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1.
Psychol Serv ; 19(3): 494-501, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34110867

RESUMO

Given the ongoing dilemma for college counseling centers to meet steady increases in demand for services, this study outlines the implementation of an adapted stepped care model in a university counseling center. Our adapted model focused, as do other stepped care models, on treatment planning and lower-intensity interventions, with the addition of the intensive therapy option being provided on a weekly basis. We adopted our stepped care model across a large center and hypothesized that after implementation we would be able to serve a similar number of clients as our previous model and that treatment outcomes for these clients would improve. Descriptive data and regression analyses demonstrated support for our hypotheses, including an increased likelihood of clinically significant improvement for clients postimplementation. Implications for adapting service delivery models using practice-based evidence are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Aconselhamento , Atenção à Saúde , Humanos , Resultado do Tratamento , Universidades
2.
J Couns Psychol ; 69(4): 531-540, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34780207

RESUMO

With increasing demand for psychotherapy services, clinicians are carrying increasingly large caseloads (Bailey et al., 2020). As the number of new intakes exceeds the number of clinical hours available each week in some settings, psychotherapy is delivered on an attenuated schedule for returning clients (rather than the traditional weekly frequency); there is, however, little support for the efficacy of this practice. The present study explored the effect of session frequency on psychotherapy outcomes using a quasi-randomized controlled design. In a working university counseling center, we assigned therapists to either a treatment-as-usual (TAU) group (attenuated session frequency) or an experimental group (weekly session frequency). Clients were randomly assigned to a therapist in either condition. Using hierarchical linear modeling and survival analyses, we examined psychotherapy outcomes (measured by session-by-session Outcome Questionnaire 45 scores) for 1,322 clients (3,919 individual sessions). We found no differences between groups when examining the full sample, but also found limited fidelity in the experimental group. When identifying individuals who were seen weekly in at least the first three sessions after intake (sensitivity analysis), we found the following: (a) weekly therapy resulted in faster trajectories of change over time, (b) weekly therapy resulted in a greater likelihood of achieving recovery, and (c) weekly therapy resulted in a greater likelihood of achieving recovery sooner. We discuss the importance of including session frequency when considering the dose of therapy, as well as the implication that prioritizing weekly therapy may increase therapy efficacy and efficiency in routine practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Relações Profissional-Paciente , Psicoterapia , Aconselhamento , Humanos , Psicoterapia/métodos , Resultado do Tratamento , Universidades
3.
J Tissue Eng ; 12: 20417314211005610, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889382

RESUMO

Due to the limitations of bone autografts, we aimed to develop new composite biomaterials with pro-angiogenic and osteogenic properties to be used as scaffolds in bone tissue engineering applications. We used a porous, cross-linked and slowly biodegradable fibrin/alginate scaffold originally developed in our laboratory for wound healing, throughout which deposits of calcium phosphate (CaP) were evenly incorporated using an established biomimetic method. Material characterisation revealed the porous nature and confirmed the deposition of CaP precursor phases throughout the scaffolds. MC3T3-E1 cells adhered to the scaffolds, proliferated, migrated and differentiated down the osteogenic pathway during the culture period. Chick chorioallantoic membrane (CAM) assay results showed that the scaffolds were pro-angiogenic and biocompatible. The work presented here gave useful insights into the potential of these pro-angiogenic and osteogenic scaffolds for bone tissue engineering and merits further research in a pre-clinical model prior to its clinical translation.

4.
Psychol Serv ; 18(4): 574-583, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32551729

RESUMO

As demand increased for mental health services, especially in university counseling centers, providers have seen increasing numbers of clients. The effect of this increase on therapist caseloads is explored, with a recognition that past research on therapist caseloads lacks direct and fluctuating measures of caseload that reflect practice in naturalistic settings. Using a large dataset from a counseling center (N = 18,322), therapist caseload was conceptualized dynamically over rolling 30-day periods, using within-therapist counts of therapy sessions, unique clients seen, and the proportion of unique clients to sessions. Analysis of variance was used first to test for differences in caseload between months, years, then to test for differences between therapists (n = 173). Hierarchical linear models were constructed to examine the relationship between changes in therapist caseload across time and client outcome. Logistic and ordinal regression approaches were used to further examine this relationship for clinically significant change. Results included finding a small, but significant, effect of therapist caseload on outcome, with this finding discussed in the context of the effect sizes in the literature on therapist effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Aconselhamento , Relações Profissional-Paciente , Humanos , Psicoterapia
5.
ACS Appl Bio Mater ; 3(11): 7666-7676, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33225238

