PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS: ATTACHMENT STYLE, OUTCOME EXPECTATIONS, NEED FOR THERAPY, SESSION DURATION, AND THERAPIST HELPING SKILLS IN INTAKE SESSIONS

The present study investigated client attachment style, outcome expectations, need for therapy, intake duration and therapist helping skills associated with psychotherapy engagement. Intake sessions of 16 adults (8 non-engagers, i.e., post-intake dropouts; 8 engagers, i.e., clients who attended at least 8 sessions) in individual long-term therapy were divided into thirds (beginning, middle, and end of session). Statistical controls for therapist verbal activity level and clients nested within therapists were employed for helping skills analyses. With non-engagers, compared to engagers, therapists used more approval-reassurance in the beginning third of intake sessions, but marginally more reflections of feeling and marginally less information about the helping process in the last third of intakes. Non-engagers had higher pre-therapy anxious attachment and pre-therapy self-rated need for therapy than engagers. In sum, non-engagers versus engagers differed with therapist helping skills, client attachment style, and client need for therapy, but not intake duration or client outcome expectations

Molecular epidemiological study of clinical Acinetobacter baumannii isolates: phenotype switching of antibiotic resistance

BackgroundThe presence of clinical Acinetobacter baumannii (A. baumannii) isolates with differing antibiotic resistance phenotypes in the same patient causes difficulties and confusion in treatment. This phenomenon may be caused by reasons such as cross-infection from neighboring patients that switches to different A. baumannii strain, natural mutation of A. baumannii, inducing of different antibiotic resistance genes expression or acquisition of genes conferring resistance from another source. To elucidate this question, clinical A. baumannii strains, isolated from the same individual patients, showed antibiotic resistance phenotypes switching during the same hospitalization period, were attentively collected for further analysis. Molecular approaches for phylogenetic analysis, including pulsed field gel electrophoresis, multilocus sequence typing, and short tandem repeat analysis, were employed for the chronological studies.FindingsOur results showed that antibiotic resistance phenotype switching could have occurred as a result through both cross-infection and natural mutation roots. Our results also suggest that rapid phenotype switching between paired isolates could occur during one single course of antibiotic treatment.ConclusionsThough cross infection caused antibiotic resistance phenotype switching does occur, natural mutation of A. baumannii isolates is particularly cautious for antibiotic treatment

Risk factor analysis for extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections in central Taiwan

BackgroundEnterobacter cloacae (E.cloacae) bloodstream infection (EcBSI) is an important cause of morbidity and mortality, with an increasing incidence in our hospital. We wanted to elucidate the risk factors of mortality among patients with ESBL-positive EcBSI in central Taiwan.MethodsWe ordered the clinical and microbiological data of cases with diagnosis of EcBSI, and analyzed the isolates by using antibiotyping, detection of ESBL, detection of class 1 integron and genomic fingerprinting by pulsed-field gel electrophoresis (PFGE).ResultsSeventy episodes of EcBSI from 70 patients (56 hospital-acquired infections) were enrolled. Significant differences were found between ESBL-positive and ESBL-negative isolates with regard to risk factors, including the diseases severity (p = 0.03), category of health care-associated infection (p = 0.04), prior use of antibiotics (p = 0.023), and prior use of a ventilator (p = 0.037). A significant difference in mortality between two groups (p = 0.004) was determined using the chi-square test, and a trend in mortality between two groups (p = 0.006, OR = 4.750, 95% C.I.=1.573-14.344) was determined using univariate logistic regression analysis. The predominant clone in ESBL-positive strains was associated with a higher mortality rate but not with the presence of the integron.ConclusionsThe study disclosed four types of clinical characteristics to obtain ESBL-positive EcBSI, and there was a trend in mortality too. We suggested the need to review antibiotic prescription practices, and the possible need to consider ESBL-positive strains in empirical treatment of bloodstream infection

THE INFLUENCE OF DIFFERENT STRIKE PAITERNS ON ENERGY CONTIBUTION DURING RUNNING

Purpose: The purpose of this study was to determine the differences of joint power and work between forefoot strike (FFS) and rear-foot strike (RFS) during the stance phase of running. Methods: A 10-camera Vicon system and two force plates were used to collect the kinematics and kinetics data of 15 healthy male triathletes with different foot strike strategies during running. Results: The joint power and positive work at hip and ankle were increased in FFS during the stance phase. FFS also showed decreased knee negative work. Conclusion: Running with FFS would consume more energy than running with RFS at the same speed. The lack of ankle pint shock absorption in RFS might cause higher injury risk in knee

THE INFLUENCE OF TAI-CHI EXERCISE ON DYNAMICS OF LOWER EXTREMITY FOR THE ELDERLY DURING SIT-TO-STAND

The purpose of this study was to investigate the influence of Tai Chi exercise on sit-tostand in the elderly. Ten healthy female elders (normal group) and nine healthy Tai-Chi female practitioner (Tai-Chi group) participated in this study. The results indicated: (1) During the forward flexion phase, normal group showed significantly greater hip flexion angle and moment than Tai-Chi group (

