP of a single part, shown at two orientations in depth. The cells were more sensitive to changes in NAPs than in MPs, even though the image variation (as assessed by wavelet-like measures) produced by the former were smaller than the latter. The magnitude of the response modulation from the rotation itself was, on average, similar to that produced by the NAP differences, although the image changes from the rotation were much greater than that produced by NAP differences. Multidimensional scaling of the neural responses indicated a NAP/MP dimension, independent of an orientation dimension. The present results thus demonstrate that a significant portion of the neural code of IT cells represents differences in NAPs rather than MPs. This code may enable immediate recognition of novel objects at new views.