Experience-Based Competency Training in Child and Adolescent Psychotherapy

Background: Compared to adult psychotherapy training, there is little knowledge about the use of standardized actor-patients (SPs) for the development of professional competencies for younger patient populations. Objective: We assessed the effectiveness of two university-based training programs for diagnostic as well as intervention skills in child and adolescent psychotherapy. Methods: Psychology students took part in two courses on the development of diagnostic competencies (NÂ =Â 59) and on intervention skills (NÂ =Â 51). We applied active and experience-based learning strategies, including exercises on self-awareness, mindfulness, peer role-play, and the use of SPs. Competence gain as well as a general evaluation of the seminars were assessed by self-report. Results: For both seminars, self-reported competence increased significantly with a large effect. The retrospective evaluation of learning success and acceptance ratings of the didactic formats were high. Conclusions: Experience-based trainings that include SPs are a feasible option for child and adolescent psychotherapy. The findings are discussed from a conceptual as well as a practical perspective.Hintergrund: Im Vergleich zur Psychotherapieausbildung für Erwachsene fehlt es an Wissen über den Einsatz von standardisierten Schauspielpatient_innen (SP) für die Entwicklung professioneller Kompetenzen für jüngere Patient_innenpopulationen. Fragestellung: Wir untersuchten die Effektivität zweier universitärer Trainings zu diagnostischen und interventionellen Fertigkeiten in der Kinder- und Jugendlichenpsychotherapie. Methoden: Psychologiestudierende nahmen an zwei Kursen zur Entwicklung diagnostischer Kompetenzen (N = 59) und Interventionsfertigkeiten (N = 51) teil. Wir setzten aktive, erfahrungsbasierte Lernstrategien ein, darunter Übungen zur Selbstwahrnehmung, Achtsamkeit, Peer-Rollenspiele und Schauspielpatient_innen. Subjektiver Kompetenzgewinn wurde im Fragebogen sowie durch eine allgemeine Bewertung des Seminars erfasst. Ergebnisse: In beiden Seminaren stieg das subjektive Kompetenzerleben signifikant mit einem großen Effekt an. Retrospektive Bewertung des Lernerfolgs und Akzeptanz der didaktischen Formate waren hoch. Schlussfolgerungen: Erfahrungsbasierte Trainings unter Einbeziehung von SPs für die Kinder- und Jugendlichenpsychotherapie sind machbar. Die Ergebnisse werden unter konzeptuellen und anwendungsbezogenen Aspekten diskutiert

Methane output of rabbits (Oryctolagus cuniculus) and guinea pigs (Cavia porcellus) fed a hay-only diet: Implications for the scaling of methane production with body mass in non-ruminant mammalian herbivores

It is assumed that small herbivores produce negligible amounts of methane, but it is unclear whether this is a physiological peculiarity, or simply a scaling effect. A respiratory chamber experiment was conducted with six rabbits (Oryctolagus cuniculus, 1.57 ± 0.31 kg body mass) and six guinea pigs (Cavia porcellus, 0.79 ± 0.07 kg) offered grass hay ad libitum. Daily dry matter (DM) intake and DM digestibility were 50 ± 6 g kg–0.75 d–1 and 55 ± 6 % in rabbits and 59 ± 11 g kg–0.75 d–1 and 61 ± 3 % in guinea pigs, respectively. Methane production was similar for both species (0.20 ± 0.10 L d–1 and 0.22 ± 0.08 L d–1) and represented 0.69 ± 0.32 and 1.03 ± 0.29 % of gross energy intake in rabbits and guinea pigs, respectively. In relation to body mass (BM) guinea pigs produced significantly more methane. The data on methane per unit of BM obtained in this study and from literature on methane output of elephant, wallabies and hyraxes all lay close to a regression line derived from roughage-fed horses, showing an increase in methane output with BM. The regression including all data was nearly identical to that based on the horse data only (methane production in horses [L d–1] = 0.18 body mass [kg]0.97 (95%CI 0.92–1.02)) and indicates linear scaling. Because feed intake typically scales to BM0.75, linear scaling of methane output translates into increasing energetic losses at increasing BM. Accordingly, the data collection indicates that an increasing proportion of ingested gross energy is lost because relative methane production increases with BM. Different from ruminants, such losses (1-2% of gross energy) appear too small in non-ruminant herbivores to represent a physiologic constraint on body size. Nevertheless, this relationship may represent a physiological disadvantage with increasing herbivore body size

