Ruptures and repairs of group therapy alliance. an untold story in psychotherapy research

Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context

Traumatic brain injury patients' family members' evaluations of the social support provided by healthcare professionals in acute care hospitals

Aims and objectives The study aimed to examine traumatic brain injury (TBI) patient family members' (FMs) experiences of the support they received from healthcare professionals in acute care hospitals. Background The length of hospitalisation following TBI is constantly decreasing, and patients may return home with several problems. FMs care for the patients at home although they may not be prepared for the patient's medical needs or financial burden of the illness. The burden which some FMs experience can impair patient care and rehabilitation outcomes. Therefore, FMs require support during acute phases of TBI treatment. Design A structured questionnaire was sent to 216 TBI patients FMs. The response rate was 47% (n = 102). Methods A structured questionnaire-based on a systematic literature review and a previous questionnaire on TBI patient FMs' perceptions of support-was developed and used in the data collection. The questionnaire included 46 statements and 11 background questions. Data were collected via an electronic questionnaire. The STROBE checklist was followed in reporting the study. Results A factor analysis identified five factors that describe the guidance of TBI patient FMs: guidance of TBI patients' symptoms and survival; benefits of guidance; needs-based guidance; guidance for use of services; and guidance methods. Most of the FMs (51%-88%) felt that they had not received enough guidance from healthcare professionals in acute care hospitals across all five aspects of support. Conclusions The content of guidance should be developed, and healthcare staff should be trained to consider a FM's starting point when providing guidance. A calm environment, proper timing, sufficient information in different forms and professional healthcare staff were found to be key factors to comprehensive guidance. Involving FMs in the discharge process and rehabilitation of their loved ones both supports the abilities of caregivers and promotes the outcome of the patient's rehabilitation. Relevance to clinical practice This study provides varied information on the need for social support of TBI patients FMs in the early stages of treatment from the FMs' perspective. This research adopted the FM's perspective to identify various areas of social support that need to be developed so that the FMs of TBI patients receive enough support during the early stages of TBI treatment.Peer reviewe

Eye-movements reveal semantic interference effects during the encoding of naturalistic scenes in long-term memory

Similarity-based semantic interference (SI) hinders memory recognition. Within long-term visual memory paradigms, the more scenes (or objects) from the same semantic category are viewed, the harder it is to recognize each individual instance. A growing body of evidence shows that overt attention is intimately linked to memory. However, it is yet to be understood whether SI mediates overt attention during scene encoding, and so explain its detrimental impact on recognition memory. In the current experiment, participants watched 372 photographs belonging to different semantic categories (e.g., a kitchen) with different frequency (4, 20, 40 or 60 images), while being eye-tracked. After 10 minutes, they were presented with the same 372 photographs plus 372 new photographs and asked whether they recognized (or not) each photo (i.e., old/new paradigm). We found that the more the SI, the poorer the recognition performance, especially for old scenes of which memory representations existed. Scenes more widely explored were better recognized, but for increasing SI, participants focused on more local regions of the scene in search for its potentially distinctive details. Attending to the centre of the display, or to scene regions rich in low-level saliency was detrimental to recognition accuracy, and as SI increased participants were more likely to rely on visual saliency. The complexity of maintaining faithful memory representations for increasing SI also manifested in longer fixation durations; in fact, a more successful encoding was also associated with shorter fixations. Our study highlights the interdependence between attention and memory during high-level processing of semantic information

Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998–2004

<p>Abstract</p> <p>Background</p> <p>Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown.</p> <p>Methods</p> <p>Analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878). Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones.</p> <p>Results</p> <p>Broad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P < .001 for trend). The trend was primarily attributable to an increase in prescribing of amoxicillin/clavulanate (8% to 15%; P < .001 for trend) and macrolides (9% to 15%; P < .001 for trend). Prescribing remained stable for amoxicillin and cephalosporins while decreasing for narrow-spectrum agents (12% to 3%; P < .001 for trend) over the study period. Independent predictors of broad-spectrum antibiotic prescribing were ear pain, non-white race, public and other insurance (compared to private), hospital outpatient department setting, emergency department setting, and West region (compared to South and Midwest regions), each of which was associated with lower rates of broad-spectrum prescribing. Age and fever were not associated with prescribing choice.</p> <p>Conclusion</p> <p>Prescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.</p

Unidimensional and Multidimensional Methods for Recurrence Quantification Analysis with crqa

Recurrence quantification analysis is a widely used method for characterizing patterns in time series. This article presents a comprehensive survey for conducting a wide range of recurrence based analyses to quantify the dynamical structure of single and multivariate time series and capture coupling properties underlying leader-follower relationships. The basics of recurrence quantification analysis (RQA) and all its variants are formally introduced step-by-step from the simplest auto recurrence to the most advanced multivariate case. Importantly, we show how such RQA methods can be deployed under a single computational framework in R using a substantially renewed version of our crqa 2.0 package. This package includes implementations of several recent advances in recurrence based analysis, among them applications to multivariate data and improved entropy calculations for categorical data. We show concrete applications of our package to example data, together with a detailed description of its functions and some guidelines on their usage

reply to the letter to the editor by C.Nicolazzo et al.: "circulating cell-free DNA and circulating tumor cells as prognostic and predictive biomarkers in advanced non-small cell lung cancer patients treated with first-line chemotherapy"

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ka band phase locked loop oscillator dielectric resonator oscillator for satellite ehf band receiver

This paper describes the design and fabrication of a Ka Band PLL DRO having a fundamental oscillation frequency of 19.250 GHz, used as local oscillator in the low-noise block of a down converter (LNB) for an EHF band receiver. Apposite circuital models have been created to describe the behaviour of the dielectric resonator and of the active component used in the oscillator core. The DRO characterization and measurements have shown very good agreement with simulation results. A good phase noise performance is obtained by using a very highQdielectric resonator