Becoming Psychotherapists: Experiences of Novice Trainees in a Beginning Graduate Class

The authors investigated the experiences related to becoming psychotherapists for 5 counseling psychology doctoral trainees in their first prepracticum course. Qualitative analyses of weekly journals indicated that trainees discussed challenges related to becoming psychotherapists (e.g., being self-critical, having troubling reactions to clients, learning to use helping skills), gains made during the semester related to becoming psychotherapists (e.g., using helping skills more effectively, becoming less self-critical, being able to connect with clients), as well as experiences in supervision and activities that helped them cope with their anxieties. Results are discussed in 5 broad areas: feelings about self in role of psychotherapist, awareness of reactions to clients, learning and using helping skills, reactions to supervision, and experiences that fostered growth. Implications for training and research are provided

Optimising inertial focusing for high concentration processing : application to microalgal dewatering

This project focuses on addressing some of the key challenges currently found within the field of inertial focusing microfluidics. A specific goal was to determine the potential of inertial focusing for use as an alternative to existing harvesting technology for the dewatering of microalgal cultures. This application was investigated to address the challenges faced by existing dewatering technology, due to the dilute nature of the cultures and the challenges faced specifically in the separation of the small diameter cells. Inertial focusing microfluidics has shown success relating to the high efficiency concentration of small diameter particles but requires further improvement in its application to cell suspensions in place of rigid particles and over higher concentration samples, where performance is seen to degrade. These factors would act to inhibit potential application to microalgal harvest and it is these challenges that are the focus of this project. The work within the project has achieved successful separation, >95% recovery efficiency, of small microalgal cells (<10 µm) for standard, dilute, culture concentrations using a spiral inertial focusing microfluidic device. This result shows that inertial focusing technology can be used for the low concentration separation of small cell diameter microalgal cultures, where existing harvesting technologies incur challenges, while maintaining the high efficiencies seen when using uniform and rigid particles. A new method for operation of the inertial focusing microfluidic devices was developed, enabling application of the devices to the concentration of microalgal culture from dilute to high concentrations (0.5% to >48.8% v/v). This work achieved concentration factors and power consumption values similar to existing harvesting methods, 130 and 1.1 kWh/m3 respectively. It was also determined that any processing in the inertial focusing microfluidic devices tested resulted in reduced cell propagation, indicating cell damage, with the resulting cell damage being amplified by recirculation within the devices. This shows that further investigation into the effect of processing using these inertial focusing microfluidic devices on cell health is required to investigate the potential scope for application within microalgal processing. In addition to these results, current limitations in the manufacturing methods for inertial focusing devices were identified and an improved method for the in-house, low-cost rapid prototyping of spiral inertial focusing microfluidic device developed and tested within this project. This method was shown to produce spiral inertial focusing devices able to survive the required operational back pressures of >25 bar. Subsequent testing of these manufactured devices showed successful separation of microalgal cultures, achieving >95% recovery efficiency. This result showed successful application of the developed method. However, it was also shown that this method requires further development for successful application to small, <10 µm, microalgae through reduction of channel height

Oral complementary medicine and alternative practitioner use varies across chronic conditions and attitudes to risk

Objectives: To determine whether chronic conditions and patient factors, such as risk perception and decision-making preferences, are associated with complementary medicine and alternative practitioner use in a representative longitudinal population cohort. Participants and setting: Analysis of data from Stage 2 of the North West Adelaide Health Study of 3161 adults who attended a study clinic visit in 2004–2006. The main outcome measures were the medications brought by participants to the study clinic visit, chronic health conditions, attitudes to risk, levels of satisfaction with conventional medicine, and preferred decision-making style. Results: At least one oral complementary medicine was used by 27.9% of participants, and 7.3% were visiting alternative practitioners (naturopath, osteopath). Oral complementary medicine use was significantly associated with arthritis, osteoporosis, and mental health conditions, but not with other chronic conditions. Any pattern of complementary medicine use was generally significantly associated with female gender, age at least 45 years, patient-driven decision-making preferences(odds ratio [OR] 1.38, 95% confidence interval [CI]: 1.08–1.77), and frequent general practitioner visits (.five per year; OR 3.62, 95% CI: 2.13–6.17). Alternative practitioner visitors were younger, with higher levels of education (diploma/trade [OR 1.88, 95% CI: 1.28–2.76], bachelor’s degree [OR 1.77, 95% CI: 1.11–2.82], income . $80,000 (OR 2.28, 95% CI: 1.26–4.11), female gender (OR 3.15, 95% CI: 2.19–4.52), joint pain not diagnosed as arthritis (OR 1.68, 95% CI: 1.17–2.41), moderate to severe depressive symptoms (OR 2.15, 95% CI: 1.04–4.46), and risk-taking behaviour (3.26, 1.80–5.92), or low-to-moderate risk aversion (OR 2.08, 95% CI: 1.26–4.11). Conclusion: Although there is widespread use of complementary medicines in the Australian community, there are differing patterns of use between those using oral complementary medicines and those using alternative practitioners.Robert J Adams, Sarah L Appleton, Antonia Cole, Tiffany K Gill, Anne W Taylor and Catherine L Hil

