Convergence and Divergence of Themes in Successful Psychotherapy: An Assimilation Analysis

Theme convergence is the linking of seemingly unrelated problem domains as they advance through assimilation stages-a developmental sequence of cognitive and affective changes through which problematic content is hypothesized to pass during successful psychotherapy. Theme divergence is the contradiction or conflict of solutions to different problems, so that progress in one domain leads to stagnation or regression in another domain. An intensive qualitative method called assimilation analysis was used to examine theme convergence and divergence in a successful psychodynamic psychotherapy with a 20–yr–old female patient. Because specific problems often fail to progress monotonically, even in successful psychotherapy cases, it is suggested that clients\u27 problems cannot be resolved in isolation; instead, they may influence each other toward resolution or stagnation in complex and unpredictable ways

The Second-Shell Metal Ligands of Human Arginase Affect Coordination of the Nucleophile and Substrate†

ABSTRACT: The active sites of eukaryotic arginase enzymes are strictly conserved, especially the first- and second-shell ligands that coordinate the two divalent metal cations that generate a hydroxide molecule for nucleophilic attack on the guanidinium carbon of L-arginine and the subsequent production of urea and L-ornithine. Here by using comprehensive pairwise saturation mutagenesis of the first- and second-shell metal ligands in human arginase I, we demonstrate that several metal binding ligands are actually quite tolerant to amino acid substitutions. Of>2800 double mutants of first- and second-shell residues analyzed, we found more than 80 unique amino acid substitutions, of which four were in first-shell residues. Remarkably, certain second-shell mutations could modulate the binding of both the nucleophilic water/hydroxide molecule and substrate or product ligands, resulting in activity greater than that of the wild-type enzyme. The data presented here constitute the first comprehensive saturation mutagenesis analysis of a metallohydrolase active site and reveal that the strict conservation of the second-shell metal binding residues in eukaryotic arginases does not reflect kinetic optimization of the enzyme during the course of evolution. Arginases (EC 3.5.3.1) are typically homotrimeric enzymes with an R/β fold comprising an eight-strand β-sheet surrounded by several helices. The enzyme contains a dinuclear metal center tha

Antenatal Screening for Down Syndrome Using Serum Placental Growth Factor with the Combined, Quadruple, Serum Integrated and Integrated Tests

PMCID: PMC3463523This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Screening Mammograms in Alzheimer’s Disease Patients

Very little guidance exists to help clinicians and families decide whether mammograms are useful in elderly women with Alzheimer’s Disease (AD). We present a case of a patient with moderate AD who had a positive mammogram and discuss the dilemma faced by the family and clinician in deciding what was best to do for the patient. In this case, the family opted for breast conserving surgery (BCS) followed by palliative care which brought up the question of whether screening was appropriate with this treatment goal in mind. We reviewed the literature on AD and breast cancer screening and summarize these findings in our discussion

Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke

Innovations in Information Systems Education - Reflections of AIS Award Winners

AIS Council monitors social and technical trends that might affect the timeliness and relevance of IS curricula. Consequently, AIS Council charged the AIS VP for Education with developing a process to highlight the importance of these trends and to stimulate the development of education innovations to address them. The result is an AIS-sponsored awards competition (http://www.aisnet.org/award/awards.asp), first held in 2004. The call for submissions focused on the two themes of offshore outsourcing and software development innovations. A panel of expert judges made six awards— three awards of excellence and three honorable mentions. Members of five of the six winning teams appear on this panel. Panelists will address the following questions: · What was the origin of the innovation idea? · What support did you receive upfront for developing your innovation? · What barriers did you encounter in developing your innovation and how did you overcome them? · What learning or other benefits did you, your students, and your program experience from the innovation? · What other areas do you see where innovation in the IS curriculum is required? · What advice do you have for other IS educational innovators

Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period. MEASUREMENTS: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0-30) and 72-hour ED revisits. RESULTS: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: -9.9% risk of inpatient admission, 95% confidence interval (CI) = -12.3% to -7.5%; site 2: -16.5%, 95% CI = -18.7% to -14.2%; site 3: -4.7%, 95% CI = -7.5% to -2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7-2.3%; site 2: 1.4%, 95% CI = 0.7-2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: -7.8%, 95% CI = -10.3% to -5.3%; site 2: -13.8%, 95% CI = -16.1% to -11.6%). CONCLUSION: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission

A Case Control Study of Nutrient Intake Deficiencies in Patients Taking Warfarin

Introduction We previously published the case of a woman taking warfarin who was found to have scurvy, a disease caused by a deficiency of vitamin C. This led us to hypothesize that patients taking warfarin who consume a diet limited in vitamin K rich foods may be at risk for other nutrient deficiencies. To test our hypothesis, we studied dietary nutrient intake in patients taking warfarin compared to patients with heart disease not taking warfarin. Methods The warfarin (n=59) and control groups (n=24) comprised convenience samples of patients with heart disease over age 60 years. Patients completed a three-day food diary and reported use of supplements. Results Based on diet history, the most common deficiencies were vitamin D (100% both groups), vitamin E (93% warfarin, 92% control), vitamin A (71% warfarin, 71% control), vitamin K (66% warfarin, 58% control), vitamin C (58 % warfarin, 46% control) and pantothenic acid (69% warfarin, 71% control) with no significant differences in intake deficiencies between warfarin and control groups. Conclusion All of our patients had nutritional intake deficiencies. This may be due to Appalachian dietary habits and not the low vitamin K diet. It seems prudent to recommend multivitamins, however, universal multivitamin supplementation has not been supported by randomized controlled trials. More study is needed to determine the reason for poor nutritional intake in our Appalachian population and to determine whether similar results are evident in a larger sample

Clustered Cardiometabolic Risk, Cardiorespiratory Fitness and Physical Activity in 10-11 Year-Old Children. The CHANGE! Project Baseline

Objectives: The primary objective of this cross sectional pilot study was to report clustered risk scores combining traditional invasive with non invasive cardiometabolic risk markers in 10-11 year old children participating in the CHANGE! project at baseline. A secondary objective was to determine the relationship between clustered risk score and objectively measured physical activity (PA) and cardiorespiratory fitness (CRF). Methods: Habitual PA was measured using accelerometry and CRF (VO2peak) was assessed using an individually calibrated treadmill based protocol. Twenty-nine participants had valid data for all components of the clustered risk score, calculated using total cholesterol: high density lipoprotein-cholesterol (TC:HDL-C), glucose, systolic blood pressure (BP), LV Mass Index (g/m2.7), and trunk fat mass (g). Participants with a clustered risk score greater than 1SD above the mean, were categorised as ‘higher’ risk (n=6); all others were categorised as ‘normal’ risk. \ud \ud Results: Clustered risk score, controlling for somatic maturity and gender, was negatively correlated with VPA (r= -0.51, p=0.01), MVPA (r= -0.44, p=0.03) and VO2peak (r= -0.57, p<0.01). ANCOVA, with somatic maturity and gender as covariates, revealed that those in the ‘normal’ risk group were more fit than those in the ‘higher’ risk group [f (1,24)=4.518, p=0.044]). There were no statistically significant differences between risk groups and PA however mean data suggest that those in the ‘normal’ risk group accrued 4 minutes more daily VPA than the ‘higher’ risk group which may be clinically important. \ud \ud Conclusions: This provides further evidence of the importance of promoting CRF and VPA in children, to reduce cardiometabolic risk especially for those that are ‘higher’ risk