National survey on equine assisted therapy: An exploratory study of current practitioners and programs

Equine facilitated psychotherapy (EFP), a new field in psychology, is an alternative method of therapy that uses horses to facilitate therapeutic outcomes. There is minimal peer reviewed literature and few published studies examining efficacy. The conceptual lens of this study was grounded theory, as there is insufficient evidence of theoretical frame-works guiding equine assisted therapy. The purpose of this exploratory concurrent mixed methods study was to examine the theoretical foundation of practitioners; program make up; client populations; efficacy of program; and why the horse serves as the therapeutic catalyst of this model. A 43-item survey was sent to 800 programs, current members of the North American Riding for the Handicapped Association, Equine Assisted Learning and Growth Association, and the Equine Facilitated Mental Health Association who use equine assisted therapy. Twenty nine percent (n=232) of the surveys were returned. Chi square and cross tabulations were utilized to examine relationships between specific theoretical orientations of therapists and the therapeutic role served by the horses. Results illustrated that therapists who used experiential theory were more likely to use horses for development of confidence, development of self-efficacy, mirroring of behavior, and manner in which the therapist treats the horse. Open coding of qualitative questions was followed by axial coding into emergent themes were used to confirm and expand the quantitative results. Results illustrated the primary orientation within EFP was experiential theory; and that horses were universally considered essential aspects of the program because specific characteristics of the species facilitate key therapeutic processes. This study contributes to social change by providing the EFP field with a comprehensive analysis of current conceptual orientations and practice that can inform efforts to unify and extend this emerging therapy

A decomposition of the increased stability of GDP growth

Since 1984, the U.S. economy has grown at a remarkably steady pace. An analysis of this increased stability shows that every major component of GDP has exhibited smoother growth. However, two components--inventory investment and consumer spending--are responsible for the bulk of the decline in overall volatility.Gross domestic product ; Capital investments ; Inventories ; Consumption (Economics)

Large volume dye spread in transversus abdominis plane block via three injection sites: a cadaveric study

Background: Transversus abdominis plane (TAP) block is a recently described regional anaesthesia technique that provides analgesia for the abdominal wall. Three access points for injection have been described: via the lumbar triangle of Petit (LTOP), via the midaxillary line and via the subcostal region (SC). This study aimed to investigate the spread of dye following injection via all 3 sites with a large volume injectate. Materials and Methods: 24 hemiabdomens were injected with 40 mL 25% black food dye: 8 via the LTOP) 4 via the MAL, 4 via the SC. Dissection was performed to reveal the extent of nerve involvement and dye spread. Results: Variation in the size and shape of the LTOP was found between cadavers. Mean areas of dye spread (range of nerve involvement) in the remaining 16 hemiabdomens for LTOP, MAL and SC were 77.9 cm2 (T10-ilioinguinal), 50.3 cm2 (T10-ilioinguinal) and 91.3 cm2 (T7-ilioinguinal) respectively. Communications were seen between nerves within the TAP in one dissection. Dye staining was seen to involve nerves outside the TAP. Conclusion: Subcostal injection gives more superior dye spread, with a greater area and awider range of nerve involvement. This should perhaps be the preferred injection site, and could have broader indications

Combining preschool teacher training with parenting education : a cluster-randomized controlled trial

This paper evaluates a government program in Malawi, which aimed to improve quality at community-based childcare centers and complemented these efforts with a group-based parenting support program. Children in the integrated intervention arm (teacher training and parenting) had significantly higher scores in measures of language and socio-emotional development than children in centers receiving teacher training alone at the 18-month follow-up. However, the study finds no effects on child assessments at the 36-month follow-up. Significant improvements at the centers relating to classroom organization and teacher behavior in the teacher-training only arm did not translate into improvements in child outcomes at either follow-up. The findings suggest that, in resource-poor settings with informal preschools, programs that integrate parenting support within preschools may be more effective than programs that simply improve classroom quality

Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

<p>Abstract</p> <p>Background</p> <p>Cardiovascular magnetic resonance (CMR) can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM).</p> <p>Results</p> <p>We consecutively studied 86 patients with ICM (LVEF < 50%, mean LVEF: 26 ± 12%) with CMR before revascularization or medication therapy ± implantable cardiac defibrillator, determined the amount of myocardial scar, and followed for development of cardiovascular events. Thirty-three patients (38%) had cardiovascular events (mean follow-up: 20 ± 16 months). Patients who developed cardiovascular events had larger scar volume and scar percentage of the myocardium than those who did not develop cardiovascular events (16.8 ± 12.4 cm3 vs. 11.7 ± 12.6 cm3, p = 0.023 and 10.2 ± 6.9% vs. 7.2 ± 6.7%, p = 0.037, respectively). There were no significant differences in LVEDV, LVESV and LVEF between the patients with and without cardiovascular events (231 ± 76 ml vs. 230 ± 88 ml; 180 ± 73 ml vs. 175 ± 90 ml; and 25 ± 10% vs. 27 ± 13%, respectively).</p> <p>Conclusion</p> <p>Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.</p

Effect of disinfectants used in clinical facilities on the induction of the SOS response and mutation frequency in Escherichia coli

Motivation: The development of antibiotic resistance is one of the mechanism used to study adaptive evolution. Antibiotics not only select for preexisting resistant strains in a population, but they can also promote the appearance of resistant strains (1, 2). Antibiotics at high concentrations can be lethal to bacteria, but it has been shown that sub-inhibitory concentrations of some antibiotics can stimulate horizontal transfer of DNA and mutation in different chromosomal loci (1, 3). These antibiotics can increase the mutation rate through several mechanisms, such as oxidative stress and the SOS response, which is triggered by DNA damage (2, 3). In this context, we wanted to determine if commonly-used disinfectants also promote mutation. Methods: The disinfectants used were ethanol, sodium hypochlorite, chlorhexidine, silver nitrate, benzalkonium chloride, triclosan and povidone-iodine complex. The E.coli strain used was IBDS1, which includes a tetracycline gene regulated by the cI (Ind-) repressor gene, that allows us to measure the mutation rate.To study the effect of these disinfectants, the strain IBDS1 was tested with a window of concentrations very close to the minimum inhibitory concentration (MIC) by evaluating the appearance of mutants resistant to rifampicin or tetracycline (3). To determine if this effect could be linked to the induction of the SOS system, we used a plasmid which expresses the "Green Fluorescence Protein" (GFP) under the control of the promoter of the recA gene to detect when the SOS system is activated by measuring fluorescence.Results: Three of the disinfectants tested increased mutation frequency. Concentrations of 0.013 μg/ml and 0.026 μg/ml of NaClO (1/4x CMI y 1/2x MIC) increased the mutation frequency approximatly 4 fold and 0.5 μg/ml of clorhexidine (1/4x MIC) and 0.125 μg/ml of triclosan (1/4x MIC) 3 fold, approximately. In relation to the SOS system, none of the concentrations tested induced the SOS response. Conclusions: These results show that certain concentrations of sodium hypochlorite, chlorhexidine and triclosan increase the mutation frequency and therefore may facilitate the appearance of resistant strains, although it appears that this mutagenic effect is not related to the induction of the SOS system. Therefore, it would be interesting to study whether this mutagenic effects is due to the reactive oxygen species (ROS) produced by disinfectants.

Long-Term Changes in Physical Activity Following a One-Year Home-Based Physical Activity Counseling Program in Older Adults with Multiple Morbidities

This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed

Right coronary wall cmr in the older asymptomatic advance cohort: positive remodeling and associations with type 2 diabetes and coronary calcium

<p>Abstract</p> <p>Background</p> <p>Coronary wall cardiovascular magnetic resonance (CMR) is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort.</p> <p>Results</p> <p>Cross-sectional images of the proximal right coronary artery (RCA) were acquired using spiral black-blood coronary CMR (0.7 mm resolution) in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female). Coronary measurements (total vessel area, lumen area, wall area, and wall thickness) had small intra- and inter-observer variabilities (r = 0.93~0.99, all p < 0.0001), though one-third of these older subjects had suboptimal image quality. Increased coronary wall thickness correlated with increased coronary vessel area (p < 0.0001), consistent with positive remodeling. On multivariate analysis, type 2 diabetes was the only risk factor associated with increased coronary wall area and thickness (p = 0.03 and p = 0.007, respectively). Coronary wall CMR measures were also associated with coronary calcification (p = 0.01-0.03).</p> <p>Conclusions</p> <p>Right coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.</p