Interpersonal Behavior in Couple Therapy: Concurrent and Prospective Associations with Depressive Symptoms and Relationship Distress

Objective: This study investigated associations between couples’ interpersonal behavior, depressive symptoms, and relationship distress over the course of couple psychotherapy. Method: After every other session of Integrative Systemic Therapy (M = 13 sessions), N = 100 individuals within 50 couples rated their in-session affiliation and autonomy behavior using the circumplex-based Structural Analysis of Social Behavior Intrex. Concurrent and prospective associations of interpersonal behavior with depressive symptoms and relationship distress were evaluated via multivariate multilevel modeling using the Actor-Partner Interdependence Model. Results: An individual’s hostility, as well as the partner’s hostility, positively predicted an individual’s concurrent depressive symptoms and relationship distress, as well as his or her relationship distress at the following session. Partner hostility during one session predicted an individual’s subsequent depressive symptoms. During sessions in which individuals controlled the partner, and separated themselves from the partner, they reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. When partners separated themselves, individuals reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. Conclusions: Results underscore the importance of couples’ in-session affiliation and autonomy behavior in the treatment of depressive symptoms and relationship distress within couple therapy

Electricity Governance and the Western Energy Imbalance Market in the United States: The Necessity of Interorganizational Collaboration

In the Western United States, widespread growth of wind and solar resources is putting pressure on state policy makers, electricity system operators, and utilities to integrate renewable resources into the grid, while maintaining reliability, affordability, and improving efficiency. These resources are creating new challenges because their variability can contribute to transmission constraints and system imbalances. This paper examines a recent initiative to make energy imbalance market services available throughout the Western Interconnection and provides insight into evolving electricity system governance. Drawing on boundary organization and interorganizational collaboration literature, this research explores the processes and practices used to create a new interorganizational collaboration. The research supports theoretical claims that facilitating policy innovation requires discursive formation of a collective identity

General Acid–Base Catalysis Mediated by Nucleobases in the Hairpin Ribozyme

The catalytic mechanism by which the hairpin ribozyme accelerates cleavage or ligation of the phosphodiester backbone of RNA has been incompletely understood. There is experimental evidence for an important role for an adenine (A38) and a guanine (G8), and it has been proposed that these act in general acid-base catalysis. In this work we show that a large reduction in cleavage rate on substitution of A38 by purine (A38P) can be reversed by replacement of the 5′-oxygen atom at the scissile phosphate by sulfur (5′-PS), which is a much better leaving group. This is consistent with A38 acting as the general acid in the unmodified ribozyme. The rate of cleavage of the 5′-PS substrate by the A38P ribozyme increases with pH log-linearly, indicative of a requirement for a deprotonated base with a relatively high pK(a). On substitution of G8 by diaminopurine, the 5′-PS substrate cleavage rate at first increases with pH and then remains at a plateau, exhibiting an apparent pK(a) consistent with this nucleotide acting in general base catalysis. Alternative explanations for the pH dependence of hairpin ribozyme reactivity are discussed, from which we conclude that general acid-base catalysis by A38 and G8 is the simplest and most probable explanation consistent with all the experimental data

Hydrological and seasonal controls of phosphorus in Northern Great Plains agricultural streams

PostprintControls on nutrient transport in cold, low relief agricultural regions vary dramatically among seasons. The spring snowmelt is often the dominant runoff and nutrient loading event of the year. However, climate change may increase the proportion of runoff occurring with rainfall and there is an urgent need to understand seasonal controls on nutrient transport in order to understand how patterns may change in the future. In this study, we assess patterns and drivers of total phosphorus (TP) dynamics in eight streams draining agriculturally-dominated watersheds, located in southern Manitoba, Canada. Data from three years of monitoring revealed highly coherent patterns of TP concentrations in streams, with pronounced peaks in the spring and mid- summer across the region. This coherent pattern was in spite of considerable interannual variability in the magnitude and timing of discharge; in particular, a major storm event occurred in summer 2014, which resulted in more discharge than the preceding spring melt. Concentration-discharge model fits were generally poor or not significant, suggesting that runoff generation is not the primary driver of TP dynamics in the majority of streams. Seasonal patterns of conductivity and stream temperature suggest mechanisms controlling TP vary by season; a spring TP concentration maximum may be related to surface runoff over frozen soils while the summer TP maximum may be related to temperature-driven biogeochemical processes, which are not well-represented in current conceptual or predictive models. These findings suggest that controls on stream TP concentrations are dynamic through the year, and responses to increases in dormant and non-dormant season temperatures may depend on seasonally-variable processes

American Institute of Ultrasound in Medicine Recommendations for Contrast‐Enhanced Liver Ultrasound Imaging Clinical Trials

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135306/1/jum2007266705.pd

Delivering word retrieval therapies for people with aphasia in a virtual communication environment

