Confronting Patients: Therapists' Model of a Responsiveness Based Approach

Confrontation represents a way of challenging patients in psychotherapy to stimulate change. Confrontation draws attention to discrepancies, for example between elements in a patient’s functioning. The present study was designed to construct a conceptual model of confrontation used by therapists when trying to address two main questions: what are the risks and opportunities of confrontation and how can these effects be influenced? Fifteen therapists from the Psychotherapy Outpatient Clinic of the University of Bern in Switzerland participated in semi-standardized interviews, which were analyzed using qualitative content analysis and thematic analysis. Several main themes merged into a dynamic, sequential model: groundwork required before a confrontation, shaping the confrontation, the (immediate) effects, and management of negative consequences. Therapists assume that a confrontation may induce insight and can strengthen the therapeutic relationship either directly or indirectly through the repair of a rupture in the alliance

Analysis of a stabilized penalty-free Nitsche method for the Brinkman, Stokes, and Darcy problems

International audienceIn this paper we study the Brinkman model as a unified framework to allow the transition between the Darcy and the Stokes problems. We propose an unconditionally stable low-order finite element approach, which is robust with respect to the whole range of physical parameters, and is based on the combination of stabilized equal-order finite elements with a non-symmetric penalty-free Nitsche method for the weak imposition of essential boundary conditions. In particular, we study the properties of the penalty-free Nitsche formulation for the Brinkman setting, extending a recently reported analysis for the case of incompressible elasticity (Boiveau and Burman, IMA J. Numer. Anal. 36 (2016) 770-795). Focusing on the two-dimensional case, we obtain optimal a priori error estimates in a mesh-dependent norm, which, converging to natural norms in the cases of Stokes or Darcy ows, allows to extend the results also to these limits. Moreover, we show that, in order to obtain robust estimates also in the Darcy limit, the formulation shall be equipped with a Grad-Div stabilization and an additional stabilization to control the discontinuities of the normal velocity along the boundary. The conclusions of the analysis are supported by numerical simulations

An in-service training to support teachers of different professions in the implementation of ‘inclusive education’ in the mathematics classroom

International audienc

Effectiveness of the clinical decision support tool ESR eGUIDE for teaching medical students the appropriate selection of imaging tests: randomized cross-over evaluation

Objectives: To evaluate ESR eGUIDE-the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities-for learning purposes in different clinical scenarios. Methods: This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups. Results: Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66). Conclusion: The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended. Key points: • ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool

Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial.

BACKGROUND There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. OBJECTIVE The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. METHODS The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. RESULTS Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. CONCLUSIONS This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47656

Leader peptide exchange to produce hybrid, new-to-nature ribosomal natural products

Ribosomal natural products contain exquisite post-translational peptide modifications that are installed by a range of pathway-specific enzymes. We present proof of principle for a Sortase A-based approach that enables peptide modifcation by enzymes from unrelated pathways. This allowed the one-pot synthesis of a new-to-nature, hybrid ribosomal natural product

Real-World Safety and Effectiveness Outcomes of a Zotarolimus-Eluting Stent: Final 3-Year Report of the RESOLUTE International Study

Objectives: We evaluated the safety and effectiveness of the Resolute™ zotarolimus-eluting stent (R-ZES) in real-world clinical practice through 3 years. Background: A randomized comparison of the R-ZES and the XIENCE V™ everolimus-eluting stent showed no difference in any outcomes through 3-year follow-up in high-volume academic centers. RESOLUTE International is a confirmatory trial designed to evaluate the R-ZES in real-world clinical practice. Methods: RESOLUTE International is a single arm, observational trial that enrolled 2,349 patients from 88 centers with only a few inclusion and exclusion criteria. The primary end-point was the composite of cardiac death and target vessel myocardial infarction (TV-MI) at 1 year. Secondary end-points include target lesion failure (TLF), target vessel revascularization (TVR), and their components, and stent thrombosis (ST). Results: At 3 years 97.2% of patients completed clinical follow-up. The mean age was 63.4 ± 11.2 years, 77.8% were male, and 30.4% had diabetes. The average number of stents per patient was 1.6 ± 1.0; and mean stent length was 30.9 ± 20.5 mm. Dual antiplatelet therapy was used in 91.1% of patients at 1 year, 43.0% at 2 years, and 34.6% at 3 years. Cardiac death and TV-MI occurred in 161 patients (7.0%). There were 6 (0.3%) very late ST events for a total ST rate of 1.1% through 3 years. The rates of clinically driven target lesion revascularization (TLR), TVR, and TLF were 5.7%, 7.4%, and 11.4%, respectively. Conclusions: The safety and effectiveness of the R-ZES through 3 years in this real-world all-comer study was consistent with previously reported all-comer trials. (J Interven Cardiol 2013;26:515-523

Complete phase retrieval of photoelectron wavepackets

Coherent, broadband pulses of extreme ultraviolet (XUV) light provide a new and exciting tool for exploring attosecond electron dynamics. Using photoelectron streaking, interferometric spectrograms can be generated that contain a wealth of information about the phase properties of the photoionization process. If properly retrieved, this phase information reveals attosecond dynamics during photoelectron emission such as multielectron dynamics and resonance processes. However, until now, the full retrieval of the continuous electron wavepacket phase from isolated attosecond pulses has remained challenging. Here, after elucidating key approximations and limitations that hinder one from extracting the coherent electron wavepacket dynamics using available retrieval algorithms, we present a new method called Absolute Complex Dipole transmission matrix element reConstruction (ACDC). We apply the ACDC method to experimental spectrograms to resolve the phase and group delay difference between photoelectrons emitted from Ne and Ar. Our results reveal subtle dynamics in this group delay difference of photoelectrons emitted form Ar. These group delay dynamics were not resolvable with prior methods that were only able to extract phase information at discrete energy levels, emphasizing the importance of a complete and continuous phase retrieval technique such as ACDC. Here we also make this new ACDC retrieval algorithm available with appropriate citation in return

INFLUENCE OF BIODIESEL FUELS ON LUBRICITY OF PASSENGER CAR DIESEL ENGINE OILS

U ovom radu se prati fizikalni i kemijski utjecaj sastavnica biodizela, koji su već na tržištu i onih koji će se koristiti, na performance tipičnog motornog ulja putničkog automobila niskog SAPS-a (sulfati-fosfati-sumpor). Osim metilnih estera masnih kiselina (FAME) koji se danas koriste, također se proučava i buduća generacija hidroobrađenih biljnih ulja (HVO) koja će se koristiti kao biogena sastavnica prilikom namješavanja goriva. U suvremenom 4-cilindarskom dizelovom motoru provedeni su karakteristični testovi gdje su korištena različita goriva koja sadržavaju biodizel, uz istovremeno obnavljanje filtra, kako bi se ostvarila visoka opterećenja i naprezanja motornog ulja. Uzorci korištenih motornih ulja su karakterizirani i uspoređivani nakon provedbe testova.The present paper will mainly focus on the physical and chemical impact of currently used and future biodiesel components on the performance of a typical low- sulfated-ash-phosphorus-sulfur (low SAPS) passenger car engine oil. Beside a current fatty acid methyl ester (FAME), a next generation hydrotreated vegetable oil (HVO) is also investigated as a biogenic fuel blend component. In a representative modern four-cylinder diesel engine test runs with different biodiesel containing fuels were combined with diesel particulate filter regeneration to reach high loads and stresses on the engine oil. The samples of used engine oils were characterized and compared after the engine test runs