Enhancing cognitive behavioral therapy for childhood anxiety disorders: a parent manual

Anxiety disorders are among the most common psychiatric disorders affecting children and adolescents. In the past several decades, great advances have been made in the treatment of these disorders. While many psychopharmacological and psychotherapeutic treatments exist, Cognitive Behavioral Therapy (CBT) is currently the treatment approach with the most empirical support. Based on a large evidence-base, several CBT manuals have been developed for the treatment of anxiety disorders in children. While research on incorporating parents into these treatments is mixed, parent involvement is widely recommended in these treatments as well as in unmanualized CBT treatment. Although some self-help books and manual-specific guides for parents exist, there is no current manual that provides parents with information and guidance to facilitate their involvement in both manualized and unmanualized CBT for child anxiety disorders. The current project involved the development of a manual for parents whose children (ages 8-13 years) are involved in CBT treatment for Separation Anxiety Disorder, Generalized Anxiety Disorder, Specific Phobia, and Social Phobia. The resulting manual was informed by a review of the literature on child anxiety, CBT treatments for anxiety, and the roles parents may play in CBT. The manual consists of introductory psychoeducation on anxiety and CBT followed by six chapters on the major components of CBT for anxiety. In addition to descriptions of these components, each chapter includes instructions on how parents can be involved to facilitate their child’s treatment. Following a discussion of strengths, limitations, and potential modifications to the current manual, plans for evaluating the efficacy of the manual as well as disseminating it to parents are described

Stabilizing Low-Wage Work: Legal Remedies for Unpredictable Work Hours & Income Stability

Low-wage, hourly-paid service workers are increasingly subject to employers\u27 just-in-time scheduling practices. In a just-in-time model, employers give workers little advance notice of their schedules, call workers in to work during non-scheduled times to meet unexpected customer demand, and send workers home early when business is slow. The federal Fair Labor Standards Act, the main guarantor of workers\u27 wage and hour rights, provides no remedy for the unpredictable work hours and income instability caused by employers\u27 last minute call-in and send-home practices. This Article examines two alternative sources of legal protection that have received little attention in the literature on low-wage work: provisions in unionized workers\u27 collective bargaining agreements that guarantee a minimum number of hours of pay when workers are called in to or sent home from work unexpectedly, and state laws that contain similar guaranteed-pay provisions. The Article concludes by assessing these tools\u27 effectiveness in stabilizing low-wage work

Tutoring in adult-child-interaction: On the loop of the tutor's action modification and the recipient's gaze

Pitsch K, Vollmer A-L, Rohlfing K, Fritsch J, Wrede B. Tutoring in adult-child-interaction: On the loop of the tutor's action modification and the recipient's gaze. Interaction Studies. 2014;15(1):55-98.Research of tutoring in parent-infant interaction has shown that tutors - when presenting some action - modify both their verbal and manual performance for the learner (‘motherese’, ‘motionese’). Investigating the sources and effects of the tutors’ action modifications, we suggest an interactional account of ‘motionese’. Using video-data from a semi-experimental study in which parents taught their 8 to 11 month old infants how to nest a set of differently sized cups, we found that the tutors’ action modifications (in particular: high arches) functioned as an orienting device to guide the infant’s visual attention (gaze). Action modification and the recipient’s gaze can be seen to have a reciprocal sequential relationship and to constitute a constant loop of mutual adjustments. Implications are discussed for developmental research and for robotic ‘Social Learning’. We argue that a robot system could use on-line feedback strategies (e.g. gaze) to pro-actively shape a tutor’s action presentation as it emerges

