A Mixed Methodological Analysis of the Role of Culture and Diagnostic Variance Among Counselors and Counselor Trainees

As the U.S. population continues to diversify, counselors are challenged to respond to the interface of culture and mental health concerns of clients (Gushue, Constantine, & Sciarra, 2008). It is important for counselors when making clinical decisions to reflect on the diverse needs of clients as well as the potential impact of cultural factors on mental health (Sue & Sue, 2008). Accordingly, this study sought to investigate the clinical decision-making process among counselors and counselor trainees and how, if at all, cultural factors influence the case conceptualization of clients. The study also investigated how counselors and counselor trainees collect and process client data when making clinical decisions to include: diagnostic decisions, current level of functioning, and prognosis. The concurrent mixed methods study tests and revises a grounded theory of clinical decision-making and degree of match between counselors, counselor trainees, and clients (Hays, McLeod, & Prosek, 2009; Hays, Prosek, & McLeod, 2010). Participants viewed 1 of 6 mock client videos representing identical symptomology, but differing on cultural variables of race/ethnicity and gender. After viewing the video, participants diagnosed the client and completed an electronic survey packet of both qualitative open-ended survey questions and quantitative survey instruments. Demographic information was collected from participants to determine degree of cultural match with client. Results indicate counselors and counselor trainees arrive at different diagnostic decisions when provided identical clinical data. However, counselors and counselor trainees utilize similar cognitive tools when conceptualizing information from clients. Diagnostic variance was identified to account for differences in diagnoses. Cultural factors such as race/ethnicity and gender are considered within the presenting problem and/or diagnostic decision; but cultural bias also influences the clinical decision-making process. There is a statistically significant relationship between the degree of racial/ethnic match between counselor/counselor trainee and client and the consideration of race/ethnicity in the presenting problem and/or diagnostic decision. However, there was no statistically significant relationship between the degree of gender match between counselor/counselor trainee and client and the consideration of gender in the presenting problem and/or diagnostic decision. Lastly, there were no statistically significant relationships between cultural bias and perceptions of client functioning; although the small sample size limits the quantitative findings of the study. The developing theory of the clinical decision-making process of counselors and counselor trainees is presented. Implications of the theory for counselor educators and future research are discussed

Effective Remediation in Master’s-Level Counseling Students

Despite evidence that remediation is effective, little is known about counselor educators’ experience with remediation. In this consensual qualitative study, authors interviewed counselor educators (N=11) to better understand remedial practices and identify effective strategies. Findings have implications for the remediation of master’s-level students in counselor education

Acute kidney injury in patients treated with immune checkpoint inhibitors

Antígeno CTLA-4; InmunoterapiaAntigen CTLA-4; ImmunoteràpiaCTLA-4 antigen; ImmunotherapyBackground Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. Methods We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. Results ICPi-AKI occurred at a median of 16 weeks (IQR 8–32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3–10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. Conclusions Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery.The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

Adherence measurements and corrosion resistance in primer/hot-dip galvanized steel systems

This paper focuses on the adherence during ageing of a primer (made of polyester resins crosslinked with melamine) applied onto hot-dip galvanized (HDG) steel for coil coating application and its influence on corrosion protection. A chromium-free surface treatment, composed of fluorotitanic acid, phosphoric acid, manganese phosphate, and vinylphenol was applied on the HDG steel to obtain high corrosion resistance and high adherence of a polyester and melamine primer. The influence of the manganese phosphate on the corrosion and adherence was investigated. To measure the adherence between the metal and the primer, a three-point flexure test was set up. The adherence was then linked with corrosion resistance during ageing, using electrochemical impedance spectroscopy

Revealing the Appetite of the Marine Aquarium Fish Trade: The Volume and Biodiversity of Fish Imported into the United States

