Alliance Expectations and Alliance as Predictor of Therapy Engagement and Outcome

Clients begin psychotherapy with expectations that may or may not be met during treatment. Discrepancies between pretherapy expectations and the therapy experience may influence client response to treatment. This naturalistic observational pilot study investigated whether the discrepancy between initial expectations of the working alliance and the experience of the alliance predicts early client engagement and outcome. Participants were adult therapy clients at a university training clinic. Each participant completed the Expected-Working Alliance Inventory before their first session and a shortened version of the Working Alliance Inventory after. We hypothesized that the difference between expected alliance scores and actual alliance scores would predict level of client engagement and outcome. We found that participants in this study engaged at a higher rate than generally seen among therapy clients, with 82% remaining in treatment after four weeks. Even with this unusually high engagement rate, the results showed that the expected-actual alliance discrepancy predicted client engagement. Most notably, exceeding alliance expectations was associated with greater early therapy engagement. The expected-actual alliance discrepancy did not predict client outcomes. The results showed a pattern of better outcomes when the alliance exceeded expectations, but this finding was not significant, which may be due in part to a small sample size. Overall, this pilot study suggests that while initial client expectations about the therapy relationship are complex, efforts to surpass alliance expectations may lead to greater early therapy engagement. In addition, recommendations for further research and other clinical implications are discussed

Alliance Expectations and Alliance as Predictor of Therapy Engagement and Outcome

Clients begin psychotherapy with expectations that may or may not be met during treatment. Discrepancies between pretherapy expectations and the therapy experience may influence client response to treatment. This naturalistic observational pilot study investigated whether the discrepancy between initial expectations of the working alliance and the experience of the alliance predicts early client engagement and outcome. Participants were adult therapy clients at a university training clinic. Each participant completed the Expected-Working Alliance Inventory before their first session and a shortened version of the Working Alliance Inventory after. We hypothesized that the difference between expected alliance scores and actual alliance scores would predict level of client engagement and outcome. We found that participants in this study engaged at a higher rate than generally seen among therapy clients, with 82% remaining in treatment after four weeks. Even with this unusually high engagement rate, the results showed that the expected-actual alliance discrepancy predicted client engagement. Most notably, exceeding alliance expectations was associated with greater early therapy engagement. The expected-actual alliance discrepancy did not predict client outcomes. The results showed a pattern of better outcomes when the alliance exceeded expectations, but this finding was not significant, which may be due in part to a small sample size. Overall, this pilot study suggests that while initial client expectations about the therapy relationship are complex, efforts to surpass alliance expectations may lead to greater early therapy engagement. In addition, recommendations for further research and other clinical implications are discussed

Hospital and Blood Bank Liability to Patients Who Contract AIDS through Blood Transfusions

This Comment examines the possible theories of recovery available to persons who contract AIDS through blood transfusions. The author examines the medical and statistical data regarding AIDS and how this data may affect liability and recovery under the theories of negligence, strict products liability, and breach of implied warranty. The author concludes that negligence provides the only viable means of recovery for transfusion-infected persons

The effect of cave illumination on bats

Artificial light at night has large impacts on nocturnal wildlife such as bats, yet its effect varies with wavelength of light, context, and across species involved. Here, we studied in two experiments how wild bats of cave-roosting species (Rhinolophus mehelyi, R. euryale, Myotis capaccinii and Miniopterus schreibersii) respond to LED lights of different colours. In dual choice experiments, we measured the acoustic activity of bats in response to neutral-white, red or amber LED at a cave entrance and in a flight room – mimicking a cave interior. In the flight room, M. capaccinii and M. schreibersii preferred red to white light, but showed no preference for red over amber, or amber over white light. In the cave entrance experiment, all light colours reduced the activity of all emerging species, yet red LED had the least negative effect. Rhinolophus species reacted most strongly, matching their refusal to fly at all under any light treatment in the flight room. We conclude that the placement and light colour of LED light should be considered carefully in lighting concepts for caves both in the interior and at the entrance. In a cave interior, red LED light could be chosen – if needed at all – for careful temporary illumination of areas, yet areas important for bats should be avoided based on the precautionary principle. At cave entrances, the high sensitivity of most bat species, particularly of Rhinolophus spp., towards light sources almost irrespective of colour, calls for utmost caution when illuminating cave entrances

