An Outcome Evaluation of Marble Retreat\u27s Brief, Intensive Psychotherapy Program

Marble Retreat is an interdenominational psychotherapy treatment facility dedicated to ·eating clergy in crisis. Its mission is to facilitate healing and restoration to those who are in ocational Christian ministry through a Christ-centered approach to brief, intensive sychotherapy. The doors of Marble Retreat have been open since 1974. Over the past 33 years, 1arble Retreat has worked with over 3000 clergy in crisis. Recently, Marble Retreat has hanged directorship for the first time in its operation. In 2003, the Board of Directors of Marble ~etreat officially appointed Steven Cappa, PsyD and his wife Patti Cappa, MS, LMFT, CAC II ) oversee ministry operations. In an attempt to assess both the strengths and areas of growth in the current treatment 10dality employed by Marble Retreat, an outcome evaluation was conducted using a quasixperimental pre-test/post-test and 6-month follow-up research design. In particular, the esearch assessed the treatment outcomes of clients who enrolled at Marble Retreat from January 006 thru February 2007. Included are a brief history of Marble Retreat and its philosophy of treatment, as well as a review of the existing empirical research on the individual functioning of energy. At posttest Marble Retreat participants showed significantly reduced psychological [stress, improved marital adjustment, and increased spiritual well-being. It is also concluded 1at at a 6-9 month follow-up the effects of treatment were sustained in psychological mctioning and spiritual well-being, but not in marital adjustment. No differences were found in ffects of 8 and 12 day treatment programs, which supports the decision to move to an 8 day treatment model

A New Bootstrap Goodness-of-Fit Test for Normal Linear Regression Models

In this work, the distributional properties of the goodness-of-fit term in likelihood-based information criteria are explored. These properties are then leveraged to construct a novel goodness-of-fit test for normal linear regression models that relies on a non-parametric bootstrap. Several simulation studies are performed to investigate the properties and efficacy of the developed procedure, with these studies demonstrating that the bootstrap test offers distinct advantages as compared to other methods of assessing the goodness-of-fit of a normal linear regression model

Expressions 1988

https://openspace.dmacc.edu/expressions/1031/thumbnail.jp

Stromal factors involved in prostate carcinoma metastasis to bone

BACKGROUND Prostate carcinoma (PC) frequently metastasizes to bone, where it causes significant morbidity and mortality. Stromal elements in the primary and metastatic target organs are important mediators of tumor cell intravasation, chemoattraction, adhesion to target organ microvascular endothelium, extravasation, and growth at the metastatic site. METHODS The role of stromal factors in bone metastasis was determined with a cyclic DNA microarray comparison of a bone-derived cell PC cell line with a soft tissue-derived cell PC cell line and by evaluating the effects of selected stromal components on PC cell chemotaxis, cell adhesion to human bone marrow endothelium (HBME), and PC cell growth. RESULTS The authors demonstrate that PC cells express protease-activated receptor 1 (PAR1; thrombin receptor), and its expression is up-regulated in PC compared with normal prostate tissue. In addition, this overexpression was very pronounced in bone-derived PC cell lines (VCaP and PC-3) compared with soft tissue PC cell lines (DUCaP, DU145, and LNCaP). The authors report that bone stromal factors, including stromal cell-derived factor 1 (SDF-1) and collagen Type I peptides, are chemoattractants for PC cells, and they demonstrate that some of these factors (e.g., extracellular matrix components, transforming growth factor Β, bone morphogenic proteins [BMPs], and SDF-1) significantly alter PC-HBME interaction in vitro. Finally, stromal factors, such as BMPs, can regulate the proliferation of PC cells in vitro. CONCLUSIONS Soluble and insoluble elements of the stroma are involved in multiple steps of PC metastasis to bone. The authors hypothesize that PAR1 may play a central role in prostate tumorigenesis. Cancer 2003;97(3 Suppl):739–47. © 2003 American Cancer Society. DOI 10.1002/cncr.11181Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34373/1/11181_ftp.pd