Christkind vs. Santa Claus

In den letzten Jahren schien die Debatte rund um „Christkind vs. Santa Claus“ und den amerikanischen Einfluss auf das österreichische Weihnachtsfest immer lauter zu werden. Durch eine quantitative Inhaltsanalyse acht verschiedener österreichischer Zeitschriften und einer hermeneutischen Interpretation, zeigt diese Diplomarbeit auf, inwieweit die amerikanische Kultur tatsächlich die Darstellung von Weihnachten in österreichischen Zeitschriften beeinflusst hat und ob österreichische Kulturmerkmale dadurch bereits verdrängt wurden. Diverse Globalisierungsprozesse und die äußerst wichtige Rolle der Vereinigten Staaten im globalen Kulturwandel, dienten als Ausgangspunkt für diese Studie und werden ausführlich erklärt und miteinander in Bezug gebracht. Vor allem die Angst vor einer Homogenisierung der Kulturen, durch den großen Einfluss von amerikanischen Medien- und Kulturprodukten, wird näher beleuchtet. Durch die Betrachtung des historischen Einflusses der USA auf Österreich seit dem Ende des Zweiten Weltkriegs und die Bedeutung des Weihnachtsfestes im 21.Jahrhundert, soll der österreichische Kontext verstanden werden. Diverse Aussagen, die das Verschwinden österreichischer Kultursymbole durch amerikanische von Beginn an anzweifelten, wurden bestätigt. Dennoch sind amerikanische Einflüsse sehr wohl bemerkbar, vor allem in Zeitschriften mit einer größeren männlichen als weiblichen Leserschaft und in Werbeanzeigen. Santa Claus wird öfter bildlich dargestellt, während das Christkind öfter wörtlich erwähnt wird. Insgesamt zeigen die Ergebnisse, dass Merkmale beider Kulturen nebeneinander bestehen und neue Bedeutungen schaffen, wie zum Beispiel die des ChristkindsOver the last number of years there have been public objections against the adoption and inclusion of American Christmas symbols and practices in Austria. Through a quantitative content analysis of eight different Austrian magazines and a hermeneutic interpretation, this thesis will address to what extent American culture has influenced the representation of Christmas in Austrian magazines and whether Austrian characteristics are currently being replaced. Various globalization processes and the crucial role of the United States in global cultural changes served as a starting point for this study and will be explained and related to each other in this paper. Particular attention is paid to the fear of the homogenization of different cultures because of the high impact of American media and culture products. Furthermore, the historical influence of America on Austria since the end of World War II and the meaning of Christmas in the 21st century will be discussed to better understand the Austrian context. The results of this study show that numerous claims about American symbols not displacing Austrian symbols were confirmed. However, American influences are evident and can be spotted particularly well in magazines with a greater male than female audience as well as in advertisements. The visual image of Santa Claus appears more often than that of Christkind, but the term Christkind is mentioned more often than the term Santa Claus/Weihnachtsmann. Overall, the outcome of this study demonstrates that both American and Austrian symbols co-exist and generate new hybridities, such as a new meaning of Christkind

Projeto “Meio Ambiente e Cidadania” – como ferramenta de transformação e apoio ao programa de gestão ambiental no município de Jaguari/RS

A Educação Ambiental é considerada, neste trabalho, uma ferramenta de transformação social, sendo desenvolvida através de uma educação dialógica, participativa e emancipatória, proporcionando o desenvolvimento de educadores ambientais críticos aptos a decidir e atuar nas escolas frente a realidade socioambiental vivenciada na atualidade. O projeto “Meio Ambiente e Cidadania” foi realizado a partir do Convênio de Cooperação Técnica e Consultoria Ambiental entre a Fundação MO´Ã - Estudos e Pesquisas para a Proteção e o Desenvolvimento Ambiental e o Município de Jaguari - RS. Este Projeto teve como objetivo geral auxiliar na formação de educadores ambientais para a construção da Agenda Ambiental nas Escolas Municipais. Os objetivos específicos foram: Estimular o debate acerca dos problemas e potencialidades existentes no Município; Contribuir na formação e qualificação de educadores ambientais com a finalidade de potencializar os esforços do núcleo formador e Promover por meio de uma formação teóricometodológica qualificada, a reflexão e proposição pelos professores de práticas educativas ambientais para o enfrentamento das questões sócio-ambientais vividas pela comunidade escolar. A metodologia buscou a dialogicidade, onde os temas, as propostas, as atividades serão com base na metodologia da Pesquisa Ação, tendo como referências teóricas Michel Thiollent, onde o grupo desempenha um papel ativo na própria realidade dos fatos observados e nas mudanças que se pretende alcançar, promovendo a melhoria da qualidade de vida da população local. Ralizou-se encontros, proporcionando espaços de diálogo, a partir de reflexões coletivas, explanações teórico-metodológicas, estudos de caso, discussão de textos e práticas educativas ambientais que permitiram unir a qualificação teórica com a experiência prática do grupo de professores participantes. Estes momentos presenciais, somados ao trabalho que os educadores desenvolvem nas suas respectivas escolas permitirão ao município contar com um grupo de educadores ambientais aptos a propor e desenvolverem práticas ambientais transformadoras e multidisciplinares, a partir das diferentes realidades escolares