RESUMO

Atopic dermatitis (eczema) is a widespread disorder, with researchers constantly looking for more efficacious treatments. Natural oils are reported to be an effective therapy for dry skin, and medical textiles can be used as an alternative or supporting therapy. In this study, fibrous membranes from poly(vinyl butyral-co-vinyl alcohol-co-vinyl acetate) (PVB) with low and high molecular weights were manufactured to obtain nano- and micrometer fibers via electrospinning for the designed patches used as oil carriers for atopic skin treatment. The biocompatibility of PVB patches was analyzed using proliferation tests and scanning electron microscopy (SEM), which combined with a focused ion beam (FIB) allowed for the 3D visualization of patches. The oil spreading tests with evening primrose, black cumin seed, and borage were verified with cryo-SEM, which showed the advantage nanofibers have over microfibers as carriers for low-viscosity oils. The skin tests expressed the usability and the enhanced oil delivery performance for electrospun patches. We demonstrate that through the material nano- and microstructure, commercially available polymers such as PVB have great potential to be deployed as a biomaterial in medical applications, such as topical treatments for chronic skin conditions.

6.
Int J Pharm ; 572: 118784, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31676339

RESUMO

We report the self-assembly of drug-loaded solid lipid nanoparticles (SLNs) from spray dried microparticles comprising poly(vinylpyrrolidone) (PVP) loaded with glyceryl tristearate (GTS) and either indomethacin (IMC) or 5-fluorouracil (5-FU). When the spray dried microparticles are added to water, the PVP matrix dissolves and the GTS and drug self-assemble into SLNs. The SLNs provide a non-toxic delivery platform for both hydrophobic (IMC) and hydrophilic (5-FU) drugs. They show extended release profiles over more than 24 h, and in permeation studies the drug cargo is seen to accumulate inside cancer cells. This overcomes major issues with achieving local intestinal delivery of these active ingredients, in that IMC permeates well and thus will enter the systemic circulation and potentially lead to side effects, while 5-FU remains in the lumen of the small intestine and will be secreted without having any therapeutic benefit. The SLN formulations are as effective as the pure drugs in terms of their ability to induce cell death. Our approach represents a new and simple route to the fabrication of SLNs: by assembling these from spray-dried microparticles on demand, we can circumvent the low storage stability which plagues SLN formulations.


Assuntos
Fluoruracila/química , Indometacina/química , Nanopartículas , Povidona/química , Triglicerídeos/química , Administração Oral , Aerossóis , Células CACO-2 , Sobrevivência Celular/efeitos dos fármacos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Preparações de Ação Retardada , Composição de Medicamentos , Liberação Controlada de Fármacos , Estabilidade de Medicamentos , Fluoruracila/administração & dosagem , Humanos , Interações Hidrofóbicas e Hidrofílicas , Indometacina/administração & dosagem , Solubilidade
7.
Neurol Clin Pract ; 9(1): 83-88, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30859011

RESUMO

The improved use of Electronic Health Record (EHR) Systems provides an opportunity to improve the overall efficiency and quality of care of patients with epilepsy. Tools and strategies that may be incorporated into the use of EHRs include utilizing patient generated data, clinical decision support systems and natural language processing systems. Standardization of data from EHR systems may lead to improvement in clinical research through the creation of data collections and multi-center collaborations. Challenges to collaborative use of EHR Systems across centers include costs and the diversity of EHR systems.

