A Pilot Evaluation of Dialectical Behavioural Therapy in Adolescent Long-Term Inpatient Care

There is a paucity of research investigating psychosocial treatments for youth receiving long-term residential care.This study describes the implementation and impact of dialectical behavioural therapy (DBT) in a long-term psychiatric hospital located in the United States of America.Changes in overall functioning, number of psychotropic medications prescribed, non-suicidal self-injurious behaviour (NSIB), and locked seclusions were investigated in 106 consecutive unique adolescent patients who received DBT. In addition, a comparison group of historical controls was used to examine the effect of DBT in youth with the highest rates of NSIB.A statistically significant increase in overall functioning, as well as a decrease in number of psychotropic medications and non-suicidal self-injurious behaviour (NSIB) was observed within the DBT group. A decrease in locked seclusions was not observed. Accounting for the effects of age, gender, length of stay, and time, youth who received DBT were less likely to engage in NSIB relative to historical controls.These preliminary data suggest that DBT is beneficial for youth with NSIB in long term inpatient psychiatric care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79237/1/j.1475-3588.2010.00569.x.pd

Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial.

Importance: Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy. Objective: To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning. Design, Setting, and Participants: A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March 2019. Interventions: Patients were assigned to either a control group undergoing usual preoperative planning with computed tomography and/or magnetic resonance imaging only or an intervention group where imaging was supplemented with a 3-D VR model. This model was viewed on the surgeon\u27s smartphone in regular 3-D format and in VR using a VR headset. Main Outcomes and Measures: The primary outcome measure was operative time. It was hypothesized that the operations performed using the 3-D VR models would have shorter operative time than those performed without the models. Secondary outcomes included clamp time, estimated blood loss, and length of hospital stay. Results: Ninety-two patients (58 men [63%]) with a mean (SD) age of 60.9 (11.6) years were analyzed. The analysis included 48 patients randomized to the control group and 44 randomized to the intervention group. When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43). Estimated ORs were calculated using the parameter estimates from the generalized estimating equation model. Referent group values for each covariate and the corresponding nephrometry score were summed across the covariates and nephrometry score, and the sum was exponentiated to obtain the OR. A mean of the estimated OR weighted by sample size for each nephrometry score strata was then calculated. Conclusions and Relevance: This large, randomized clinical trial demonstrated that patients whose surgical planning involved 3-D VR models had reduced operative time, estimated blood loss, clamp time, and length of hospital stay. Trial Registration: ClinicalTrials.gov identifiers (1 registration per site): NCT03334344, NCT03421418, NCT03534206, NCT03542565, NCT03556943, and NCT03666104

Cutting Edge: Suppression of GM-CSF Expression in Murine and Human T Cells by IL-27:suppression of GM-CSF expression in murine and human T cells by IL-27

GM-CSF is a potent pro-inflammatory cytokine that plays a pathogenic role in the CNS inflammatory disease, EAE. As IL-27 ameliorates EAE, we hypothesised that IL-27 suppresses GM-CSF expression by T cells. We found that IL-27 suppressed GM-CSF expression in CD4(+) and CD8(+) T cells in splenocyte and purified T cell cultures. IL-27 suppressed GM-CSF in Th1, but not Th17 cells. IL-27 also suppressed GM-CSF expression by human T cells in non-polarised and Th1 but not Th17 polarised PBMC cultures. In vivo, IL-27p28 deficiency resulted in increased GM-CSF expression by CNS infiltrating T cells during Toxoplasma gondii infection. While in vitro suppression of GM-CSF by IL-27 was independent of IL-2 suppression, IL-10 up-regulation or SOCS3 signalling, we observed that IL-27-driven suppression of GM-CSF was STAT1 dependent. Our findings demonstrate that IL-27 is a robust negative regulator of GM-CSF expression in T cells which likely inhibits T cell pathogenicity in CNS inflammation

Supervisor trainees' and their supervisors' perceptions of attainment of knowledge and skills. An empirical evaluation of a psychotherapy supervisor training programme

Objectives. This study aimed to evaluate the success of a two-year, part-time training programme for psychotherapy supervisors. A second aim was to examine factors that might contribute to perceived knowledge and skills attainment during the training course. Design. This is a naturalistic, longitudinal study where several measures are used to examine group process and outcome. Methods. Supervisor trainees’ (n=21) and their facilitators’ (n=6) ratings of learning (knowledge and skills), relations to the supervisor and supervision group, usage of the group, and supervisor style were completed at three time points. Results. The findings suggested that both trainees and their supervisors perceived that the trainees attained a substantial amount of knowledge and skills during the course. In accordance with the literature and expectations, the regression analysis suggested a strong negative association between a strong focus on group processes in the initial and middle phases of the training and perceived knowledge and skills attainment in the final phase of the training. The expected, positive role of relations among trainees in the supervision group in the first half of the training and perceived knowledge and skills attainment in the final part of the training was obtained, whilst the hypothesized significance of the relationship between trainee and supervisor did not receive support. Conclusions The supervisory course seemed to provide a training that allowed trainees to attain knowledge and skills that are necessary for psychotherapy supervisors. The results of this pilot study also emphasize the need of more research on learning in the context of group supervision in psychotherapy