The Early Evolution of Primordial Pair-Instability Supernovae

The observational signatures of the first cosmic explosions and their chemical imprint on second-generation stars both crucially depend on how heavy elements mix within the star at the earliest stages of the blast. We present numerical simulations of the early evolution of Population III pair-instability supernovae with the new adaptive mesh refinement code CASTRO. In stark contrast to 15 - 40 Msun core-collapse primordial supernovae, we find no mixing in most 150 - 250 Msun pair-instability supernovae out to times well after breakout from the surface of the star. This may be the key to determining the mass of the progenitor of a primeval supernova, because vigorous mixing will cause emission lines from heavy metals such as Fe and Ni to appear much sooner in the light curves of core-collapse supernovae than in those of pair-instability explosions. Our results also imply that unlike low-mass Pop III supernovae, whose collective metal yields can be directly compared to the chemical abundances of extremely metal-poor stars, further detailed numerical simulations will be required to determine the nucleosynthetic imprint of very massive Pop III stars on their direct descendants.Comment: submitted to ApJ, comments welcom

The Formation and Fragmentation of Disks around Primordial Protostars

The very first stars to form in the Universe heralded an end to the cosmic dark ages and introduced new physical processes that shaped early cosmic evolution. Until now, it was thought that these stars lived short, solitary lives, with only one extremely massive star, or possibly a very wide binary system, forming in each dark matter minihalo. Here we describe numerical simulations that show that these stars were, to the contrary, often members of tight multiple systems. Our results show that the disks that formed around the first young stars were unstable to gravitational fragmentation, possibly producing small binary and higher-order systems that had separations as small as the distance between the Earth and the Sun.Comment: This manuscript has been accepted for publication in Science. This version has not undergone final editing. Please refer to the complete version of record at http://www.sciencemag.org

Validating international CanMEDS-based standards defining education and safe practice of nurse anesthetists.

AIM To investigate whether the CanMEDS-based International Federation of Nurse Anesthetists' Standards could adequately define the scope of practice and reliably be used to train and evaluate Swiss nurse anesthetists (NAs). BACKGROUND Although nurse anesthetists represent a majority of the global workforce in anesthesia, policies that define the scope of practice are frequently non-existent. In low- and middle-income countries, the lack of anesthesia providers with adequate training is a major challenge. INTRODUCTION Despite stringent training requirements, the scope of practice of Swiss nurse anesthetists is actually not defined. Therefore, we surveyed and assessed whether nurse anesthetists felt that the professional competencies outlined in this framework were aligned with their clinical practice. METHODS A cross-sectional survey investigated Swiss nurse anesthetists' relevance ratings of 76 competencies of the International Federation of Nurse Anesthetists according to their professional practice. Cronbach's alpha coefficients were used to determine the internal consistency of the competencies, as well as factor analyses to assess construct validity of these competencies integrated into the CanMEDS roles model. RESULTS Participants rated the Standards overall as very relevant with high reliability. Factor analyses provided evidence of construct validity of these. DISCUSSION The International Federation of Nurse Anesthetists' Standards of Practice provide a highly relevant framework and a valuable set of competencies for the scope of practice of Swiss nurse anesthetists, which enabled translation from global guides to local national standards. CONCLUSION AND IMPLICATION FOR NURSING AND HEALTH POLICY Adopted by low- and middle-income countries or countries where national standards are non-existent, this survey could introduce national and local policies at minimally acceptable standards of care for nurse anesthetists worldwide. The above standards have the potential to align education, outcomes and assessment of nurse anesthetists with the needs of national healthcare systems

A new Meckel's cartilage from the Devonian Hangenberg black shale in Morocco and its position in chondrichthyan jaw morphospace

Fossil chondrichthyan remains are mostly known from their teeth, scales or fin spines only, whereas their cartilaginous endoskeletons require exceptional preservational conditions to become fossilized. While most cartilaginous remains of Famennian (Late Devonian) chondrichthyans were found in older layers of the eastern Anti-Atlas, such fossils were unknown from the Hangenberg black shale (HBS) and only a few chondrichthyan teeth had been found therein previously. Here, we describe a Meckel's cartilage from the Hangenberg black shale in Morocco, which is the first fossil cartilage from these strata. Since no teeth or other skeletal elements have been found in articulation, we used elliptical Fourier (EFA), principal component (PCA), and hierarchical cluster (HCA) analyses to morphologically compare it with 41 chondrichthyan taxa of different size and age and to evaluate its possible systematic affiliation. PCA and HCA position the new specimen closest to some acanthodian and elasmobranch jaws. Accordingly, a holocephalan origin was excluded. The jaw shape as well as the presence of a polygonal pattern, typical for tessellated calcified cartilage, suggest a ctenacanth origin and we assigned the new HBS Meckel's cartilage to the order Ctenacanthiformes with reservations