First Elderly Client in Therapy: Factors that Influence Student Interest in Geropsychology

In the coming decades, the elderly population in United States (U.S) is expected to grow significantly (U.S. Bureau of the Census, 1996). Consequently, the number of older individuals seeking mental health services will be greater than at any other time in the history of the U.S. The field of clinical psychology, however, is unable to meet the mental health needs of the current elderly population, and this gap is expected to widen in coming years. There is an ongoing discussion within the field of professional psychology as to how to train more clinicians to work with the elderly population (Gatz & Smyer, 2001; Hinrichsen & Zweig, 2005; Norman, Ishler, Ashcraft, & Patterson, 2000; Qualls, Segal, Benight, & Kenny, 2005), and the present study set out to understand factors that may influence clinical psychology graduate students’ interest in working with clients from this population. The direction of the research was informed by current aging theory, particularly life-span and successful aging theories, and was inspired by the ongoing multicultural competency movement. Currently enrolled PsyD students (N=7) in clinical psychology programs were interviewed regarding their experiences of working with their first elderly therapy client in a supervised setting (practicum or predoctoral internship). Semi-structured interviews paid particular attention to aspects of participants’ professional and personal experiences that they identified as influential on their interest to seek out (or not) future opportunities to work, or to learn more about working with, elderly individuals. Using the qualitative methodology of interpretive phenomenological analysis (IPA), interview transcriptions were analyzed to the point of saturation and distilled into common themes. These themes fell within six overarching domains: (a) Expectations vs. Reality, (b) Subjective Experience, (c) Resources Drawn upon During Treatment, (d) Interest in Geropsychology: Pre vs. Post, (e) Factors Associated with Future Interest in Geropsychology, and (f) What Would Have Made the Experience Better? These six domains comprised a total of 31 themes and subthemes (many themes stood on their own, while others contained two or more subthemes). While a majority of the themes confirmed what is already known in the literature, unique themes also emerged, as was expected from an IPA study, whose intent was to capture the subjective voices of individual clinician-trainees. One common theme already raised by previous researchers about clinical training in geropsychology was that having at least some experience with elderly individuals in a supervised training setting is a crucial avenue for nurturing trainees’ interest in working with the population (Cummings & Galambos, 2002; Hegeman, Horowitz, Tepper, Pillemer, & Schultz, 2002; Hinrichsen, 2000; Kropf, 2002). One theme unique to the present study about training, which was not found in the available literature and has clear implications for how academic programs approach training, was that some participants described experiencing a shift in their understanding of the elderly, from a population with very specialized needs to be treated by specialists, to a population that is a part of the larger, general population, which can be adequately treated by generalists. Themes are illustrated and discussed with quotations drawn directly from participant interviews, adding richness and voice to the study’s results and conclusions. On the basis of the study’s results and on the literature reviewed herein, implications of the current status of geropsychology training and recommendations that others have made to improve it are discussed. Additional recommendations, based on this study’s unique findings, are offered as well

First Elderly Client in Therapy: Factors that Influence Student Interest in Geropsychology