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study

Objectives Missed opportunities to diagnose tuberculosis are costly to patients and society. In this study, we (1) estimate the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determine the risk factors for experiencing a diagnostic delay.Design A retrospective cohort study of patients with tuberculosis using longitudinal healthcare encounters prior to diagnosis.Setting Commercially insured enrollees from the Commercial Claims and Encounters or Medicare Supplemental IBM Marketscan Research Databases, 2001–2017.Participants All patients diagnosed with, and receiving treatment for, pulmonary tuberculosis, enrolled at least 365 days prior to diagnosis.Primary and secondary outcome measures We estimated the number of visits with tuberculosis-related symptoms prior to diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern. We computed the number of visits representing a delay and used a simulation-based approach to estimate the number of patients experiencing a delay, number of missed opportunities per patient and duration of delays (ie, time between diagnosis and earliest missed opportunity). We also explored risk factors for missed opportunities.Results We identified 3371 patients diagnosed and treated for active tuberculosis that could be followed up for 1 year prior to diagnosis. We estimated 77.2% (95% CI 75.6% to 78.7%) of patients experienced at least one missed opportunity; of these patients, an average of 3.89 (95% CI 3.65 to 4.14) visits represented a missed opportunity, and the mean duration of delay was 31.66 days (95% CI 28.51 to 35.11). Risk factors for delays included outpatient or emergency department settings, weekend visits, patient age, influenza season presentation, history of chronic respiratory symptoms and prior fluoroquinolone use.Conclusions Many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis. Missed opportunities occur most commonly in outpatient settings and numerous patient-specific, environment-specific and setting-specific factors increase risk for delays

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001-2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed

Retrieval study of tibial baseplate fracture after total knee arthroplasty

Twenty-five cases of fractured metal tibial baseplates were reviewed from retrieved knee arthroplasty. A total of 74 cases have been reported, including the 25 in this series. Baseplate fracture is an avoidable problem with careful choice of prosthesis, attention to surgical detail, and satisfactory postoperative follow-up. There is a relatively short duration of symptoms before fracture, (mean, 10.8 months; range, 1-36 months). Patients should also be advised to self-report if there is sudden onset of pain or any symptoms of instability or mechanical failure, such as squeaks, clicks, or swelling. Early revision should be considered if there is concern about potential baseplate fracture as delay may compromise the ultimate result. A classification for these baseplate fractures is proposed, and the multifactorial etiology is discussed

Toll-like receptors: Important immune checkpoints in the regression of cervical intra-epithelial neoplasia 2

Toll-like receptors (TLRs) are innate immune defenders thought to be critical for the clearance of human papillomavirus (HPV) infections hence preventing the development of HPV-associated high-grade cervical intra-epithelial neoplasia (CIN2 or 3), a potential cervical cancer precursor. However, the role of TLRs in the regression of established cervical lesions, such as CIN2, is hindered by a lack of prospective design studies. Using SYBR green real-time PCR assays, we have examined the gene expression of TLR2, TLR3, TLR7, TLR8 and TLR9, in cytobrush collected endocervical cells of 63 women diagnosed with CIN2 at study entry (baseline) and followed over a 3-year period. Wilcoxon rank-sum test was used to examine the association between TLR expression levels, measured at baseline, and CIN2 outcome (regression vs. persistence/progression) over time. HPV genotyping was performed using Roche Linear Array Assay detecting 37 HPV types. Women with CIN2 regression showed significantly higher baseline levels of TLR2 (p = 0.006) and TLR7 (p = 0.007), as well as a non-significant trend for a higher TLR8 expression (p = 0.053) compared to women with CIN2 persistence/progression. Six women with CIN2 regression, who presented with an HR-HPV DNA-negative CIN2 lesion at study entry, had significantly higher baseline levels of TLR2 (p = 0.005), TLR7 (p = 0.013) and TLR8 (p = 0.012), compared to women with CIN2 persistence/progression, suggesting their role in clearance of HPV prior to clearance of the lesion. Our results confirm a key role of TLRs in regression of CIN2 and support the potential use of TLR-agonists for treatment of these lesions