Principle-Based Integrative Therapy with Couples: Theory and a Case Example.

The Principle-Based Integrative Therapy (PBIT) framework harnesses the principles of change underlying each theoretical model within integrative couple therapy treatments. PBIT has commonalities with other integrative approaches, and additional advantages stemming from its four tenets that guide therapists in combining strengths across models and overcoming each of their deficiencies. Tenet 1 advises that each model adds a core principle or mechanism of action that other models do not automatically address. Tenet 2 focuses on how techniques of one model may actualize the principles of other models. Tenet 3 ensures complementarity and a lack of conflict across principles. A case study and common case considerations are presented to illustrate how Tenets 1-3 can work in integrating Cognitive-Behavioral, Multicultural, and Emotionally Focused Therapy models in working with a couple. Finally, Tenet 4 advocates for the use of models and empirically supported principles that also have received empirical support with diverse populations. Prerequisites and training implications for PBIT, and future clinical and research directions to further the utility of PBIT are discussed.

El marco de la Terapia Integrativa Basada en Principios (PBIT) aprovecha los principios de cambio que subyacen a cada modelo teórico dentro de los tratamientos de la terapia integrativa de pareja. La PBIT tiene similitudes con otros enfoques integrativos y otras ventajas que surgen de sus cuatro principios que guían a los terapeutas en la combinación de los puntos fuertes de los distintos modelos y en la superación de cada una de sus deficiencias. El primer principio recomienda que cada modelo agregue un principio o mecanismo fundamental de acción que otros modelos no aborden automáticamente. El segundo principio se centra en cómo las técnicas de un modelo pueden actualizar los principios de otros modelos. El tercer principio garantiza la complementariedad y la falta de conflictos entre los principios. Se presentan las consideraciones de un caso práctico y de casos comunes para ilustrar cómo estos tres principios pueden funcionar en la integración de los modelos de terapia congnitivo-conductual (CB), multicultural (MC) y centrada en las emociones (EFT) a la hora de trabajar con una pareja. Finalmente, el cuarto principio propone el uso de modelos y principios factuales que también hayan recibido apoyo empírico con diversas poblaciones. Se debaten los prerrequisitos y las consecuencias de la capacitación para la PBIT, así como las futuras direcciones clínicas y de investigación para impulsar la utilidad de la PBIT.

The impact of high-sensitivity troponin implementation on hospital operations and patient outcomes in 3 tertiary care centers.

OBJECTIVE: High-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI. METHODS: This control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days. RESULTS: Data were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score. CONCLUSIONS: This hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.

A comparison of statistical tests for detecting differential expression using Affymetrix oligonucleotide microarrays.

Signal quantification and detection of differential expression are critical steps in the analysis of Affymetrix microarray data. Many methods have been proposed in the literature for each of these steps. The goal of this paper is to evaluate several signal quantification methods (GCRMA, RSVD, VSN, MAS5, and Resolver) and statistical methods for differential expression (t test, Cyber-T, SAM, LPE, RankProducts, Resolver RatioBuild). Our particular focus is on the ability to detect differential expression via statistical tests. We have used two different datasets for our evaluation. First, we have used the HG-U133 Latin Square spike in dataset developed by Affymetrix. Second, we have used data from an in-house rat liver transcriptomics study following 30 different drug treatments generated using the Affymetrix RAE230A chip. Our overall recommendation based on this study is to use GCRMA for signal quantification. For detection of differential expression, GCRMA coupled with Cyber-T or SAM is the best approach, as measured by area under the receiver operating characteristic (ROC) curve. The integrated pipeline in Resolver RatioBuild combining signal quantification and detection of differential expression is an equally good alternative for detecting differentially expressed genes. For most of the differential expression algorithms we considered, the performance using MAS5 signal quantification was inferior to that of the other methods we evaluated.