The Therapeutic Alliance in Individual Resiliency Training for First Episode Psychosis: Relationship with Treatment Outcomes and Therapy Participation

The therapeutic alliance, or the relationship between the client and provider, has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). Given the dearth of research examining alliance and outcome in FEP in tandem with the sizeable rise in specialized FEP programs throughout the United States, the potential benefits of this work are substantial. As such, the present study examined the therapeutic alliance and its relationship to treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, the present study extended prior literature by utilizing an observer-rated alliance measure and by examining between-therapist and within-therapist effects of alliance on outcomes. Results indicated that a better therapeutic alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of 24 months controlling for the baseline measure of outcome and treatment-related covariates. Additionally, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment controlling for the baseline measure of outcome and treatment-related covariates. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time.Doctor of Philosoph

Walking Around Chapel Hill (WACH): A Pilot Exercise Program for Individuals with Serious Mental Illness

The health benefits of exercise are well documented, yet annual health care costs related to physical inactivity within the billions. Previous exercise research in individuals with serious mental illness (SMI) has been encouraging yet limited in accessibility and sustainability of interventions. The current study developed and evaluated the impact of a group, pedometer-based walking program on the health of individuals with SMI. To achieve these goals, we first conducted focus groups to obtain input from clients and clinicians regarding implementation and adoption of a walking program. Upon incorporating findings from focus groups, we developed and pilot tested a group, pedometer-based walking program in 16 individuals with SMI, Walking Around Chapel Hill (WACH). Results indicated feasibility and acceptability as well as improvements in physical health, activity level, social support, and mental health. Future research should examine group, pedometer-based walking programs in larger samples and with the inclusion of a comparison condition.Master of Art

A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress. Objectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sections 2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience. Inclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention. Search strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material. Methodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute. Data extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken. Results: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found. Definitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning. Conclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence. Implications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice. Implications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered. More research is needed on the effectiveness of group interventions and the role of midwives in administering interventions. A standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made. Outcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion

Comprehensive analysis of Hox gene expression in the amphipod crustacean Parhyale hawaiensis.

Hox genes play crucial roles in establishing regional identity along the anterior-posterior axis in bilaterian animals, and have been implicated in generating morphological diversity throughout evolution. Here we report the identification, expression, and initial genomic characterization of the complete set of Hox genes from the amphipod crustacean Parhyale hawaiensis. Parhyale is an emerging model system that is amenable to experimental manipulations and evolutionary comparisons among the arthropods. Our analyses indicate that the Parhyale genome contains a single copy of each canonical Hox gene with the exception of fushi tarazu, and preliminary mapping suggests that at least some of these genes are clustered together in the genome. With few exceptions, Parhyale Hox genes exhibit both temporal and spatial colinearity, and expression boundaries correlate with morphological differences between segments and their associated appendages. This work represents the most comprehensive analysis of Hox gene expression in a crustacean to date, and provides a foundation for functional studies aimed at elucidating the role of Hox genes in arthropod development and evolution

Fermi surface, possible unconventional fermions, and unusually robust resistive critical fields in the chiral-structured superconductor AuBe

The noncentrosymmetric superconductor (NCS) AuBe is investigated using a variety of thermodynamic and resistive probes in magnetic fields of up to 65~T and temperatures down to 0.3~K. Despite the polycrystalline nature of the samples, the observation of a complex series of de Haas-van Alphen (dHvA) oscillations has allowed the calculated bandstructure for AuBe to be validated. This permits a variety of BCS parameters describing the superconductivity to be estimated, despite the complexity of the measured Fermi surface. In addition, AuBe displays a nonstandard field dependence of the phase of dHvA oscillations associated with a band thought to host unconventional fermions in this chiral lattice. This result demonstrates the power of the dHvA effect to establish the properties of a single band despite the presence of other electronic bands with a larger density of states, even in polycrystalline samples. In common with several other NCSs, we find that the resistive upper critical field exceeds that measured by heat capacity and magnetization by a considerable factor. We suggest that our data exclude mechanisms for such an effect associated with disorder, implying that topologically protected superconducting surface states may be involved