Titration of anti-IL-5 biologics in severe asthma:an open-label randomised controlled trial (the OPTIMAL study)

Background Anti-interleukin (IL)-5 biologics effectively reduce exacerbations and the need for maintenance oral corticosteroids (mOCS) in severe eosinophilic asthma. However, it is unknown how long anti-IL-5 treatment should be continued. Data from clinical trials indicate a gradual but variable loss of control after treatment cessation. In this pilot study of titration, we evaluated a dose-titration algorithm in patients who had achieved clinical control on an anti-IL-5 biologic. Methods In this open-label randomised controlled trial conducted over 52 weeks, patients with clinical control (no exacerbations or mOCS) on anti-IL-5 treatment were randomised to continue with unchanged intervals or have dosing intervals adjusted according to a titration algorithm that gradually extended dosing intervals and reduced them again at signs of loss of disease control. The OPTIMAL algorithm was designed to down-titrate dosing until signs of loss of control, to enable assessment of the longest dosing interval possible. Results Among 73 patients enrolled, 37 patients were randomised to the OPTIMAL titration arm; 78% of patients tolerated down-titration of treatment. Compared to the control arm, the OPTIMAL arm tended to have more exacerbations during the study (32% versus 17%; p=0.13). There were no severe adverse events related to titration, and lung function and symptoms scores remained stable and comparable in both study arms throughout. Conclusion This study serves as a proof of concept for titration of anti-IL-5 biologics in patients with severe asthma with clinical control on treatment, and the OPTIMAL algorithm provides a potential framework for individualising dosing intervals in the future.</p

High early mortality following percutaneous nephrostomy in metastatic cancer:a national analysis of outcomes

Objectives: To assess the outcomes of percutaneous nephrostomy in England for renal decompression, in the context of metastatic cancer.Methods: Retrospective observational study of all patients undergoing nephrostomy with a diagnosis of metastatic cancer from 2010 to 2019 in England, identified and followed up within Hospital Episode Statistics.The primary outcome measure was mortality (14-day and 30-day postprocedure). Secondary outcomes included subsequent chemotherapy or surgery and direct complications of nephrostomy.Results: 10 932 patients were identified: 58.0% were male, 51.0% were &gt;70 years old and 57.7% had no relevant comorbidities (according to Charlson’s criteria, other than cancer).1 in 15 patients died within 14 days of nephrostomy and 1 in 6 died within 30 days. Factors associated with higher 30-day mortality were the presence of comorbidities (Charlson score 1–4 (OR 1.27, 95% CI 1.08 to 1.50, p=0.003), score 5+ (OR 1.29, 95% CI 1.14 to 1.45), p &lt; 0.001)); inpatient nephrostomy (OR 3.76, 95% CI 2.75 to 5.14, p &lt; 0.001) and admitted under the care of specialities of internal medicine (OR 2.10, 95% CI 1.84 to 2.40, p &lt; 0.001), oncology (OR 1.80, 95% CI 1.51 to 2.15, p &lt; 0.001), gynaecology/gynaeoncology (OR 1.66, 95% CI 1.21 to 2.28, p=0.002) or general surgery (OR 1.62, 95% CI 1.32 to 1.98, p &lt; 0.001)), compared with urology.25.4% received subsequent chemotherapy. Receiving chemotherapy was associated with younger patients (eg, age 18–29 (OR 4.04, 95% CI 2.66 to 6.12, p &lt; 0.001) and age 30–39 (OR 3.07, 95% CI 2.37 to 3.97, p &lt; 0.001)) and under the care of oncology (OR 1.60, 95% CI 1.40 to 1.83, p &lt; 0.001) or gynaecology/gynaeoncology (OR 1.64, 95%CI 1.28 to 2.10, p &lt; 0.001) compared with urology.43.8% had subsequent abdominopelvic surgery. Not receiving surgery was associated with inpatient nephrostomy (OR 0.82, 95%CI 0.72 to 0.95,p=0.007): non-genitourinary cancers (eg, gynaecology/gynaeoncology cancer (OR 0.86, 95% CI 0.74 to 0.99, p=0.037)); and under the care of a non-surgical specialty (medicine (OR 0.69, 95% CI 0.63 to 0.77, p &lt; 0.001), oncology (OR 0.58, 95% CI 0.51 to 0.66, p &lt; 0.001)).24.5% of patients had at least one direct complication of nephrostomy: 12.5% required early exchange of nephrostomy, 8.1% had bleeding and 6.7% had pyelonephritis.Conclusions: The decision to undertake nephrostomy in patients with poor prognosis cancer is complex and should be undertaken in a multidisciplinary team setting. Complication rates are high and minimal survival benefit is derived in many patients, especially in the context of emergency inpatient care.</div

