Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review

INTRODUCTION

Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes?

METHODS AND ANALYSIS

We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review.

ETHICS AND DISSEMINATION

Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.

Saliva-based SARS-CoV-2 serology using at-home collection kits returned via mail

Serology provides tools for epidemiologic studies, and may have a role in vaccine prioritization and selection. Automated serologic testing of saliva, especially specimens that are self-collected at home and sent to a laboratory via the mail without refrigeration, could be a highly-scalable strategy for population-wide testing. In this prospective study, non-vaccinated patients were recruited after PCR testing to self-collect saliva and return their specimens via mail. Longitudinal specimens were analyzed in order to monitor seroconversion in the weeks after a diagnostic PCR test for SARS-CoV-2. Diverse users self-collected saliva and returned specimens via mail in compliance with shipping regulations. At our pre-established threshold (0.963 AU/mL), salivary IgG reactivity to full-length spike protein achieved 95.8% sensitivity and 92.4% specificity at 2–4 weeks after diagnostic testing, which is comparable to the typical sensitivity and specificity achieved for serum testing. Reactivity to N antigen also was detected with 92.6% sensitivity and 90.7% specificity at 4–8 weeks after diagnostic testing. Moreover, serologic testing for endemic coronaviruses performed in multiplex with SARS-CoV-2 antigens has the potential to identify samples that may require retesting due to effects of pre-analytical factors. The easy-to-use saliva collection kit, coupled with thresholds for positivity and methods of flagging samples for retest, provides a framework for large-scale serosurveillance of SARS-CoV-2.

The rise of affectivism

Research over the past decades has demonstrated the explanatory power of emotions, feelings, motivations, moods, and other affective processes when trying to understand and predict how we think and behave. In this consensus article, we ask: has the increasingly recognized impact of affective phenomena ushered in a new era, the era of affectivism?

The feasibility of emotion-focused therapy for binge-eating disorder: a pilot randomised wait-list control trial

BACKGROUND

Research into psychotherapy for binge-eating disorder (BED) has focused mainly on cognitive behavioural therapies, but efficacy, failure to abstain, and dropout rates continue to be problematic. The experience of negative emotions is among the most accurate predictors for the occurrence of binge eating episodes in BED, suggesting benefits to exploring psychological treatments with a more specific focus on the role of emotion. The present study aimed to explore the feasibility of individual emotion-focused therapy (EFT) as a treatment for BED by examining the outcomes of a pilot randomised wait-list controlled trial.

METHODS

Twenty-one participants were assessed using a variety of feasibility measures relating to recruitment, credibility and expectancy, therapy retention, objective binge episodes and days, and binge eating psychopathology outcomes. The treatment consisted of 12 weekly one-hour sessions of EFT for maladaptive emotions over 3 months. A mixed model approach was utilised with one between effect (group) using a one-way analysis of variance (ANOVA) to test the hypothesis that participants immediately receiving the EFT treatment would demonstrate a greater degree of improvement on outcomes relating to objective binge episodes and days, and binge eating psychopathology, compared to participants on the EFT wait-list; and one within effect (time) using a repeated-measures ANOVA to test the hypothesis that participation in the EFT intervention would result in significant improvements in outcome measures from pre to post-therapy and then maintained at follow-up.

RESULTS

Recruitment, credibility and expectancy, therapy retention outcomes indicated EFT is a feasible treatment for BED. Further, participants receiving EFT demonstrated a greater degree of improvement in objective binge episodes and days, and binge eating psychopathology compared to EFT wait-list control group participants. When participants in the EFT wait-list control group then received treatment and outcomes data were combined with participants who initially received the treatment, EFT demonstrated significant improvement in objective binge episodes and days, and binge eating psychopathology for the entire sample.

CONCLUSIONS

These findings provide further preliminary evidence for the feasibility of individual EFT for BED and support more extensive randomised control trials to assess efficacy.

TRIAL REGISTRATION

The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12620000563965 ) on 14 May 2020.

How Collaborative Mentoring Networks Are Building Capacity in Primary Care

The need for increased capacity in primary care to treat the growing numbers of patients with complex chronic health conditions is well established (Roberts et al. 2015). Meeting that need requires not only more family physicians but also more support and resources to handle challenging cases. The Collaborative Mentoring Networks (CMNs), created in 2001 by the Ontario College of Family Physicians and funded by the Ontario government, have provided that support and proven particularly successful in improving physicians' competence and confidence in caring for patients struggling with mental health, addictions and chronic pain. The networks give family physicians timely, ongoing access to mentors with greater clinical expertise. In 2017, the networks expanded from two to seven, spreading support to palliative and end-of-life care and medical assistance in dying and focusing on leadership in primary care, early years in practice and rural medicine. CMNs' early impact involved increased primary care capacity in family practice, better-supported family physicians treating more patients with complex conditions, fewer specialist referrals, less isolation and greater retention.