Magnetic, thermodynamic, and electrical transport properties of the noncentrosymmetric B20 germanides MnGe and CoGe

We present magnetization, specific heat, resistivity, and Hall effect measurements on the cubic B20 phase of MnGe and CoGe and compare to measurements of isostructural FeGe and electronic structure calculations. In MnGe, we observe a transition to a magnetic state at $T_c=275$ K as identified by a sharp peak in the ac magnetic susceptibility, as well as second phase transition at lower temperature that becomes apparent only at finite magnetic field. We discover two phase transitions in the specific heat at temperatures much below the Curie temperature one of which we associate with changes to the magnetic structure. A magnetic field reduces the temperature of this transition which corresponds closely to the sharp peak observed in the ac susceptibility at fields above 5 kOe. The second of these transitions is not affected by the application of field and has no signature in the magnetic properties or our crystal structure parameters. Transport measurements indicate that MnGe is metal with a negative magnetoresistance similar to that seen in isostructural FeGe and MnSi. Hall effect measurements reveal a carrier concentration of about 0.5 carriers per formula unit also similar to that found in FeGe and MnSi. CoGe is shown to be a low carrier density metal with a very small, nearly temperature independent diamagnetic susceptibility.Comment: 16 pages 23 figure

Social cognition in schizophrenia : Factor structure of emotion processing and theory of mind

Factor analytic studies examining social cognition in schizophrenia have yielded inconsistent results most likely due to the varying number and quality of measures. With the recent conclusion of Phase 3 of the Social Cognition Psychometric Evaluation (SCOPE) Study, the most psychometrically sound measures of social cognition have been identified. Therefore, the aims of the present study were to: 1) examine the factor structure of social cognition in schizophrenia through the utilization of psychometrically sound measures, 2) examine the stability of the factor structure across two study visits, 3) compare the factor structure of social cognition in schizophrenia to that in healthy controls, and 4) examine the relationship between the factors and relevant outcome measures including social functioning and symptoms. Results supported a one-factor model for the patient and healthy control samples at both visits. This single factor was significantly associated with negative symptoms in the schizophrenia sample and with social functioning in both groups at both study visits

When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity

• Children with obesity face increased biopsychosocial risks during COVID-19. • Stress exacerbates inflammation and immune response in obesity and COVID-19. • The COVID-19 pandemic has significantly interrupted children\u27s daily routines. • The health effects of the obesogenic environment are exacerbated by COVID-19. • Access to timely, comprehensive healthcare is critical during COVID-19

Multiplexed immunofluorescence identifies high stromal CD68+PD‑L1+ macrophages as a predictor of improved survival in triple negative breast cancer

Triple negative breast cancer (TNBC) comprises 10–15% of all breast cancers and has a poor prognosis with a high risk of recurrence within 5 years. PD-L1 is an important biomarker for patient selection for immunotherapy but its cellular expression and co-localization within the tumour immune microenvironment and associated prognostic value is not well defined. We aimed to characterise the phenotypes of immune cells expressing PD-L1 and determine their association with overall survival (OS) and breast cancer-specific survival (BCSS). Using tissue microarrays from a retrospective cohort of TNBC patients from St George Hospital, Sydney (n = 244), multiplexed immunofluorescence (mIF) was used to assess staining for CD3, CD8, CD20, CD68, PD-1, PD-L1, FOXP3 and pan-cytokeratin on the Vectra Polaris™ platform and analysed using QuPath. Cox multivariate analyses showed high CD68+PD-L1+ stromal cell counts were associated with improved prognosis for OS (HR 0.56, 95% CI 0.33–0.95, p = 0.030) and BCSS (HR 0.47, 95% CI 0.25–0.88, p = 0.018) in the whole cohort and in patients receiving chemotherapy, improving incrementally upon the predictive value of PD-L1+ alone for BCSS. These data suggest that CD68+PD-L1+ status can provide clinically useful prognostic information to identify sub-groups of patients with good or poor prognosis and guide treatment decisions in TNBC