The aquarium trade and other wildlife consumers are at a crossroads forced by threats from global climate change and other anthropogenic stressors that have weakened coastal ecosystems. While the wildlife trade may put additional stress on coral reefs, it brings income into impoverished parts of the world and may stimulate interest in marine conservation. To better understand the influence of the trade, we must first be able to quantify coral reef fauna moving through it. Herein, we discuss the lack of a data system for monitoring the wildlife aquarium trade and analyze problems that arise when trying to monitor the trade using a system not specifically designed for this purpose. To do this, we examined an entire year of import records of marine tropical fish entering the United States in detail, and discuss the relationship between trade volume, biodiversity and introduction of non-native marine fishes. Our analyses showed that biodiversity levels are higher than previous estimates. Additionally, more than half of government importation forms have numerical or other reporting discrepancies resulting in the overestimation of trade volumes by 27%. While some commonly imported species have been introduced into the coastal waters of the USA (as expected), we also found that some uncommon species in the trade have also been introduced. This is the first study of aquarium trade imports to compare commercial invoices to government forms and provides a means to, routinely and in real time, examine the biodiversity of the trade in coral reef wildlife species

Acute kidney injury in patients treated with immune checkpoint inhibitors

Background: Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. Methods: We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. Results: ICPi-AKI occurred at a median of 16 weeks (IQR 8-32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3-10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. Conclusions: Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery

Perception of aperiodicity in pathological voice

Although jitter, shimmer, and noise acoustically characterize all voice signals, their perceptual importance in naturally produced pathological voices has not been established psychoacoustically. To determine the role of these attributes in the perception of vocal quality, listeners were asked to adjust levels of jitter, shimmer, and the noise-to-signal ratio in a speech synthesizer, so that synthetic voices matched naturally produced tokens. Results showed that, although listeners agreed well in their judgments of the noise-to-signal ratio, they did not agree with one another in their chosen settings for jitter and shimmer. Noise-dependent differences in listeners' ability to detect changes in amounts of jitter and shimmer implicate both listener insensitivity and inability to isolate jitter and shimmer as separate dimensions in the overall pattern of aperiodicity in a voice as causes of this poor agreement. These results suggest that jitter and shimmer are not useful as independent indices of perceived vocal quality, apart from their acoustic contributions to the overall pattern of spectrally shaped noise in a voice. (c) 2005 Acoustical Society of America

Acute kidney injury in patients treated with immune checkpoint inhibitors

BACKGROUND: Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. METHODS: We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. RESULTS: ICPi-AKI occurred at a median of 16 weeks (IQR 8-32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3-10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. CONCLUSIONS: Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery

Research of Teaching in Counselor Education: A Collective Effort of Improved Rigor

This special issue in Teaching and Supervision in Counseling offers several perspectives of teaching, pedagogy, and learning theory in counselor education. In this article, the author conceptualizes signature pedagogies: surface, deep, and implicit structures in terms of research questions. Methodological design considerations are discussed to broaden the scope and rigor of research on teaching in counseling. Finally, strategies for improving a favorable review of research manuscripts for publication are provided

Quantitative analysis of RD-14M large LOCA test B9401 calculations

The results obtained in a more-than-a-decade application of thermal-hydraulic system codes to the analysis of experiments performed in Integral Test Facilities (ITF) and Separate Effect test Facilities (SETF) including the participation to several International Standard Problems (ISP) and Standard Problem Exercises (SPE), organized by OECD/NEA/CSNI (Organization for Economic Cooperation and Development / Nuclear Energy Agency / Committee on the Safety of Nuclear Installations) and by IAEA (international Atomic Energy Agency), respectively, suggested the need for new methods and procedures for code application. The words nodalization-qualification, qualitative-accuracy-evaluation, quantitative-accuracy-evaluation, and acceptability-thresholds were introduced. The present document deals with accuracy quantification at the transient level in relation to the Large Break Loss of Coolant Accident (LB-LOCA) test B9401 performed in RD-14M facility availbale at the Manitoba Research center of AECL in Canada. The FFTBM (Fast Fourier Transform Based method) developed at UNIPI was applied and a hierarchy of calculation quality by various participants was determined