In the coming decades, the elderly population in United States (U.S) is expected to grow significantly (U.S. Bureau of the Census, 1996). Consequently, the number of older individuals seeking mental health services will be greater than at any other time in the history of the U.S. The field of clinical psychology, however, is unable to meet the mental health needs of the current elderly population, and this gap is expected to widen in coming years. There is an ongoing discussion within the field of professional psychology as to how to train more clinicians to work with the elderly population (Gatz & Smyer, 2001; Hinrichsen & Zweig, 2005; Norman, Ishler, Ashcraft, & Patterson, 2000; Qualls, Segal, Benight, & Kenny, 2005), and the present study set out to understand factors that may influence clinical psychology graduate students’ interest in working with clients from this population. The direction of the research was informed by current aging theory, particularly life-span and successful aging theories, and was inspired by the ongoing multicultural competency movement. Currently enrolled PsyD students (N=7) in clinical psychology programs were interviewed regarding their experiences of working with their first elderly therapy client in a supervised setting (practicum or predoctoral internship). Semi-structured interviews paid particular attention to aspects of participants’ professional and personal experiences that they identified as influential on their interest to seek out (or not) future opportunities to work, or to learn more about working with, elderly individuals. Using the qualitative methodology of interpretive phenomenological analysis (IPA), interview transcriptions were analyzed to the point of saturation and distilled into common themes. These themes fell within six overarching domains: (a) Expectations vs. Reality, (b) Subjective Experience, (c) Resources Drawn upon During Treatment, (d) Interest in Geropsychology: Pre vs. Post, (e) Factors Associated with Future Interest in Geropsychology, and (f) What Would Have Made the Experience Better? These six domains comprised a total of 31 themes and subthemes (many themes stood on their own, while others contained two or more subthemes). While a majority of the themes confirmed what is already known in the literature, unique themes also emerged, as was expected from an IPA study, whose intent was to capture the subjective voices of individual clinician-trainees. One common theme already raised by previous researchers about clinical training in geropsychology was that having at least some experience with elderly individuals in a supervised training setting is a crucial avenue for nurturing trainees’ interest in working with the population (Cummings & Galambos, 2002; Hegeman, Horowitz, Tepper, Pillemer, & Schultz, 2002; Hinrichsen, 2000; Kropf, 2002). One theme unique to the present study about training, which was not found in the available literature and has clear implications for how academic programs approach training, was that some participants described experiencing a shift in their understanding of the elderly, from a population with very specialized needs to be treated by specialists, to a population that is a part of the larger, general population, which can be adequately treated by generalists. Themes are illustrated and discussed with quotations drawn directly from participant interviews, adding richness and voice to the study’s results and conclusions. On the basis of the study’s results and on the literature reviewed herein, implications of the current status of geropsychology training and recommendations that others have made to improve it are discussed. Additional recommendations, based on this study’s unique findings, are offered as well

Ocular Refraction at Birth and Its Development During the First Year of Life in a Large Cohort of Babies in a Single Center in Northern Italy

The purpose of this study was to investigate refraction at birth and during the first year of life in a large cohort of babies born in a single center in Northern Italy. We also aimed to analyze refractive errors in relation to the gestational age at birth. An observational ophthalmological assessment was performed within 24 h of birth on 12,427 newborns. Refraction was examined using streak retinoscopy after the administration of tropicamide (1%). Values in the range of between +0.50 ≤ D ≤ +4.00 were defined as physiological refraction at birth. Newborns with refraction values outside of the physiological range were followed up during the first year of life. Comparative analyses were conducted in a subgroup of babies with known gestational ages. The following distribution of refraction at birth was recorded: 88.03% of the babies had physiological refraction, 5.03% had moderate hyperopia, 2.14% had severe hyperopia, 3.4%, had emmetropia, 0.45%, had myopia, 0.94% had astigmatism, and 0.01% had anisometropia. By the end of the first year of life, we observed reductions in hyperopia and astigmatism, and stabilization of myopia. Preterm babies had a four-fold higher risk of congenital myopia and a three-fold higher risk of congenital emmetropia as compared to term babies. Refraction profiles obtained at birth changed during the first year of life, leading to a normalization of the refraction values. Gestational age at birth affected the incidence of refractive errors and amblyopia

Annexin A1 Released in Extracellular Vesicles by Pancreatic Cancer Cells Activates Components of the Tumor Microenvironment, through Interaction with the Formyl-Peptide Receptors

Pancreatic cancer (PC) is one of the most aggressive cancers in the world. Several extracellular factors are involved in its development and metastasis to distant organs. In PC, the protein Annexin A1 (ANXA1) appears to be overexpressed and may be identified as an oncogenic factor, also because it is a component in tumor-deriving extracellular vesicles (EVs). Indeed, these microvesicles are known to nourish the tumor microenvironment. Once we evaluated the autocrine role of ANXA1-containing EVs on PC MIA PaCa-2 cells and their pro-angiogenic action, we investigated the ANXA1 paracrine effect on stromal cells like fibroblasts and endothelial ones. Concerning the analysis of fibroblasts, cell migration/invasion, cytoskeleton remodeling, and the different expression of specific protein markers, all features of the cell switching into myofibroblasts, were assessed after administration of wild type more than ANXA1 Knock-Out EVs. Interestingly, we demonstrated a mechanism by which the ANXA1-EVs complex can stimulate the activation of formyl peptide receptors (FPRs), triggering mesenchymal switches and cell motility on both fibroblasts and endothelial cells. Therefore, we highlighted the importance of ANXA1/EVs-FPR axes in PC progression as a vehicle of intercommunication tumor cells-stroma, suggesting a specific potential prognostic/diagnostic role of ANXA1, whether in soluble form or even if EVs are captured in PC