Does sticky blood predict a sticky end? Associations of blood viscosity, haematocrit and fibrinogen with mortality in the West of Scotland

There is increasing evidence that blood viscosity and its major determinants (haematocrit, plasma viscosity and fibrinogen) are associated with an increased risk of incident cardiovascular events; however, their associations with mortality are not established. We therefore studied the associations of these variables with cardiovascular events and total mortality in 1238 men and women aged 25-64 years, followed for 13 years in the first North Glasgow MONICA (MONItoring CArdiovascular disease) survey and West of Scotland centres in the Scottish Heart Health Study. After adjustment for age and sex, increasing whole blood viscosity, plasma viscosity, haematocrit and fibrinogen (analysed by both von Clauss and heat precipitation assays) were significantly associated with mortality. Only the association for fibrinogen (von Clauss assay) remained significant after adjustment for major cardiovascular risk factors. We conclude that clottable fibrinogen may be independently associated with mortality. However, the significance of this association, and the extent to which viscosity is associated with mortality, remain to be established in larger studies and meta-analyses

Reproductive non-seasonality in rhinoceroses: A review of the in-situ literature and birth records of ex-situ institutions

Mammals whose breeding activity is triggered by seasonal photoperiodic cues typically maintain seasonal reproduction in zoos, with births accumulating to various degrees in spring. For zoo-kept rhinoceroses, accumulation of births in autumn has been suggested, which would make this group unusual. We compare birthing (and hence conception) patterns of free-ranging rhinoceros populations from the scientific literature with those of the global zoo populations based on birth data available from Species360, to facilitate deductions on the cues that trigger rhinoceros reproduction. The patterns do not indicate a photoperiodic element in rhinoceros reproduction but suggest suppression of conception in free-ranging populations at times of resource scarcity. This is not evident in zoos. However, a slight accumulation of autumn births, due to a slight reduction in births in spring, is visible in the zoo populations. Given rhinoceros gestation periods, this is linked to reduced conceptions in November–December. The most parsimonious interpretation is management-related, as has been suggested (Roth 2006, Int. Zoo Yb. 40(1): 130–143): not all facilities are prepared to allow mating at times when outdoor husbandry is reduced due to weather restrictions. Given the long interbirth intervals of rhinoceroses, missed conception opportunities of 1–2 months are unlikely to affect population demographics. Nevertheless, detailed recording of approaches to facilitate mating during winter months by those zoos that achieve this may increase the general skill of rhinoceros management

Hypercoagulability progresses to hypocoagulability during evolution of acetaminophen-induced acute liver injury in pigs

Increases in prothrombin time (PT) and international normalised ratio (INR) characterise acute liver injury (ALI) and failure (ALF), yet a wide heterogeneity in clotting abnormalities exists. This study defines evolution of coagulopathy in 10 pigs with acetaminophen (APAP)-induced ALI compared to 3 Controls. APAP administration began at 0 h and continued to ‘ALF’, defined as INR >3. In APAP pigs, INR was 1.05 ± 0.02 at 0 h, 2.15 ± 0.43 at 16 h and > 3 at 18 ± 1 h. At 12 h thromboelastography (TEG) demonstrated increased clot formation rate, associated with portal vein platelet aggregates and reductions in protein C, protein S, antithrombin and A Disintegrin and Metalloprotease with Thrombospondin type 1 repeats–13 (ADAMTS-13) to 60%, 24%, 47% and 32% normal respectively. At 18 ± 1 h, INR > 3 was associated with: hypocoagulable TEG profile with heparin-like effect; falls in thrombin generation, Factor V and Factor VIII to 52%, 19% and 17% normal respectively; further decline in anticoagulants; thrombocytopenia; neutrophilia and endotoxemia. Multivariate analysis, found that ADAMTS-13 was an independent predictor of a hypercoagulable TEG profile and platelet count, endotoxin, Protein C and fibrinogen were independent predictors of a hypocoagulable TEG profile. INR remained normal in Controls. Dynamic changes in coagulation occur with progression of ALI: a pro-thrombotic state progresses to hypocoagulability

