Themes in therapy with emerging adults : a qualitative study

The path to adulthood has traditionally been marked by demographic transitions, such as graduating from college, attaining employment, becoming married, and having a child. Previous models of development have conceptualized adolescence as a time of identity exploration and consolidation. However, in the US, as well as many other countries, the timeline for attaining the aforementioned markers has been delayed. Additionally, a significant portion of individuals between the ages of 18 to 29, across several counties, report not seeing themselves fully as adults, and ascribing internal changes, such as taking responsibility for one’s actions, as more indicative of adulthood status. Emerging adulthood has been conceived as a distinct developmental period between adolescence and adulthood. It has been conceptualized as a time for self-focus, identity exploration, possibilities, instability, and feeling in-between. Research on emerging adulthood has shown this to be a time of increased well-being, as well as increased risk for mental health issues. However, little research has been conducted connecting emerging adulthood with psychotherapy. The purpose of this study was to qualitatively investigate what themes occurred related to the transition to adulthood among emerging adults who were receiving psychotherapy. The sample consisted of 10 videotaped therapy sessions from an archival database; two sessions for each of five client participants who received services from an outpatient community counseling center. Using an open coding and content analysis approach to analyze transcripts of the taped sessions, two Parent Themes emerged from the sessions, Self-Development and Interpersonal Relationships. These themes and their corresponding content supported existing models of emerging adulthood, and demonstrated that the developmental processes related to this period are relevant to clinicians. Additionally, the findings pointed to potential areas of future research including the need to study emerging adults who are parents and whether and how feeling in-between adolescence and adulthood relates to clinical presentations in this population

Catastrophes and complicated intraoperative events during robotic lung resection.

Intraoperative complications and catastrophes are an accepted and perhaps inevitable aspect of all surgeries. Anatomic pulmonary resection puts in close proximity the tracheal-bronchial tree, pulmonary vasculature, heart and great vessels within the small volume area of the chest. Fortunately, major complications and catastrophes are uncommon regardless of surgical approach. Pulmonary arterial injury is the most frequently reported. Most injuries necessitate a thoracotomy for definitive management though novel techniques are emerging for minimally invasive management. This section focuses on intraoperative pulmonary artery and vein injuries, major airway injuries and transections, injuries to major abdominal organs and effects of carbon dioxide insufflation during robotic pulmonary resection

The current state of per oral endoscopic myotomy for achalasia.

Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM)

Transport and Use of a Centaur Second Stage in Space

As nations continue to explore space, the desire to reduce costs will continue to grow. As a method of cost reduction, transporting and/or use of launch system components as integral components of missions may become more commonplace in the future. There have been numerous scenarios written for using launch vehicle components (primarily space shuttle used external tanks) as part of flight missions or future habitats. Future studies for possible uses of launch vehicle upper stages might include asteroid diverter using gravity orbital perturbation, orbiting station component, raw material at an outpost, and kinetic impactor. The LCROSS (Lunar CRater Observation and Sensing Satellite) mission was conceived as a low-cost means of determining whether water exists at the polar regions of the moon. Manifested as a secondary payload with the LRO (Lunar Reconnaissance Orbiter) spacecraft aboard an Atlas V launch vehicle, LCROSS guided its spent Centaur Earth Departure Upper Stage (EDUS) into the lunar crater Cabeu's, as a kinetic impactor. This paper describes some of the challenges that the LCROSS project encountered in planning, designing, launching with and carrying the Centaur upper stage to the moon

Sentinel surveillance of HIV-1 transmitted drug resistance, acute infection and recent infection.

BackgroundHIV-1 acute infection, recent infection and transmitted drug resistance screening was integrated into voluntary HIV counseling and testing (VCT) services to enhance the existing surveillance program in San Francisco. This study describes newly-diagnosed HIV cases and characterizes correlates associated with infection.Methodology/principal findingsA consecutive sample of persons presenting for HIV VCT at the municipal sexually transmitted infections (STI) clinic from 2004 to 2006 (N = 9,868) were evaluated by standard enzyme-linked immunoassays (EIA). HIV antibody-positive specimens were characterized as recent infections using a less-sensitive EIA. HIV-RNA pooled testing was performed on HIV antibody-negative specimens to identify acute infections. HIV antibody-positive and acute infection specimens were evaluated for drug resistance by sequence analysis. Multivariable logistic regression was performed to evaluate associations. The 380 newly-diagnosed HIV cases included 29 acute infections, 128 recent infections, and 47 drug-resistant cases, with no significant increases or decreases in prevalence over the three years studied. HIV-1 transmitted drug resistance prevalence was 11.0% in 2004, 13.4% in 2005 and 14.9% in 2006 (p = 0.36). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) was the most common pattern detected, present in 28 cases of resistance (59.6%). Among MSM, recent infection was associated with amphetamine use (AOR = 2.67; p<0.001), unprotected anal intercourse (AOR = 2.27; p<0.001), sex with a known HIV-infected partner (AOR = 1.64; p = 0.02), and history of gonorrhea (AOR = 1.62; p = 0.03).ConclusionsNew HIV diagnoses, recent infections, acute infections and transmitted drug resistance prevalence remained stable between 2004 and 2006. Resistance to NNRTI comprised more than half of the drug-resistant cases, a worrisome finding given its role as the backbone of first-line antiretroviral therapy in San Francisco as well as worldwide. The integration of HIV-1 drug resistance, recent infection, and acute infection testing should be considered for existing HIV/STI surveillance and prevention activities, particularly in an era of enhanced efforts for early diagnosis and treatment