8.
Proc Biol Sci ; 285(1891)2018 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-30429307

RESUMO

Microorganisms are the chief primary producers within present-day deep-sea hydrothermal vent ecosystems, and play a fundamental role in shaping the ecology of these environments. However, very little is known about the microbes that occurred within, and structured, ancient vent communities. The evolutionary history, diversity and the nature of interactions between ancient vent microorganisms and hydrothermal vent animals are largely undetermined. The oldest known hydrothermal vent community that includes metazoans is preserved within the Ordovician to early Silurian Yaman Kasy massive sulfide deposit, Ural Mountains, Russia. This deposit contains two types of tube fossil attributed to annelid worms. A re-examination of these fossils using a range of microscopy, chemical analysis and nano-tomography techniques reveals the preservation of filamentous microorganisms intimately associated with the tubes. The microfossils bear a strong resemblance to modern hydrothermal vent microbial filaments, including those preserved within the mineralized tubes of the extant vent polychaete genus Alvinella The Yaman Kasy fossil filaments represent the oldest animal-microbial associations preserved within an ancient hydrothermal vent environment. They allude to a diverse microbial community, and also demonstrate that remarkable fine-scale microbial preservation can also be observed in ancient vent deposits, suggesting the possible existence of similar exceptionally preserved microfossils in even older vent environments.


Assuntos
Archaea/fisiologia , Fósseis , Poliquetos/microbiologia , Animais , Fenômenos Fisiológicos Bacterianos , Evolução Biológica , Fontes Hidrotermais/microbiologia , Microbiota/fisiologia
9.
Neurology ; 90(9): e771-e778, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29386277

RESUMO

OBJECTIVE: To retrospectively examine nationwide trends in intracranial monitoring (ICM) for pediatric medically intractable epilepsy (MIE) from 2000 to 2012. METHODS: The Healthcare Cost and Utilization Project Kids' Inpatient Database was analyzed to identify admissions with ICD-9-CM codes corresponding to MIE and ICM from 2000 to 2012, inclusive. Associations between independent variables and outcomes were tested using χ2 test or Fisher exact test. A multivariate logistic regression analysis of variables associated with ICM was completed using stepwise selection. The Cochran-Armitage test was used to test for trend of a variable over the study period. RESULTS: The number of ICM procedures increased over the study period; however, secondary to large increases in the number of MIE admissions, the rate of ICM declined from 5.39% in 2000 to 2.56% in 2012 (p < 0.001). Despite this decline, ICM increasingly resulted in resective epilepsy procedures. In 2000, only 45.18% of ICM cases led to resective epilepsy surgery, which increased to 75.83% by 2012 (p < 0.001). ICM complication rates were comparable to, if not lower than, standard resective surgery. Disparities in access to ICM exist, with African American individuals and those with Medicaid significantly less likely to undergo ICM. CONCLUSION: In this nationwide characterization of pediatric ICM trends, we identified a slight, significant downward trend in the rate of utilization of ICM for MIE. This was secondary to substantial increases in the number of hospital admissions for MIE. Reasons for this large increase and why it has not led to increased rates of ICM warrant further investigation.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/cirurgia , Monitorização Neurofisiológica/métodos , Monitorização Neurofisiológica/tendências , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Epilepsia Resistente a Medicamentos/epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Estudos Longitudinais , Masculino , Medicaid/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
10.
J Child Neurol ; 32(14): 1123-1124, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29129156

RESUMO

The differential diagnosis of fever-induced movement disorders in childhood is broad. Whole exome sequencing has yielded new insights into those cases with a suspected genetic basis. We report the case of an 8-year-old boy with a history of neonatal seizures who presented with near-continuous hyperkinetic movements of his limbs during a febrile illness. Initial diagnostic testing did not explain his abnormalities; however, given the suspicion for a channelopathy, whole exome sequencing was performed and it demonstrated a de novo pathogenic heterozygous variant in KCNQ2. There is an expanding phenotypic spectrum of heterozygous alterations in KCNQ2; however, this report provides the first description of a pathogenic KCNQ2 variant fever-induced hyperkinetic movement disorder in childhood. We also review the literature of cases previously published with the same pathogenic variant.