Circulating markers of arterial thrombosis and late-stage age-related macular degeneration: a case-control study.

PURPOSE: The aim of this study was to examine the relation of late-stage age-related macular degeneration (AMD) with markers of systemic atherothrombosis. METHODS: A hospital-based case-control study of AMD was undertaken in London, UK. Cases of AMD (n=81) and controls (n=77) were group matched for age and sex. Standard protocols were used for colour fundus photography and to classify AMD; physical examination included height, weight, history of or treatment for vascular-related diseases and smoking status. Blood samples were taken for measurement of fibrinogen, factor VIIc (FVIIc), factor VIIIc, prothrombin fragment F1.2 (F1.2), tissue plasminogen activator, and von Willebrand factor. Odds ratios from logistic regression analyses of each atherothrombotic marker with AMD were adjusted for age, sex, and established cardiovascular disease risk factors, including smoking, blood pressure, body mass index, and total cholesterol. RESULTS: After adjustment FVIIc and possibly F1.2 were inversely associated with the risk of AMD; per 1 standard deviation increase in these markers the odds ratio were, respectively, 0.62 (95% confidence interval 0.40, 0.95) and 0.71 (0.46, 1.09). None of the other atherothrombotic risk factors appeared to be related to AMD status. There was weak evidence that aspirin is associated with a lower risk of AMD. CONCLUSIONS: This study does not provide strong evidence of associations between AMD and systematic markers of arterial thrombosis, but the potential effects of FVIIc, and F1.2 are worthy of further investigation

Associations of plasma fibrinogen assays, C-reactive protein and interleukin-6 with previous myocardial infarction

Background: The association of plasma fibrinogen with myocardial infarction (MI) may (like that of C-reactive protein, CRP) be a marker of subclinical inflammation, mediated by cytokines such as interleukin-6 (IL-6). There are well- recognized discrepancies between commonly performed fibrinogen assays. Increased ratio of clottable fibrinogen to intact fibrinogen (measured by a recently developed immunoassay) has been proposed as a measure of hyperfunctional fibrinogen, and is elevated in acute MI.<br/> Objective: To compare the associations of intact fibrinogen and four routine fibrinogen assays (two von Clauss assays; one prothrombin-time derived; and one immunonephelometric) in a case-control study of previous MI. Patients/methods: Cases (n = 399) were recruited 3-9 months after their event; 413 controls were age- and sex-matched from the case-control study local population. Intact fibrinogen was measured in 50% of subjects. Results: All routine fibrinogen assays showed high intercorrelations (r = 0.82-0.93) and significant (P lt 0.0001) increased mean levels in cases vs. controls. These four routine assays correlated only moderately with intact fibrinogen (r = 0.45-0.62), while intact fibrinogen showed only a small, nonsignificant increase in cases vs. controls. Consequently, the ratio of each of the four routine assays to the intact fibrinogen assay was significantly higher (P lt 0.0003) in cases vs. controls. Each fibrinogen assay correlated with plasma levels of CRP and IL-6 (which were also elevated in cases vs. controls). Each routine fibrinogen assay remained significantly elevated in cases vs. controls after further adjustment for C-reactive protein and interleukin-6. Conclusions: These data provide evidence for acquired, increased hyperfunctional plasma fibrinogen in MI survivors, which is not associated with markers of inflammatory reactions. The causes and significance of these results remain to be established in prospective studies

Male gender, Charnley class C, and severity of bone defects predict the risk for aseptic loosening in the cup of ABG I hip arthroplasty