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.

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.

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.

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.

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.

Emotion-focused family therapy for eating disorders in children and adolescents

Family-based therapy (FBT) is regarded as best practice for the treatment of eating disorders in children and adolescents. In FBT, parents play a vital role in bringing their child or adolescent to health; however, a significant minority of families do not respond to this treatment. This paper introduces a new model whereby FBT is enhanced by integrating emotion-focused therapy (EFT) principles and techniques with the aims of helping parents to support their child's refeeding and interruption of symptoms. Parents are also supported to become their child's 'emotion coach'; and to process any emotional 'blocks' that may interfere with their ability to take charge of recovery. A parent testimonial is presented to illustrate the integration of the theory and techniques of EFT in the FBT model. EFFT (Emotion-Focused Family Therapy) is a promising model of therapy for those families who require a more intense treatment to bring about recovery of an eating disorder.

KEY PRACTITIONER MESSAGE

More intense therapeutic models exist for treatment-resistant eating disorders in children and adolescents. Emotion is a powerful healing tool in families struggling with an eating disorder. Working with parent's emotions and emotional reactions to their child's struggles has the potential to improve child outcomes.

Working with identity and self-soothing in Emotion-Focused Therapy for Couples

This paper will outline new developments in Emotion-Focused Therapy for Couples (EFT-C) (Greenberg & Goldman, Emotion-focused couples therapy: The dynamics of emotion, love, and power, Washington, DC, American Psychological Association, 2008). People are seen as primarily motivated by their affective goals and the regulation of emotional states. The three motivational systems of attachment, identity, and attraction/liking, viewed as reflective of the core concerns people bring to therapy, are briefly outlined and elaborated. The five-stage model of EFT-C is briefly described. The paper will then provide two illustrations, one that demonstrates how EFT-C therapists work with core issues related to identity, and the other that shows how therapy can promote self-soothing. In the first example, annotated transcripts taken from therapy sessions illustrate how an EFT therapist addresses issues of identity in a highly distressed couple. The second example demonstrates how to facilitate work with individuals within the couples' context to engender and develop capacities for self-soothing, seen as fundamental for the promotion of healthy emotion regulation and couples' overall health.

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.

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.

Emotion-focused couples therapy and the facilitation of forgiveness

The goal of this study was to evaluate the effectiveness of an emotion-focused couple therapy intervention for resolving emotional injuries. Twenty couples acting as their own waitlist controls were offered a 10-12-session treatment to help resolve unresolved anger and hurt from a betrayal, an abandonment, or an identity insult that they had been unable to resolve for at least 2 years. Treated couples fared significantly better on all outcome measures over the treatment period compared to the waitlist period. They showed a significant improvement in dyadic satisfaction, trust, and forgiveness as well as improvement on symptom and target complaint measures. Changes were maintained on all of the measures at 3-month follow-up except trust, on which the injured partners deteriorated. At the end of treatment, 11 couples were identified as having completely forgiven their partners and six had made progress toward forgiveness compared with only three having made progress toward forgiveness over the waitlist period. The results suggest that EFT is effective in alleviating marital distress and promoting forgiveness in a brief period of time but that additional sessions may be needed to enhance enduring change.

Review of Transformative relationships: The control-mastery theory of psychotherapy

Reviews the book, Transformative relationships: The control-mastery theory of psychotherapy by George Silberschatz (see record 2005-00928-000). This book is an edited text that thoroughly reviews theory, research, and practice on control-mastery theory, a psychodynamic method developed at the San Francisco Psychoanalytic Institute. Overall, this is an impressive research program summarized in this chapter in a very accessible manner. The research program is a good case study of an effort to build an evidence-based treatment close to clinical reality. In addition, the book as a whole is probably the best way to get a summary of all aspects of control-mastery theory as well as a clear and interesting exposition of different aspects of the theory, research, and practice. One important clinical implication of the testing concepts is that the meaning of a therapist's interventions will vary depending on what specific pathogenic beliefs the client is testing. Control-mastery theory is highly case specific; a technique that is helpful to one client may not be appropriate or helpful to another. How effective the therapy is will be determined not by the technique used but by the extent to which the therapist can disconfirm the client's pathogenic beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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.