Assuntos
Saúde da Família , Febre/complicações , Canal de Potássio KCNQ2/genética , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/genética , Mutação/genética , Criança , Eletroencefalografia , Humanos , Masculino
11.
J Couns Psychol ; 64(5): 514-524, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29048197

RESUMO

This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time. (PsycINFO Database Record


Assuntos
Aconselhamento/educação , Relações Profissional-Paciente , Psicoterapia/educação , Feminino , Humanos , Masculino , Inquéritos e Questionários
12.
J Affect Disord ; 205: 234-238, 2016 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-27449556

RESUMO

BACKGROUND: Researchers have examined the relationship between mental health and weather/pollution with mixed results. The current study aimed to examine a range of weather and atmospheric phenomena and their association with time-bound mental health data. METHODS: Nineteen different weather/pollution variables were examined in connection with an archive of self-reported mental health data for university students participating in mental health treatment (n=16,452) using the Outcome Questionnaire 45.2 (OQ-45). Statistical approach involved randomly selecting 500 subjects from the sample 1000 different times and testing each variable of interest using mixed models analyses. RESULTS: Seasonal changes in sun time were found to best account for relationships between weather variables and variability in mental health distress. Increased mental health distress was found during periods of reduced sun time hours. A separate analysis examining subjects' endorsement of a suicidality item, though not statistically significant, demonstrated a similar pattern. Initial results showed a relationship between pollution and changes in mental health distress; however, this was mediated by sun time. LIMITATIONS: This study examined a relatively homogenous, predominantly European American, and religious sample of college counseling clients from an area that is subject to inversions and is at a high altitude and a latitude where sun time vacillates significantly more than locations closer to the equator. CONCLUSIONS: Seasonal increases in sun time were associated with decreased mental health distress. This suggests the need for institutions and public health entities to plan for intervention and prevention resources and strategies during periods of reduced sun time.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Luz Solar , Tempo (Meteorologia) , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Retrospectivos , Estações do Ano , Adulto Jovem
13.
ACS Appl Mater Interfaces ; 7(30): 16645-52, 2015 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-26176304

RESUMO

Wetting behavior between electrospun nanofibrous networks and liquids is of critical importance in many applications including filtration and liquid-repellent textiles. The relationship between intrinsic nanofiber properties, including surface characteristics, and extrinsic nanofibrous network organization on resultant wetting characteristics of the nanofiber network is shown in this work. Novel 3D imaging exploiting focused ion beam (FIB) microscopy and cryo-scanning electron microscopy (cryo-SEM) highlights a wetting hierarchy that defines liquid interactions with the network. Specifically, small length scale partial wetting between individual electrospun nanofibers and low surface tension liquids, measured both using direct SEM visualization and a nano Wilhelmy balance approach, provides oleophobic surfaces due to the high porosity of electrospun nanofiber networks. These observations conform to a metastable Cassie-Baxter regime and are important in defining general rules for understanding the wetting behavior between fibrous solids and low surface tension liquids for omniphobic functionality.

14.
Psychother Res ; 25(6): 724-34, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25751744

RESUMO

OBJECTIVE: The Clinical Support Tools (CSTs) were developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is the Assessment for Signal Clients. The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases. METHOD: The responses and scores from 107 off-track clients from a hospital-based outpatient clinic were analyzed. RESULTS: A cluster analysis of the 107 off-track clients revealed three client types: those whose problems were characterized by alliance and motivational difficulties; those characterized by social support and life event difficulties; and those whose problems had an indistinguishable pattern. Log-linear modeling showed that if patients had less therapeutic alliance problems they were also less likely to have motivational problems. Findings were also consistent with the cluster analysis, which showed that a relatively higher percentage of not-on-track participants received signal alerts for the social support items and scale. CONCLUSIONS: Individuals whose progress goes off-track while in psychotherapy appear to have their greatest difficulty with social support, followed closely by motivation for therapy and therapeutic alliance.


Assuntos
Retroalimentação , Transtornos Mentais/psicologia , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Escalas de Graduação Psiquiátrica , Psicoterapia/métodos , Adulto , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Relações Profissional-Paciente , Apoio Social , Falha de Tratamento
15.
Neuron ; 79(6): 1067-77, 2013 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-24050398

RESUMO

Direct electrical access to presynaptic ion channels has hitherto been limited to large specialized terminals such as the calyx of Held or hippocampal mossy fiber bouton. The electrophysiology and ion-channel complement of far more abundant small synaptic terminals (≤ 1 µm) remain poorly understood. Here we report a method based on superresolution scanning ion conductance imaging of small synapses in culture at approximately 100-150 nm 3D resolution, which allows presynaptic patch-clamp recordings in all four configurations (cell-attached, inside-out, outside-out, and whole-cell). Using this technique, we report presynaptic recordings of K(+), Na(+), Cl(-), and Ca(2+) channels. This semiautomated approach allows direct investigation of the distribution and properties of presynaptic ion channels at small central synapses.