<p>Abstract</p> <p>Background</p> <p>We studied which factor could predict aseptic loosening in ABG I hip prosthesis with hydroxyapatite coating. Aseptic loosening and periprosthetic osteolysis are believed to be caused, at least in part, by increased polyethylene (PE) wear rate via particle disease. Based on it, increased PE wear rate should be associated with aseptic loosening regardless of the type of implant.</p> <p>Methods</p> <p>We analyzed data from 155 revisions of ABG I hip prostheses to examine the influence of patient, implant, surgery, and wear related factors on the rate of aseptic loosening at the site of the cup. This was calculated by stepwise logistic regression analysis. The stability of the implant and severity of bone defects were evaluated intraoperatively.</p> <p>Results</p> <p>We found that men (odds ratio, OR = 5.6; <it>p </it>= 0.004), patients with Charnley class C (OR = 6.71; <it>p </it>= 0.013), those having more severe acetabular bone defects (OR = 4 for each degree of severity; <it>p </it>= 0.002), and longer time to revision surgery (OR = 1.51 for each additional year; <it>p </it>= 0.012) had a greater chance of aseptic loosening of the cup. However, aseptic loosening was not directly predicted by polyethylene wear rate in our patients.</p> <p>Conclusion</p> <p>Severity of bone defects predicts the risk for aseptic loosening in ABG I cup. Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence on the risk of aseptic loosening in this implant.</p

Fibrinogen petoskey: Identification of a new dysfibrinogenemia characterized by altered release of fibrinopeptide A

A new congenital dysfibrinogenemia, designated fibrinogen Petoskey, which was traced through four generations of a Michigan family, was found to exhibit an abnormally slow rate of release of fibrino-peptide A upon treatment with thrombin and batroxobin. Batroxobin only partially hydrolyzed and polymerized the fibrinogen from affected individuals, suggesting that these patients had both normal and abnormal fibrinogen in their circulation and that batroxobin was not capable of releasing fibrinopeptide A from the abnormal fibrinogen. Polymerization of fibrin monomers from fibrinogen Petoskey and plasmin mediated digestion of fibrinogen Petoskey were normal. The Factor XIIIa-catalyzed cross-linking of fibrinogen Petoskey was slightly delayed at low (but not at high) concentrations of thrombin. This delayed cross-linking appeared to be a secondary effect of the lower rate of release of fibrinopeptide A.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24257/1/0000520.pd

Methane emission by Camelids

Methane emissions from ruminant livestock have been intensively studied in order to reduce contribution to the greenhouse effect. Ruminants were found to produce more enteric methane than other mammalian herbivores. As camelids share some features of their digestive anatomy and physiology with ruminants, it has been proposed that they produce similar amounts of methane per unit of body mass. This is of special relevance for countrywide greenhouse gas budgets of countries that harbor large populations of camelids like Australia. However, hardly any quantitative methane emission measurements have been performed in camelids. In order to fill this gap, we carried out respiration chamber measurements with three camelid species (Vicugna pacos, Lama glama, Camelus bactrianus; n = 16 in total), all kept on a diet consisting of food produced from alfalfa only. The camelids produced less methane expressed on the basis of body mass (0.3260.11 L kg21 d21) when compared to literature data on domestic ruminants fed on roughage diets (0.5860.16 L kg21 d21). However, there was no significant difference between the two suborders when methane emission was expressed on the basis of digestible neutral detergent fiber intake (92.7633.9 L kg21 in camelids vs. 86.2612.1 L kg21 in ruminants). This implies that the pathways of methanogenesis forming part of the microbial digestion of fiber in the foregut are similar between the groups, and that the lower methane emission of camelids can be explained by their generally lower relative food intake. Our results suggest that the methane emission of Australia’s feral camels corresponds only to 1 to 2% of the methane amount produced by the countries’ domestic ruminants and that calculations of greenhouse gas budgets of countries with large camelid populations based on equations developed for ruminants are generally overestimating the actual levels