Stress Identification and Management in COTS Family Shelter Residents

Introduction. Previous studies have demonstrated that the homeless population experience higher stress levels than the general population. The goal of our study was to identify potential sources of stress for families staying with COTS, the largest service provider for the homeless and those at risk of becoming homeless in Vermont, and also to gauge potential interest in evidence-based stress-reduction strategies. Methods. Interviews were conducted with seven adult representatives of seven different families (of fourteen eligible) currently residing at the family shelters managed by COTS, in fall 2016. Questions included a mix of short answer items and open ended prompts. Responses that yielded quantifiable data were compiled while responses that were open-ended were qualitatively analyzed to extract core themes. Results. 6 out of 7 residents indicated they were at least as stressed while living at COTS as when they were homeless, and 5 out of 7 were receptive to some form of stress reduction. Common stressors included health, finances, lack of privacy, children and employment status. Discussion. Residents at the family shelters come from a variety of cultural and experiential backgrounds. The composition of COTS\u27 inhabitants and their needs are in dynamic flux. Accordingly, our conclusions may not translate into the future. Our observations underscore a need and a desire for stress-reduction intervention. Thus, we recommend COTS pilot both a weekly mediation class and weekly yoga class. We also suggest the organization provide nutritional information sheets to residents and explore implementing a car share program.https://scholarworks.uvm.edu/comphp_gallery/1243/thumbnail.jp

Explorations, Vol. 3, No. 3

Cover: Artwork by Marcia Spencer, University of Maine art student. Articles include: Characterization of Normal and Carcinogen Induced Neoplastic Cells of Teleost Origin, by Tim Lyden Attitutdes and Opinions of Maine Dairy Farmers, by John Muth and James Leiby Background: the quest for the eighteen month oyster, by Kevin Scully The Quest for the Eighteen Month Oyster, by Kevin Scully Measurement of Surface Tension of Kraft Black Liquor, by Jayalakshmi Jaya Krishnagopalan From the former student, by Jayalakshmi Krishnagopalan From the faculty advisor, by Ivar H. Stockel Aquatic Fungal Decomposers in Two Adjacent Maine Lakes of Different Acidity, by Peter Wagner Studies on a New Mouse Mutation, by Luanne L. Peters Opportunities for Students: Maine Agricultural Experiment Station Research Programs, by Mark W. Anderson Experimental Embryogenesis in Red Pine, by Judy C. Gates The V-Notched Lobster in Maine, by Cheryl Waltz Undernutrition in a Pediatric Population, by Paula Quatromoni From the Advisor Archaeology of the Central Maine Coast, by Douglas Kellogg Marketing Strategies for Computer Consultants in Small Business, by Kimberly Dagher Our Cover Artist From the Advisor, by James Lineha

Prevalence in Britain of abnormal prion protein in human appendices before and after exposure to the cattle BSE epizootic

Widespread dietary exposure of the population of Britain to bovine spongiform encephalopathy (BSE) prions in the 1980s and 1990s led to the emergence of variant Creutzfeldt-Jakob Disease (vCJD) in humans. Two previous appendectomy sample surveys (Appendix-1 and -2) estimated the prevalence of abnormal prion protein (PrP) in the British population exposed to BSE to be 237 per million and 493 per million, respectively. The Appendix-3 survey was recommended to measure the prevalence of abnormal PrP in population groups thought to have been unexposed to BSE. Immunohistochemistry for abnormal PrP was performed on 29,516 samples from appendices removed between 1962 and 1979 from persons born between 1891 through 1965, and from those born after 1996 that had been operated on from 2000 through 2014. Seven appendices were positive for abnormal PrP, of which two were from the pre-BSE-exposure era and five from the post BSE-exposure period. None of the seven positive samples were from appendices removed before 1977, or in patients born after 2000 and none came from individuals diagnosed with vCJD. There was no statistical difference in the prevalence of abnormal PrP across birth and exposure cohorts. Two interpretations are possible. Either there is a low background prevalence of abnormal PrP in human lymphoid tissues that may not progress to vCJD. Alternatively, all positive specimens are attributable to BSE exposure, a finding that would necessitate human exposure having begun in the late 1970s and continuing through the late 1990s

Imaging of Glucose Metabolism by 13C-MRI Distinguishes Pancreatic Cancer Subtypes in Mice

Metabolic differences among and within tumors can be an important determinant in cancer treatment outcome. However, methods for determining these differences non-invasively in vivo is lacking. Using pancreatic ductal adenocarcinoma as a model, we demonstrate that tumor xenografts with a similar genetic background can be distinguished by their differing rates of the metabolism of 13C labeled glucose tracers, which can be imaged without hyperpolarization by using newly developed techniques for noise suppression. Using this method, cancer subtypes that appeared to have similar metabolic profiles based on steady state metabolic measurement can be distinguished from each other. The metabolic maps from 13C-glucose imaging localized lactate production and overall glucose metabolism to different regions of some tumors. Such tumor heterogeneity would not be not detectable in FDG-PET