Assuntos
Ativação do Canal Iônico/fisiologia , Canais Iônicos/fisiologia , Neurônios/citologia , Terminações Pré-Sinápticas/fisiologia , Animais , Animais Recém-Nascidos , Fenômenos Biofísicos/fisiologia , Cálcio/metabolismo , Células Cultivadas , Espinhas Dendríticas/fisiologia , Espinhas Dendríticas/ultraestrutura , Estimulação Elétrica , Eletrodos , Corantes Fluorescentes/metabolismo , Hipocampo/citologia , Imageamento Tridimensional , Canais Iônicos/ultraestrutura , Potenciais da Membrana/fisiologia , Microscopia de Tunelamento , Técnicas de Patch-Clamp , Terminações Pré-Sinápticas/ultraestrutura , Ratos
16.
Micron ; 50: 51-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23726471

RESUMO

Focused ion beam (FIB) microscopy uses Ga(+) ions to remove material from a sample for a variety of imaging and preparation techniques. While considerable work has examined the effects of FIB exposure on a number of materials, optimized FIB conditions for use with softer polymeric materials are yet to be determined. In this report we use phase contrast AFM to measure local changes in the elastic modulus of polycarbonate surfaces parallel to a sectioning FIB at varying beam energies. We show that polycarbonate surfaces exposed to lower FIB energies appear stiffer than the bulk material whereas surfaces exposed to the higher beam energies of up to 25keV are more representative of the bulk material. Energy dispersive spectroscopy (EDS) indicates that the polymer surfaces become stiffer because of Ga(+) implantation from the FIB. Our experimental observations are supported by computer simulations showing an increase in the residual Ga(+) concentration near-surface at lower FIB energies. A high energy FIB is therefore shown to be less invasive, producing a surface more representative of the bulk material, than using low energy FIB when sectioning polymers.

17.
ACS Appl Mater Interfaces ; 4(5): 2577-82, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22524442

RESUMO

Engineered fiber reinforced polymer composites require effective impregnation of polymer matrix within the fibers to form coherent interfaces. In this work, we investigated solution interactions with electrospun fiber mats for the manufacture of nanocomposites with optimized mechanical properties. Void free composites of electrospun nonwoven PA6 nanofibers were manufactured using a PVA matrix that is introduced into the nonwoven mat using a solution-based processing method. The highest failure stress of the composites was reported for an optimum 16 wt % of PVA in solution, indicating the removal of voids in the composite as the PVA solution both impregnates the nanofiber network and fills all the pores of the network with PVA matrix upon evaporation of the solvent. These processing methods are effective for achieving coherent nanofiber-matrix interfaces, with further functionality demonstrated for optically transparent electrospun nanofiber composites.

18.
Nanotechnology ; 22(36): 365708, 2011 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-21844643

RESUMO

A nanomechanical testing set-up is developed by integrating an atomic force microscope (AFM) for force measurements with a scanning electron microscope (SEM) to provide imaging capabilities. Electrospun nanofibers of polyvinyl alcohol (PVA), nylon-6 and biological mineralized collagen fibrils (MCFs) from antler bone were manipulated and tensile-tested using the AFM-SEM set-up. The complete stress-strain behavior to failure of individual nanofibers was recorded and a diversity of mechanical properties observed, highlighting how this technique is able to elucidate mechanical behavior due to structural composition at nanometer length scales.


Assuntos
Teste de Materiais/métodos , Microscopia de Força Atômica/métodos , Nanofibras/química , Resistência à Tração , Animais , Caprolactama/análogos & derivados , Caprolactama/química , Cervos , Colágenos Fibrilares/química , Colágenos Fibrilares/ultraestrutura , Interferometria , Lasers , Microscopia Eletrônica de Varredura , Nanofibras/ultraestrutura , Polímeros/química , Álcool de Polivinil/química
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