The role of theory and research in clinical practice: an investigation of therapists' perceptions of the scientist-practitioner model according to stage of professional development and professional allegiance

The scientist -·practitioner model has been widely espoused as the optimum model of professional training and practice for clinical psychologists and increasingly, the related professions of counselling psychology and counselling. However, it has also proved to be contentious regarding the extent to which it reflects or informs the realities of professional practice. This debate has taken on a new meaning in the current health care climate with the increasing emphasis on using research to achieve evidence-based practice'. This study explores clinical psychologists', counselling psychologists' and counsellors' beliefs about the scientist-practitioner model. Key themes relevant to this, and the related areas of theory, research and clinical formulation, were identified through in-depth, qualitative interviews and then tested further by using a survey instrument devised to reflect these themes. The results suggested differences between the professional groups in beliefs about research and the scientist-practitioner model and also indicated the influence of work setting. Differences in idiosyncratic definition of the scientist-practitioner model also emerged, which appeared to be related to beliefs about its value. Implications for training and professional practice are discussed and the contribution of the study to the existing literature and wider debate are reviewed

Coaching individuals with perfectionistic tendencies When high standards help and hinder

Perfectionism has been widely recognised in the clinical field but has received less attention in the coaching psychology literature. Referring to overly high and unforgiving personal standards of performance that are accompanied by harsh self-evaluation when self-imposed standards are not met, perfectionism has the potential to undermine the coachee’s ability to achieve their goals as well as the coaching process itself. In consequence, it is important for practitioners to be able to identify and work effectively with those coachees whose perfectionistic tendencies represent an obstacle to progress. This paper discusses the current literature on perfectionism and provides recommendations on how to work effectively with coachees for whom unremittingly high personal standards are an impediment to personal growth and development.Keywords: Perfectionism; perfectionistic tendencies; self-evaluation; high personal standards; self-acceptance;context

Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm.

Ocular immune-related adverse events (IrAEs) associated with use of checkpoint inhibitors (CPIs) in cancer therapeutics are relatively rare, occurring in approximately 1% of treated patients. Recognition and early intervention are essential because the degree of tissue damage may be disproportionate to the symptoms, and lack of appropriate treatment risks permanent loss of vision. International guidelines on managing ocular IrAEs provide limited advice only. Importantly, local interventions can be effective and may avoid the need for systemic corticosteroids, thereby permitting the continuation of CPIs. We present a single institution case series of eight affected patients managed by our multidisciplinary team. Consistent with previously published series and case reports, we identified anterior uveitis as the most common ocular IrAE associated with CPIs requiring intervention. Based on our experience, as well as published guidance, we generated a simple algorithm to assist clinicians efficiently manage patients developing ocular symptoms during treatment with CPIs. In addition, we make recommendations for optimising treatment of uveitis and address implications for ongoing CPI therapy

Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm.

Ocular immune-related adverse events (IrAEs) associated with use of checkpoint inhibitors (CPIs) in cancer therapeutics are relatively rare, occurring in approximately 1% of treated patients. Recognition and early intervention are essential because the degree of tissue damage may be disproportionate to the symptoms, and lack of appropriate treatment risks permanent loss of vision. International guidelines on managing ocular IrAEs provide limited advice only. Importantly, local interventions can be effective and may avoid the need for systemic corticosteroids, thereby permitting the continuation of CPIs. We present a single institution case series of eight affected patients managed by our multidisciplinary team. Consistent with previously published series and case reports, we identified anterior uveitis as the most common ocular IrAE associated with CPIs requiring intervention. Based on our experience, as well as published guidance, we generated a simple algorithm to assist clinicians efficiently manage patients developing ocular symptoms during treatment with CPIs. In addition, we make recommendations for optimising treatment of uveitis and address implications for ongoing CPI therapy

A discussion of statistical methods to characterise early growth and its impact on bone mineral content later in childhood