Background: Delivering therapy remotely, via digital technology, can enhance provision for people with aphasia. EVA Park is a multi-user virtual island that can be used for such delivery. The first EVA Park study showed that daily language stimulation delivered via the platform improved functional communication and was positively received by users (Marshall et al, 2016; Amaya et al, 2018). This paper reports two single case studies, evaluating its capacity to deliver targeted language interventions. The first employed therapy for noun retrieval, using cued picture naming and modified Sematic Feature Analysis. The second employed modified Verb Network Strengthening Treatment (VNeST). Aims: This study aimed to determine if treatment delivery was feasible in EVA Park, as assessed by participant compliance, treatment fidelity and participants’ views. It explored the impact of the therapies on treated and untreated word production, connected speech and functional communication. Methods & Procedures: Two participants with aphasia each received 20 sessions of individual therapy in EVA Park, delivered over 5 weeks. Feasibility was assessed by measuring compliance with the therapy regime, recording and checking the fidelity of 20% of treatment sessions, and using post therapy interviews to explore participant views. Treatment outcomes were evaluated via repeated measures single case designs, in which assessments were administered twice before therapy, immediately post therapy and five weeks later. Outcome measures included Object Picture Naming (study 1), Sentence Elicitation Pictures (study 2), Naming 84 items from the Object and Action Naming Battery (study 2), Narrative Production (Study 2), the Northwestern Assessment of Verb and Sentences: Argument Structure Production Test (Study 2) and Communication Activities of Daily Living – 2 (Study 1 & 2). Outcomes & Results: Feasibility results were excellent. Both participants were fully compliant with the therapy regime. There was at least 90% fidelity with the treatment protocols and participant views were positive. Outcomes varied across the studies. The noun therapy significantly improved the naming of treated words, with good maintenance. Lexical gains were less evident on the Sentence Elicitation Pictures used in the VNeST study. Neither study demonstrated generalisation to untreated words, connected speech or functional communication. Conclusions: Two treatment approaches, designed for face to face delivery, could be delivered remotely in EVA Park. Outcomes for the noun treatment were comparable to previous evaluations. Comparisons with previous research were more challenging for VNeST, owing to differences in methodology. Further evaluations of other treatment approaches are warranted

Leukotriene antagonists as first-line or add-on asthma controller therapy

Most randomized trials of treatment for asthma study highly selected patients under idealized conditions. METHODS: We conducted two parallel, multicenter, pragmatic trials to evaluate the real-world effectiveness of a leukotriene-receptor antagonist (LTRA) as compared with either an inhaled glucocorticoid for first-line asthma-controller therapy or a long-acting beta(2)-agonist (LABA) as add-on therapy in patients already receiving inhaled glucocorticoid therapy. Eligible primary care patients 12 to 80 years of age had impaired asthma-related quality of life (Mini Asthma Quality of Life Questionnaire [MiniAQLQ] score =6) or inadequate asthma control (Asthma Control Questionnaire [ACQ] score =1). We randomly assigned patients to 2 years of open-label therapy, under the care of their usual physician, with LTRA (148 patients) or an inhaled glucocorticoid (158 patients) in the first-line controller therapy trial and LTRA (170 patients) or LABA (182 patients) added to an inhaled glucocorticoid in the add-on therapy trial. RESULTS: Mean MiniAQLQ scores increased by 0.8 to 1.0 point over a period of 2 years in both trials. At 2 months, differences in the MiniAQLQ scores between the two treatment groups met our definition of equivalence (95% confidence interval [CI] for an adjusted mean difference, -0.3 to 0.3). At 2 years, mean MiniAQLQ scores approached equivalence, with an adjusted mean difference between treatment groups of -0.11 (95% CI, -0.35 to 0.13) in the first-line controller therapy trial and of -0.11 (95% CI, -0.32 to 0.11) in the add-on therapy trial. Exacerbation rates and ACQ scores did not differ significantly between the two groups. CONCLUSIONS: Study results at 2 months suggest that LTRA was equivalent to an inhaled glucocorticoid as first-line controller therapy and to LABA as add-on therapy for diverse primary care patients. Equivalence was not proved at 2 years. The interpretation of results of pragmatic research may be limited by the crossover between treatment groups and lack of a placebo group

Computer delivery of gesture therapy for people with severe aphasia

Background: Using gesture as a compensatory communication strategy may be challenging for people with severe aphasia. Therapy can improve skills with gesture, at least in elicitation tasks, but gains ar often modest. Raising the treatment dose with technology might improve outcomes. Aims: This feasibility study developed a computer gesture therapy tool (GeST), and piloted it with nine people who have severe aphasia. It aimed to determine whether practice with GeST would improve gesture production and/or spoken naming. It also explored whether GeST encouraged independent practice and was easy to use. Methods & Procedures: Pilot participants had 6 weeks practice with GeST, flanked by pre- and post-therapy tests of gesture and word production. Usability was explored through interviews and structured observations, and the amount of time spent in the programme was monitored. Outcomes & Results: Scores on the gesture test were evaluated by 36 independent raters. Recognition scores for gestures practised with the tool improved significantly after therapy and the gain was maintained. However, gains were small and only occurred on items that were practised with regular therapist support. There was no generalisation to unpractised gestures and no effect on spoken naming. Usability results were positive. Participants undertook an average of 64.4 practice sessions with GeST, and the average session length was just under 14 minutes. Conclusions: GeST was proved to be easy and enjoyable to use and had some effect on participants’ gesturing skills. Increasing the magnitude of gains would be desirable. The effect on everyday communication needs to be explored