The development of the Broaching Assessment Scale: A client-rated measure of therapists' broaching behaviour in clinical counselling

Objective: Addressing ethnic-cultural topics during the process of psychotherapy, i.e. broaching, is considered highly important for ethnic minority clients who consult mental health care services. Surprisingly little is known, however, about clients' perception of a therapist's broaching qualities, and how clients' mental construction of broaching translates into behavioural broaching acts a therapist may display.

Method: Based on previous work and nine in-depth interviews with ethnic minority clients, a client-rated measure of therapists' broaching behaviour was developed and psychometrically evaluated in two samples. Sample 1 (N = 252 UK ethnic minority clients) was used to empirically delineate the factor structure of an initial item set. Participants were then resolicited to complete a revised item pool.

Results: The empirical structure resulted in a final 25-item broaching instrument with five subscales probing into therapists' broaching behaviour. This Broaching Assessment Scale (BrAS) was validated in Sample 2 (N = 239 US ethnic minority clients). Strict measurement invariance of the factor structure was observed across the two samples and distinctive correlational patterns with therapeutic process measures were found.

Conclusion: The BrAS provides new insights on how sensitivity to ethnic-cultural topics can be targeted along its concrete features, and is a promising tool for conceptualizing culturally sensitive mental healthcare assessment.

Energy expenditure of femoral broaching in direct anterior total hip replacements-Comparison between manual and automated techniques

INTRODUCTION

Little information is known regarding the energy expenditure of the surgeon during total hip arthroplasty (THA). We sought to compare the energy expenditure associated with femoral broaching using two techniques: manual and automated.

METHODS

We recorded energy expenditure, minute ventilation, heart rate, and total broaching time of a single surgeon while broaching the femoral canal during direct anterior THA using two different techniques: Manual broaching (n = 26) and automated broaching (n = 20).

RESULTS

Manual broaching required a longer time than automated broaching (6.1 ± 1.1 vs. 3.7 ± 0.9 min; p < 0.001) with an increase in energy expenditure (32.6 ± 7.0 vs. 16.0 ± 7.1 Calories; p < 0.001). Heart rate was higher with manual broaching (99.4 ± 9.8 vs. 90.1 ± 9.8 beats per min; p = 0.003), along with minute ventilation (36.5 ± 7.0 vs. 30.3 ± 5.8 L/min; p = 0.003). There were no intraoperative complications.

CONCLUSIONS

Automated femoral broaching during THA can decrease the energy expenditure of broaching by 50% and time of broaching by 40%, when compared to manual technique.

CLINICAL TRIAL REGISTRATION

This research was not a clinical trial.

The Review of Current and Proposed Methods of Manufacturing Fir Tree Slots of Turbine Aero Engine Discs

This review article presents a summary of currently used and proposed methods of manufacturing fir tree slots of discs in turbine engines. The production of aircraft, including aircraft engines during times of overlapping global economic crises related to the COVID-19 pandemic or the war in Eastern Europe requires a quick response to the changing numbers of passengers and cargo. Similarly, the aviation industry must adapt to these conditions, and thus utilize flexible production methods allowing for a quick change in the design or type of a given part. Due to the constant adoption of new materials for the most critical aero engine parts and the necessity of complying with environmental regulations, it is necessary to search for new methods of manufacturing these parts, including fir tree slots. As an alternative to currently used expensive and energy-intensive broaching, many manufacturers try to implement creep feed grinding CFG or contour milling. However, other manufacturing methods, thus far rarely used for crucial machine parts such as WEDM, ECDM or AWJ, are gaining more and more popularity in the aviation industry. This article presents the advantages and shortcomings of these methods in the context of manufacturing fir tree slots.

Addressing cultural topics during psychotherapy: Evidence-based do's and don'ts from an ethnic minority perspective

OBJECTIVE

: Broaching-i.e., a counsellor's effort to install meaningful conversations in psychotherapy concerning one's cultural identity-is a strong predictor of positive treatment outcomes and client satisfaction, especially for minority-identified clients. Despite this understanding, the broaching literature has struggled to translate broaching principles into practical recommendations for specific behaviours and skills. The current study therefore explores the effects of broaching approaches by the therapist (i.e., direct, indirect and avoidant approach) about cultural topics including ethnicity, religion, gender expression and socioeconomic status on clients' perception of (1) the multicultural orientation of the therapist and (2) the frequency of microaggressions during therapy.

METHOD

: These research questions were investigated in a sample of ethnic minority clients (N = 231) who followed at least one session of mental healthcare counselling during the last 12 months.

RESULTS

: Findings show that indirect broaching is the overall most favourable approach, whilst avoidant broaching is consistently negatively associated with all therapy-related outcome measures.

CONCLUSION

: The results lay the basis for practical guidelines for broaching in psychotherapy, and provide counsellors with a foundation for having cultural conversations in an effective and respectful manner.

A Five-Year Randomized Radiostereometric Analysis and Dual Energy X-Ray Absorption Study

BACKGROUND

Short-term experimental and animal studies have confirmed superior fixation of cementless implants inserted with compaction compared to broaching of the cancellous bone.

METHODS

Forty-four hips in 42 patients (19 men) were randomly operated using cementless hydroxyapatite-coated Bi-Metric stems. Patients were followed with radiostereometric analysis at baseline, 6 and 12 weeks, 1, 2, and 5 years, and measurements of periprosthetic bone mineral density at baseline, 1, 2, and 5 years. Complications during the study period and clinical outcome measures of Harris Hip Score were recorded at mean 7 years (5-8.8) after surgery.

RESULTS

Absolute migrations of medio/lateral translations between the broaching group and the compaction group of mean 0.14 mm (standard deviation [SD] 0.10) vs mean 0.30 mm (SD 0.27) (P = .01) at 1 year, and of mean 0.13 mm (SD 0.10) vs 0.34 mm (0.31) (P = .01) at 5 years were different. Absolute valgus/varus rotations of mean 0.12° (SD 0.13°) in the broaching group were less than mean 0.35° (0.45°) in the compaction group (P < .01) at 1 year, but at 5 years no difference was observed (P = .19). Subsidence and retroversion were similar between groups at all follow-ups (P > .13). The compaction group had significantly less bone loss than the broaching group in Gruen zone 3 (distal-lateral to the stem) at 1 and 5 years. No further differences in bone mineral density changes were found between groups up to 5 years after surgery. Complications throughout the period and clinical outcome measures of Harris Hip Score were similar at 7 years (5-8.8) after surgery.

CONCLUSION

We found increased migration when preparing the bone with compaction compared with broaching in cementless femoral stems.