What are user perspectives of exoskeleton technology? A literature review

Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology.Methods: A systematic literature search was conducted across several healthcare related online databases.Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users' expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training.Conclusions: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users' perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable

Patient perceptions of health-related quality of life in giant cell arteritis: International development of a disease-specific patient-reported outcome measure

Objectives: GCA is a large vessel vasculitis (LVV) presenting with headache, jaw claudication, musculoskeletal and visual involvement. Current treatment is glucocorticoids and anti-IL-6 tocilizumab in refractory disease. The objective of this study was to explore the impact of GCA and its treatment on people's health-related quality of life (HRQoL), to inform the development of a disease-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. Methods: Participants from the UK and Australia, with biopsy- or imaging-confirmed GCA, were interviewed to identify salient aspects of HRQoL in relation to GCA and its treatment. Purposive sampling included a range of demographic and disease features (cranial, LVV-GCA and visual involvement). Inductive analysis identified individual themes of importance, then domains. Candidate questionnaire items were developed from the individual themes, refined by piloting, cognitive interviews and a linguistic translatability assessment. Results: Thirty-six interviews were conducted to saturation with participants with GCA from the UK (25) and Australia (11). Mean age was 74 years, 23 (63.9%) were female, 13 (36.1%) had visual loss and 5 (13.9%) had LVV-GCA. Thirty-nine individual themes within five domains were identified: physical symptoms; activity of daily living and function; participation; psychological impact; and impact on sense of self and perception of health. Sixty-nine candidate items were developed from individual themes; piloting and refinement resulted in a 40-item draft questionnaire. Conclusion: This international qualitative study underpins the development of candidate items for a disease-specific PROM for GCA. The draft questionnaire is now ready for psychometric testing

Jaw claudication and jaw stiffness in giant cell arteritis: Secondary analysis of a qualitative research dataset

Objectives Jaw symptoms can be a vital clue to the diagnosis of giant cell arteritis (GCA). Guidelines recommend more intensive treatment if jaw claudication is present. We sought to explore how patients with GCA described their jaw symptoms. Methods Secondary, qualitative analysis of interview data from 36 participants from the UK (n = 25) and Australia (n = 11), originally collected in order to develop a patient-reported outcome measure for GCA. In all cases, GCA had been confirmed by biopsy/imaging. Interview transcripts were organised within QSR NVivo 12 software, and analysed using template analysis. Themes were refined through discussion among the research team including a patient partner. Results 20/36 participants reported jaw symptoms associated with GCA. Median age of these 20 participants was 76.5 years; 60% were female. Five themes were identified: physical sensations; impact on function; impact on diet; symptom response with steroids; attribution to other causes. Physical sensations included ache, cramp, stiffness and “lock-jaw”. Functional impacts included difficulty in eating/chewing, cleaning teeth, speaking, or opening the mouth. Dietary impacts included switching to softer food. Response to steroids was not always immediate. Jaw symptoms were initially mis-attributed by some participants to arthritis, age or viral illnesses; or by healthcare professionals to dental cavity, ear infection or teeth-grinding. Conclusion Jaw symptoms in GCA are diverse and can lead to diagnostic confusion with primary temporomandibular joint (TMJ) disorder, potentially contributing to delay in GCA diagnosis. Further research is needed to determine the relationship of jaw stiffness to jaw claudication. Lay Summary Giant cell arteritis (GCA) causes inflammation of some of the larger blood vessels of the body, especially around the head and shoulders. If not treated, GCA can cause sight loss. Therefore, prompt diagnosis is important. Doctors are taught that one of the vital clues to GCA is jaw claudication: pain that comes on with chewing and resolves with rest. Guidelines state that patients presenting with jaw claudication need more intensive treatment. We looked back at interviews that had been done for a study to develop a questionnaire about the impact of GCA on patients. In these interviews, over half the participants described experiencing jaw symptoms, but these symptoms were not always typical “jaw claudication”. Jaw stiffness or difficulty opening the mouth were also described. For some patients, difficulty opening the mouth had the greatest impact on diet. Clinicians should be aware that GCA can present with a variety of jaw symptoms. Further research is needed to define the symptom of jaw claudication more precisely, as it may have diagnostic and treatment implications