MECHANISM OF LANDING STRATERGY DURING STEP AEROBICS WITH DIFFERENT BENCH HEIGHTS AND LOADS

The purpose of this study was to investigate effects of different heights (6inch, 8inch, 10inch) and external loads (0% BW, 10% BW, 15% BW) on lower extremity during step aerobics. Ten college physical education students (age: 23.8 ± 2.1 years, height: 173.5 ± 6.1 cm, weight: 68.5 ± 8.0 kg) participated in this study. A Mega high-speed camera (100 Hz) and an ATMI force plate (1000Hz) were used to record kinematic and kinetic data respectively during step aerobics. Increased vertical ground reaction force, ankle movement, and decreased leg stiffness and ankle joint stiffness were found as the bench height increased to 10 inches which were considered to a high loading rates and shock to the lower extremity, especially at ankle joint. Therefore, people should avoid doing step aerobics at 10-inch bench height for a long time to protect ankle joint and soft tissue from injury

WHEN THERAPY RELATIONSHIPS MAKE A DIFFERENCE: CORRECTIVE RELATIONAL EXPERIENCES OF ADULT CLIENTS IN OPEN-ENDED INDIVIDUAL PSYCHOTHERAPY

The present study examined the antecedents, types, and consequences of Corrective Relational Experiences (CREs), as well as whether these aspects of CREs (antecedents, types, and consequences) differ depending on client attachment anxiety and avoidance. Clients completed a measure of adult attachment (Experiences in Close Relationships scale; ECR; Brennan, Clark, & Shaver, 1998) before starting open-ended, individual psychotherapy at a psychodynamic-interpersonal therapy clinic. After completion of therapy, 31 clients completed post-therapy interviews assessing their therapy experience, including the occurrence and nature of CREs. Interviews were analyzed qualitatively using CQR (Hill, Thompson, & Williams, 1997; Hill et al., 2005; Hill, 2012). Results indicated that CRE antecedents typically included both positive client-therapist relationships as well as difficulties in therapeutic relationships. Therapists typically facilitated CREs by identifying or questioning client behavior patterns, as well as conveying profound trustworthiness (deep care, understanding, nonjudgmentalness, or credibility). Types of corrective shifts typically involved clients gaining a new understanding of behavior patterns or the therapist/therapy. Consequences of CREs generally included improvements in the therapy relationship, and improvements in the clients' intrapersonal well-being. Clients who did not have CREs variantly wished their therapist's theoretical orientation was a better match, while none of the clients who had CREs did so. Non-CRE clients had lower pre-therapy attachment anxiety and avoidance in comparison to clients who reported CREs. Antecedents, types, and consequences of CREs differed depending on client attachment anxiety and avoidance. Clients with high attachment anxiety seemed to have a greater interpersonal focus (e.g., indicated enacting their maladaptive behavior patterns with therapists prior to the CRE, had CREs focused on understanding clients' behavior patterns) while clients high in attachment avoidance seemed to have a greater intrapersonal focus (reported more client facilitators of CREs, especially deep disclosure prior to CREs, and more reduction in unwanted feelings after CREs). Implications for practice and research are discussed

Plant-Microbe Ecology: Interactions of Plants and Symbiotic Microbial Communities

Plant community dynamics are driven by the microbial mediation of soil resource partitioning and sharing by the inhibition of other host symbionts or sharing the broadly specific symbiotic fungi. The plant phenotype and ecology can be affected by the impact of the symbiotic microbes on the environment and competition for soil resources

Accelerated Policy Gradient: On the Nesterov Momentum for Reinforcement Learning

Policy gradient methods have recently been shown to enjoy global convergence at a $\Theta(1/t)$ rate in the non-regularized tabular softmax setting. Accordingly, one important research question is whether this convergence rate can be further improved, with only first-order updates. In this paper, we answer the above question from the perspective of momentum by adapting the celebrated Nesterov's accelerated gradient (NAG) method to reinforcement learning (RL), termed \textit{Accelerated Policy Gradient} (APG). To demonstrate the potential of APG in achieving faster global convergence, we formally show that with the true gradient, APG with softmax policy parametrization converges to an optimal policy at a $\tilde{O}(1/t^2)$ rate. To the best of our knowledge, this is the first characterization of the global convergence rate of NAG in the context of RL. Notably, our analysis relies on one interesting finding: Regardless of the initialization, APG could end up reaching a locally nearly-concave regime, where APG could benefit significantly from the momentum, within finite iterations. By means of numerical validation, we confirm that APG exhibits $\tilde{O}(1/t^2)$ rate as well as show that APG could significantly improve the convergence behavior over the standard policy gradient.Comment: 51 pages, 8 figure