How trainee therapists experience resilience: an interpretative phenomenological analysis

While the importance of nurturing resilience in therapists (professionals in psychological therapies, e.g. counsellors, psychotherapists and counselling psychologists), and, in particular, trainees, is broadly recognised, there remains limited research directly exploring this area. The intention of the present study, therefore, is to explore how prequalification trainee therapists who have started seeing clients make sense of their experiences of resilience and to investigate what fosters and sustains their resilience. Four trainee therapists were recruited and one‐to‐one audio‐recorded interviews conducted. Interpretative phenomenological analysis was used to analyse the interview transcripts. Three overarching themes emerged from an analysis across the four cases: ‘Reframing resilience’, ‘Locating resilience’ and ‘Finding the right path’. Understanding how resilience is developed is integral to fuller understanding of trainee development. Trainees need to develop competence and confidence en route to becoming therapists. Perhaps somewhat paradoxically then, findings in the present study suggest that building resilience is about becoming more vulnerable. Trainees' feelings of empowerment, self‐efficacy and control may be fostered through a new less judging relationship to the experience of vulnerability. Indeed, a sense of confidence may emanate from the capacity for managed vulnerability

The Role of Star Formation and AGN in Dust Heating of z=0.3-2.8 Galaxies - II. Informing IR AGN Fraction Estimates through Simulations

A key question in extragalactic studies is the determination of the relative roles of stars and active galactic nuclei (AGNs) in powering dusty galaxies at z ~ 1–3 where the bulk of star formation and AGN activity took place. In Paper I, we present a sample of 336 24 μm selected (Ultra)Luminous Infrared Galaxies, (U)LIRGs, at z ~ 0.3–2.8, where we focus on determining the AGN contribution to the IR luminosity. Here, we use hydrodynamic simulations with dust radiative transfer of isolated and merging galaxies to investigate how well the simulations reproduce our empirical IR AGN fraction estimates and determine how IR AGN fractions relate to the UV-mm AGN fraction. We find that: (1) IR AGN fraction estimates based on simulations are in qualitative agreement with the empirical values when host reprocessing of the AGN light is considered; (2) for star-forming galaxy (SFG)–AGN composites our empirical methods may be underestimating the role of AGN, as our simulations imply >50% AGN fractions, ~3x higher than previous estimates; (3) 6% of our empirically classified SFGs have AGN fractions ≳50%. While this is a small percentage of SFGs, if confirmed it would imply that the true number density of AGNs may be underestimated; (4) this comparison depends on the adopted AGN template—those that neglect the contribution of warm dust lower the empirical fractions by up to two times; and (5) the IR AGN fraction is only a good proxy for the intrinsic UV-mm AGN fraction when the extinction is high (A_V ≳ 1 or up to and including coalescence in a merger)

The Rat Medial Prefrontal Cortex Exhibits Flexible Neural Activity States during the Performance of an Odor Span Task

Medial prefrontal cortex (mPFC) activity is fundamental for working memory (WM), attention, and behavioral inhibition; however, a comprehensive understanding of the neural computations underlying these processes is still forthcoming. Toward this goal, neural recordings were obtained from the mPFC of awake, behaving rats performing an odor span task of WM capacity. Neural populations were observed to encode distinct task epochs and the transitions between epochs were accompanied by abrupt shifts in neural activity patterns. Putative pyramidal neuron activity increased earlier in the delay for sessions where rats achieved higher spans. Furthermore, increased putative interneuron activity was only observed at the termination of the delay thus indicating that local processing in inhibitory networks was a unique feature to initiate foraging. During foraging, changes in neural activity patterns associated with the approach to a novel odor, but not familiar odors, were robust. Collectively, these data suggest that distinct mPFC activity states underlie the delay, foraging, and reward epochs of the odor span task. Transitions between these states likely enables adaptive behavior in dynamic environments that place strong demands on the substrates of working memory

The Role of Star Formation and AGN in Dust Heating of z=0.3-2.8 Galaxies - II. Informing IR AGN Fraction Estimates through Simulations

A key question in extragalactic studies is the determination of the relative roles of stars and active galactic nuclei (AGNs) in powering dusty galaxies at z ~ 1–3 where the bulk of star formation and AGN activity took place. In Paper I, we present a sample of 336 24 μm selected (Ultra)Luminous Infrared Galaxies, (U)LIRGs, at z ~ 0.3–2.8, where we focus on determining the AGN contribution to the IR luminosity. Here, we use hydrodynamic simulations with dust radiative transfer of isolated and merging galaxies to investigate how well the simulations reproduce our empirical IR AGN fraction estimates and determine how IR AGN fractions relate to the UV-mm AGN fraction. We find that: (1) IR AGN fraction estimates based on simulations are in qualitative agreement with the empirical values when host reprocessing of the AGN light is considered; (2) for star-forming galaxy (SFG)–AGN composites our empirical methods may be underestimating the role of AGN, as our simulations imply >50% AGN fractions, ~3x higher than previous estimates; (3) 6% of our empirically classified SFGs have AGN fractions ≳50%. While this is a small percentage of SFGs, if confirmed it would imply that the true number density of AGNs may be underestimated; (4) this comparison depends on the adopted AGN template—those that neglect the contribution of warm dust lower the empirical fractions by up to two times; and (5) the IR AGN fraction is only a good proxy for the intrinsic UV-mm AGN fraction when the extinction is high (A_V ≳ 1 or up to and including coalescence in a merger)

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

Preliminary Acceptability of a Home-Based Peripheral Blood Collection Device for Viral Load Testing in the Context of Analytical Treatment Interruptions in HIV Cure Trials: Results from a Nationwide Survey in the United States

Frequent viral load testing is necessary during analytical treatment interruptions (ATIs) in HIV cure-directed clinical trials, though such may be burdensome and inconvenient to trial participants. We implemented a national, cross-sectional survey in the United States to examine the acceptability of a novel home-based peripheral blood collection device for HIV viral load testing. Between June and August 2021, we distributed an online survey to people with HIV (PWH) and community members, biomedical HIV cure researchers and HIV care providers. We performed descriptive analyses to summarize the results. We received 73 survey responses, with 51 from community members, 12 from biomedical HIV cure researchers and 10 from HIV care providers. Of those, 51 (70%) were cisgender men and 50 (68%) reported living with HIV. Most (>80% overall) indicated that the device would be helpful during ATI trials and they would feel comfortable using it themselves or recommending it to their patients/participants. Of the 50 PWH, 42 (84%) indicated they would use the device if they were participating in an ATI trial and 27 (54%) also expressed a willingness to use the device outside of HIV cure studies. Increasing sensitivity of viral load tests and pluri-potency of the device (CD4 count, chemistries) would augment acceptability. Survey findings provide evidence that viral load home testing would be an important adjunct to ongoing HIV cure-directed trials involving ATIs. Survey findings may help inform successful implementation and uptake of the device in the context of personalized HIV care

Rationale and design: telepsychology service delivery for depressed elderly veterans

<p>Abstract</p> <p>Background</p> <p>Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas.</p> <p>Methods</p> <p>We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use).</p> <p>Discussion</p> <p>Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services.</p> <p>Trial registration</p> <p>National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).</p

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care