Biomarkers to personalize the treatment of rheumatoid arthritis: Focus on autoantibodies and pharmacogenetics

Rheumatoid arthritis (RA) is a chronic inflammatory disease that is very complex and heterogeneous. If not adequately treated, RA patients are likely to manifest excess of morbidity and disability with an important impact on the quality of life. Pharmacological treatment is based on the administration of the disease-modifying antirheumatic drugs (DMARDs), subdivided into conventional synthetic (csDMARDs), targeted synthetic (tsDMARDs), and biological (bDMARDs). bDMARDs are now frequently administered in patients, both as alternative treatment and together with csDMARDs. Unfortunately, there is a therapeutic response variability both to old and new drugs. Therefore, to identify pre-therapeutic and on-treatment predictors of response is a priority. This review aims to summarize recent advances in understanding the causes of the variability in treatment response in RA, with particular attention to predictive potential of autoantibodies and DMARD pharmacogenetics. In recent years, several biomarkers have been proposed to personalize the therapy. Unfortunately, a magic bullet does not exist, as many factors concur to disease susceptibility and treatment outcomes, acting around the patient’s congenital background. Models integrating demographic, clinical, biochemical, and genetic data are needed to enhance the predictive capacity of specific factors singularly considered to optimize RA treatment in light of multidisciplinary patient management

Fluorescein angiography findings in eyes with lamellar macular hole and epiretinal membrane foveoschisis

PURPOSE. The purpose of this paper was to study fluorescein angiography (FA) findings in eyes with lamellar macular hole (LMH), and epiretinal membrane (ERM) foveoschisis. METHODS. In this prospective, observational case series, 46 eyes of patients affected by either LMH or ERM foveoschisis were examined using optical coherence tomography (OCT) and FA. All patients underwent a comprehensive ophthalmological examination and a general workup to exclude uveitis. Main outcome measures were: presence of FA abnormalities, measurements of the areas of vascular leakage, and intensity of pixels in the vitreous. RESULTS. Twenty-four (52.2%) eyes with LMH and 22 (47.8%) with ERM foveoschisis were studied. Overall, FA abnormalities were found in 20 (83.3%) eyes with LMH and 18 (81.8%) with ERM foveoschisis. The median areas of posterior pole and peripheral leakage were 7.52 vs. 1.07 mm2 (P = 0.03) and 21.8 vs. 3.74 mm2 (P = 0.02) in the LMH and ERM foveoschisis group, respectively. Disk hyperfluorescence was found in 8 and 4 eyes and perivascular leak in 10 and 4 eyes with LMH and ERM foveoschisis, respectively. OCT-derived measurements of vitreous intensity did not differ between the two groups, and the investigational workup for uveitis was negative in all patients. CONCLUSIONS. Discrete areas of central and peripheral leakage are commonly found in eyes with LMH and ERM foveoschisis, whereas perivascular leak and hyperfluorescence of the disc are less frequently observed. These findings suggest that breakdown of the retinal blood barrier, involving the posterior pole and the periphery, is frequently associated with these two vitreoretinal disorders

Sirt1 activity in pbmcs as a biomarker of different heart failure phenotypes

Heart Failure (HF) is a syndrome, which implies the existence of different phenotypes. The new categorization includes patients with preserved ejection fraction (HFpEF), mid-range EF (HFmrEF), and reduced EF (HFrEF) but the molecular mechanisms involved in these HF phenotypes have not yet been exhaustively investigated. Sirt1 plays a crucial role in biological processes strongly related to HF. This study aimed to evaluate whether Sirt1 activity was correlated with EF and other parameters in HFpEF, HFmrEF, and HFrEF. Seventy patients, HFpEF (n = 23), HFmrEF (n = 23) and HFrEF (n = 24), were enrolled at the Cardiology Unit of the University Hospital of Salerno. Sirt1 activity was measured in peripheral blood mononuclear cells (PBMCs). Angiotensin-Converting Enzyme 2 (ACE2) activity, Tumor Necrosis Factor-alpha (TNF-α) and Brain Natriuretic Peptide (BNP) levels were quantified in plasma. HFpEF showed lower Sirt1 and ACE2 activities than both HFmrEF and HFrEF (p < 0.0001), without difference compared to No HF controls. In HFmrEF and HFrEF a very strong correlation was found between Sirt1 activity and EF (r2 = 0.899 and r2 = 0.909, respectively), and between ACE2 activity and Sirt1 (r2 = 0.801 and r2 = 0.802, respectively). HFrEF showed the highest TNF-α levels without reaching statistical significance. Significant differences in BNP were found among the groups, with the highest levels in the HFrEF. Determining Sirt1 activity in PBMCs is useful to distinguish the HF patients’ phenotypes from each other, especially HFmrEF/HFrEF from HFpEF