Changes in the Freshwater Mussel (Bivalvia: Unionidae) Fauna of the Cuyahoga River, Ohio, Since Late Prehistory

We provide new information from archaeological samples on the historical freshwater mussel fauna (Mollusca: Bivalvia: Unionoidea) of the Cuyahoga River (South Park site: occupied between ca. A.D. 950 and 1650) and Black River (White Fort site, occupation centered at ca. A.D. 1350), northeast Ohio. Data from these prehi storic sites are compared with information on extant mussel populations of the Cuyahoga River published between 1890 and 2000. The high representation at both archaeological sites of the species Actinonaias ligamentina, Elliptio dilatata, and Ptychobranchus fasciolaris suggests that these were· among the important clean water species in northeast Ohio prior to European settlement. By comparison, the modem mussel fauna of the lower Cuyahoga River (between Cleveland and Akron) contains none of these relatively abundant species, or any of the species represented in the archaeological material. The modern fauna of the lower river was established during the 20\u27 century. This fauna is a low diversity assemblage of pollution tolerant species represented by rare live individuals. The modem mussel fauna of the upper Cuyahoga River (between Akron and the source) suggests that the upper and lower reaches are effectively isolated from each other. Published records indicate little change in the fauna during the last three quarters of the 20\u27 century. Nevertheless, overall diversity, although substantially higher than that of the lower river, is considerably lower than that of the Grand River, which is located to the east of the Cuyahoga. Overall, the mussel fauna of the Cuyahoga River has changed greatly over time, most notably in terms of losses in diversity of clean water species and overall abundance

Gender Disparities in Out-of-Hospital Cardiac Arrests

Background Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) has an average survival rate of only 12% nationwide, compared to 24.8% of patients who suffer from cardiac arrest while in hospital. Additionally, gender is an important element of human health, and there is a clear pattern for gender-specific survivability in cardiac arrest. This study examined differences in presentations, treatment, management, and outcomes. Aim The primary focus of this study was to shed light on differences in presentations, treatments, and outcomes between men and women suffering from an out-of-hospital cardiac arrest and the accompanying contributing factors. Methods All emergency medical services-related data, including age, date, initial rhythm, chemical interventions (i.e., epinephrine, dextrose), blood glucose levels, defibrillations, endotracheal tube (ETT) attempts, final airway management, achievement of return of spontaneous circulation (ROSC), and the conclusion of the case up to the emergency department, were recorded using a standardized emergency medical services (EMS) charting record by the highest-ranking EMS provider on the ambulance. The reports were retrospectively collected and analyzed. Conclusion The study examined demographics, treatments rendered, and outcomes in OOHCA cases that occurred in a major United States (US) city in 2016. Several significant differences in care were noted between men and women. In general, women received less respiratory, chemical, and electrical interventions than men; however, statistically significant differences were only observed in the number of attempts of endotracheal intubations, number of doses of epinephrine per encounter, and number of defibrillations per encounter. In spite of generally receiving less care, women appeared to respond more favorably to cardiac arrest interventions, as demonstrated by higher rates of ROSC. Despite this, women were also found to be eight years older at the time of arrest. Future studies are needed to determine causality in discrepancies between the genders in addition to investigating differences in treatment in other areas of the United States

Optimal Scene Time to Achieve Favorable Outcomes in Out-of-hospital Cardiac Arrest: How Long Is Too Long?

Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene

Genome-independent hypoxic repression of estrogen receptor alpha in breast cancer cells

Averages and standard deviations of band intensities calculated for all repeats of each western blot in Fig. 2a. Specific band intensities normalized to the loading control bands (β-actin). Calculations derived from at least three independent experiments. (DOCX 17 kb

Students Age at Which EFL is Introduced in Schools and Educational Outcomes

To see the relationship between the age at which EFL is introduced in some Indonesian public schools and student outcomes a survey involving 229 students both from elementary and junior high schools in Palembang is conducted. These students are given the test comprising vocabulary, reading comprehension, and grammar. It is hypothesized that those who start learning English earlier have better achievement. Factors such as school and home environments are also considered in the analysis. Stepwise regression analysis is applied to identify which variable contributes to students outcomes. The results show that there is no correlation between age alone and the students EFL achievement. However, significant influence is found when teacher education level and teacher ELT experience are added to the prediction model predicting EFL achievement from age