High early mortality after percutaneous liver biopsy in metastatic cancer:national analysis

Objective: The study aimed to assess outcomes in patients undergoing liver biopsy for metastatic cancer, focusing on mortality rates and chemotherapy following their biopsy. Methods: Hospital Episode Statistics data from 2010 to 2019 identified 30 992 patients with metastatic cancer who underwent percutaneous liver biopsy. Primary outcomes included 14-day and 30-day mortality rates, as well as the proportion receiving chemotherapy within 6 months. Results: 30 992 patients were studied (median age of 69 (IQR 59–74) years, 52% female). 28% underwent inpatient biopsy with 8% dying within 14 days and 26% within 30 days. Outpatient biopsies had lower mortality rates: 2.2% at 14 days and 8.6% at 30 days. 30-day mortality was associated with: inpatient biopsy (OR 3.5 (95% CI 3.26 to 3.76)) and increasing comorbidity (Charlson score 1–4: 1.21 (95% CI 1.11 to 1.32)); but negatively with all ages under 70 (eg, for 18–29 years 0.35 (95% CI 0.20 to 0.63)) and biopsy at a radiotherapy centre (0.88 (95% CI 0.82 to 0.95)). 46% of patients received chemotherapy within 6 months of biopsy (53% with outpatient biopsies but only 33% with inpatient biopsies). Receiving chemotherapy was associated with: all ages under 70 (eg, 18–29 years 3.3 (95% CI 2.62 to 5.30)), female sex (1.06 (95% CI 1.01 to 1.11)) and medium (1.13 (95% CI 1.04 to 1.22) and high (1.49 (95% CI 1.38 to 1.62)) volume liver biopsy providers; but negatively with inpatient biopsy (0.45 (95% CI 0.43 to 0.48)) and increasing comorbidity (Charlson score 1–4: 0.85 (95% CI 0.79 to 0.91)). Conclusions: Mortality rates following liver biopsy for metastatic cancer are notably higher among patients undergoing emergency inpatient procedures. Clinicians should carefully weigh the risks and benefits of biopsy in elderly, comorbid or poor performance status patients. Multidisciplinary approaches involving palliative care may aid in decision-making for these patients

Efficacy of cannabinoids for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis

Background: Cannabinoids have potential efficacy as prophylaxis for chemotherapy-induced nausea and vomiting (CINV), but no recent meta-analysis has reported on their relative efficacy compared to other antiemetics. The aim of this meta-analysis is to examine the relative efficacy of cannabinoids for prophylaxis of CINV. Methods: A literature search was conducted in OVID Medline, EMBASE, and Cochrane Central Register of Controlled Trials from inception up until March 2024. Articles were included if they reported on complete response, no nausea, no vomiting or no use of rescue medications, and were randomized controlled trials with cannabinoids in one arm. Meta-analysis was conducted for each endpoint and for a composite endpoint amalgamating existing endpoints. Subgroup analyses by medication used in control arm and by study design were conducted. Cumulative and leave-one-out analysis was also conducted. Type I error was set at 0.05. Results: A total of 26 studies were included in this meta-analysis, of which 23 were published before the 2000s. Nearly half of the included studies had some concern for bias. Cannabinoid had superior overall CINV control compared to placebo (RR 2.65, 95% CI 1.70–4.12, I2 = 0.00%). However, there was no difference between cannabinoid and active treatment alternatives (most using dated single-agent regimens) for any outcomes. A recent phase II/III trial demonstrated superior efficacy of THC:CBD for secondary prevention of CINV when used as adjunctive therapy alongside modern antiemetic regimens, albeit mostly without olanzapine. Conclusions: There is scant evidence for efficacy of cannabinoids for CINV in the era of triple and quadruple antiemetics. Although THC:CBD showed promised in a recent trial, further trials should examine its safety and efficacy in the context of regimens containing olanzapine