\u201cWeekly docetaxel and gemcitabine as first line treatment for metastatic breast cancer: results of a multicenter phase II study\u201d

Objectives: We conducted a multicenter phase II study to evaluate the clinical effi cacy, toxicity, and dose intensity of a new weekly schedule of docetaxel and gemcitabine as fi rst-line treatment of metastatic breast cancer patients. Methods: We enrolled 58 patients, 52% of whom had received a previous anthracycline-containing chemotherapy. The treatment schedule was: docetaxel 35 mg/m 2 and gemcitabine 800 mg/m 2 i.v. on days 1, 8,15 every 28 days. Results: All patients were assessable for toxicity and 56 for effi cacy. Overall response rate was 64.3% with 16.1% of complete responses and 48.2% of partial responses. Median survival was 22.10 months (95% CI: 15.53\u201328.67) and median time to tumor progression was 13.6 months (95% CI: 10.71\u201316.49). The most common hematological toxicity was neutropenia (no febrile neutropenia), which occurred in 28 patients (48.3%) but grade 3\u20134 in only 8 patients (14%). Alopecia, the most common nonhematological toxicity, occurred in 20 (34.5%) patients, but only 5 patients (8.6%) experienced grade 3 alopecia. Conclusion: The activity of docetaxel and gemcitabine in metastatic breast cancer is confirmed. The promising results of the employed schedule,in agreement with other published studies, need to be further confirmed within a phase III study

Climate change impacts on human health at an actionable scale: a state-level assessment of Indiana, USA

Climate change is already being felt on local levels, with historical records from the State of Indiana (USA) revealing warmer winters and more extreme precipitation events. To refine our understanding of climate change impacts on human health, we conducted a state-level assessment of future climate change impacts on human health using outputs from advanced climate model projections for this century. Future projections show a steep increase in extreme heat events, leading to greater potential vulnerability to heat disasters for Indiana communities. Additionally, a 2- to 4-fold increase in days with “uncomfortable night” conditions by the end of the century will strongly impact the cardiopulmonary health of more vulnerable populations (i.e., elderly, those with pre-existing conditions, children, and those with inadequate access to cooling). Continued trends for warmer winters and more flooding suggest a much greater risk for the expansion and virulence of a number of vector-borne diseases, such as Lyme disease, West Nile Virus, and “tropical” diseases for which the mosquito vectors will thrive. Higher temperatures will also drive more frequent and severe harmful algal blooms in lakes and reservoirs, with implications for human and animal health. Food systems will also be impacted, particularly with increased risk of contamination by bacteria and mycotoxins due to elevated heat and humidity

Exercise promotes angiogenesis and improves beta-adrenergic receptor signalling in the post-ischaemic failing rat heart.

We investigated whether exercise training could promote angiogenesis and improve blood perfusion and left ventricular (LV) remodelling of the post-myocardial infarction (MI) failing heart. We also explored the contribution of ameliorated beta-adrenergic receptor signalling and function on the overall improvement of cardiac contractility reserve induced by exercise.Adult Wistar male rats were randomly assigned to one of four experimental groups. Sham-operated and post-MI heart failure (HF) rats were housed under sedentary conditions or assigned to 10-weeks of a treadmill exercise protocol. At 4 weeks after MI, sedentary HF rats showed LV eccentric hypertrophy, marked increase of LV diameters associated with severely impaired fractional shortening (14 +/- 5\%), increased LV end diastolic pressure (20.9 +/- 2.6 mmHg), and pulmonary congestion. In addition, cardiac contractile responses to adrenergic stimulation were significantly blunted. In trained HF rats, exercise was able to (i) reactivate the cardiac vascular endothelial growth factor pathway with a concurrent enhancement of myocardial angiogenesis, (ii) significantly increase myocardial perfusion and coronary reserve, (iii) reduce cardiac diameters, and (iv) improve LV contractility in response to adrenergic stimulation. This latter finding was also associated with a significant improvement of cardiac beta-adrenergic receptor downregulation and desensitization.Our data indicate that exercise favourably affects angiogenesis and improves LV remodelling and contractility reserve in a rat model of severe chronic HF