Microbes central to human reproduction

As studies uncover the breadth of microbes associated with human life, opportunities will emerge to manipulate and augment their functions in ways that improve health and longevity. From involvement in the complexities of reproduction and fetal/infant development, to delaying the onset of disease, and indeed countering many maladies, microbes offer hope for human well-being. Evidence is emerging to suggest that microbes may play a beneficial role in body sites traditionally viewed as being sterile. Although further evidence is required, we propose that much of medical dogma is about to change significantly through recognition and understanding of these hitherto unrecognized microbe–host interactions. A meeting of the International Scientific Association for Probiotics and Prebiotics held in Aberdeen, Scotland (June 2014), presented new views and challenged established concepts on the role of microbes in reproduction and health of the mother and infant. This article summarizes some of the main aspects of these discussions

A Phase 2b Randomised Trial of the Candidate Malaria Vaccines FP9 ME-TRAP and MVA ME-TRAP among Children in Kenya

OBJECTIVE: The objective was to measure the efficacy of the vaccination regimen FFM ME-TRAP in preventing episodes of clinical malaria among children in a malaria endemic area. FFM ME-TRAP is sequential immunisation with two attenuated poxvirus vectors (FP9 and modified vaccinia virus Ankara), which both deliver the pre-erythrocytic malaria antigen construct multiple epitope–thrombospondin-related adhesion protein (ME-TRAP). DESIGN: The trial was randomised and double-blinded. SETTING: The setting was a rural, malaria-endemic area of coastal Kenya. PARTICIPANTS: We vaccinated 405 healthy 1- to 6-year-old children. INTERVENTIONS: Participants were randomised to vaccination with either FFM ME-TRAP or control (rabies vaccine). OUTCOME MEASURES: Following antimalarial drug treatment children were seen weekly and whenever they were unwell during nine months of monitoring. The axillary temperature was measured, and blood films taken when febrile. The primary analysis was time to a parasitaemia of over 2,500 parasites/μl. RESULTS: The regime was moderately immunogenic, but the magnitude of T cell responses was lower than in previous studies. In intention to treat (ITT) analysis, time to first episode was shorter in the FFM ME-TRAP group. The cumulative incidence of febrile malaria was 52/190 (27%) for FFM ME-TRAP and 40/197 (20%) among controls (hazard ratio = 1.52). This was not statistically significant (95% confidence interval [CI] 1.0–2.3; p = 0.14 by log-rank). A group of 346 children were vaccinated according to protocol (ATP). Among these children, the hazard ratio was 1.3 (95% CI 0.8–2.1; p = 0.55 by log-rank). When multiple malaria episodes were included in the analyses, the incidence rate ratios were 1.6 (95% CI 1.1–2.3); p = 0.017 for ITT, and 1.4 (95% CI 0.9–2.1); p = 0.16 for ATP. Haemoglobin and parasitaemia in cross-sectional surveys at 3 and 9 mo did not differ by treatment group. Among children vaccinated with FFM ME-TRAP, there was no correlation between immunogenicity and malaria incidence. CONCLUSIONS: No protection was induced against febrile malaria by this vaccine regimen. Future field studies will require vaccinations with stronger immunogenicity in children living in malarious areas