Background Many statistical methods are available to model longitudinal growth data and relate derived summary measures to later outcomes. Aim To apply and compare commonly used methods to a realistic scenario including pre- and postnatal data, missing data and confounders. Subjects and methods Data were collected from 753 offspring in the Southampton Women’s Survey with measurements of bone mineral content (BMC) at age 6 years. Ultrasound measures included crown-rump length (11 weeks’ gestation) and femur length (19 and 34 weeks’ gestation); postnatally, infant length (birth, 6 and 12 months) and height (2 and 3 years) were measured. A residual growth model, two-stage multilevel linear spline model, joint multilevel linear spline model, SITAR and a growth mixture model were used to relate growth to 6-year BMC. Results Results from the residual growth, two-stage and joint multilevel linear spline models were most comparable: an increase in length at all ages was positively associated with BMC, the strongest association being with later growth. Both SITAR and the growth mixture model demonstrated that length was positively associated with BMC. Conclusions Similarities and differences in results from a variety of analytic strategies need to be understood in the context of each statistical methodology

DNA extraction protocols cause differences in 16S rRNA amplicon sequencing efficiency but not in community profile composition or structure

The recent development of methods applying next-generation sequencing to microbial community characterization has led to the proliferation of these studies in a wide variety of sample types. Yet, variation in the physical properties of environmental samples demands that optimal DNA extraction techniques be explored for each new environment. The microbiota associated with many species of insects offer an extraction challenge as they are frequently surrounded by an armored exoskeleton, inhibiting disruption of the tissues within. In this study, we examine the efficacy of several commonly used protocols for extracting bacterial DNA from ants. While bacterial community composition recovered using Illumina 16S rRNA amplicon sequencing was not detectably biased by any method, the quantity of bacterial DNA varied drastically, reducing the number of samples that could be amplified and sequenced. These results indicate that the concentration necessary for dependable sequencing is around 10,000 copies of target DNA per microliter. Exoskeletal pulverization and tissue digestion increased the reliability of extractions, suggesting that these steps should be included in any study of insect-associated microorganisms that relies on obtaining microbial DNA from intact body segments. Although laboratory and analysis techniques should be standardized across diverse sample types as much as possible, minimal modifications such as these will increase the number of environments in which bacterial communities can be successfully studied

A discussion of statistical methods to characterize early growth and its impact on bone mineral content later in childhood

Background Many statistical methods are available to model longitudinal growth data and relate derived summary measures to later outcomes. Aim To apply and compare commonly used methods to a realistic scenario including pre- and postnatal data, missing data and confounders. Subjects and methods Data were collected from 753 offspring in the Southampton Women’s Survey with measurements of bone mineral content (BMC) at age 6 years. Ultrasound measures included crown-rump length (11 weeks’ gestation) and femur length (19 and 34 weeks’ gestation); postnatally, infant length (birth, 6 and 12 months) and height (2 and 3 years) were measured. A residual growth model, two-stage multilevel linear spline model, joint multilevel linear spline model, SITAR and a growth mixture model were used to relate growth to 6-year BMC. Results Results from the residual growth, two-stage and joint multilevel linear spline models were most comparable: an increase in length at all ages was positively associated with BMC, the strongest association being with later growth. Both SITAR and the growth mixture model demonstrated that length was positively associated with BMC. Conclusions Similarities and differences in results from a variety of analytic strategies need to be understood in the context of each statistical methodology

Understanding Cultivar-Specificity and Soil Determinants of the <i>Cannabis</i> Microbiome

Understanding microbial partnerships with the medicinally and economically important crop Cannabis has the potential to affect agricultural practice by improving plant fitness and production yield. Furthermore, Cannabis presents an interesting model to explore plant-microbiome interactions as it produces numerous secondary metabolic compounds. Here we present the first description of the endorhiza-, rhizosphere-, and bulk soil-associated microbiome of five distinct Cannabis cultivars. Bacterial communities of the endorhiza showed significant cultivar-specificity. When controlling cultivar and soil type the microbial community structure was significantly different between plant cultivars, soil types, and between the endorhiza, rhizosphere and soil. The influence of soil type, plant cultivar and sample type differentiation on the microbial community structure provides support for a previously published two-tier selection model, whereby community composition across sample types is determined mainly by soil type, while community structure within endorhiza samples is determined mainly by host cultivar.</p

Are we over-treating with checkpoint inhibitors?

Anti-PD-1 antibodies offer potentially life-saving treatment for some cancer patients, but their chronic administration generates high and ever-increasing costs. Despite licensing for long-term use, optimal treatment duration is unknown. We challenge the need for long-term treatment duration, using evidence from melanoma research, both published and in process