Banter in psychotherapy: Relationship to treatment type, therapeutic alliance, and therapy outcome.

INTRODUCTION: The use of humor in psychotherapy is widely considered to improve therapy outcomes and typically depends on context, patient sensitivity, and the therapist's humor style. Different types of humor may impact treatment type, therapeutic alliance, and therapy outcome; however, evidence from psychotherapy sessions on the role of banter has been sparse to date. Therefore, the study aims to examine banter in a secondary analysis of psychotherapy sessions. METHOD: The sample consisted of 68 depressed outpatients treated with one of three treatment types: psychoanalytic therapy (PA), psychodynamic therapy (PD), and cognitive-behavioral therapy (CBT). Banter and therapeutic alliance were rated for therapy sessions taken from the middle phase of treatment, outcome was assessed at the end of treatment. RESULTS: The main findings were (1) clinical examples of banter in psychotherapy were found in 62 from 68 sessions, (2) significantly more bantering in the main bantering category of facilitation for CBT sessions as compared to other treatment types, (3) facilitative banter as a significant predictor for the positive introject, (4) a significant correlation between bantering and bond between therapist and client. Furthermore, based on these results, psychometric properties of the Klagenfurt Bantering Instrument (KBI) are reported. CONCLUSION: From a bantering perspective, this study emphasizes the need to consider session context, client response, and sarcastic markers when categorizing negative banter using the KBI.

[Mass-gathering medical care: what is at stake? The example of the 2019 Fête des Vignerons]. / Dispositif sanitaire lors de grandes manifestations : quels enjeux ? - L'exemple de la Fête des Vignerons 2019.

During an event, the organizer is responsible for ensuring compliance with all standards, including in the medical and health field. It is therefore up to them to set up a display capable of handling potential patients. The planning of this display requires a preliminary risk assessment, including an estimate of the probability of occurrence and the potential severity in the event of occurrence. There are few decision-making tools available to plan such a device; the impact of major events, particularly on the surrounding care structures, or the sizing of such devices remains a poorly studied field. This article provides an update on recommendations and trends in this area, illustrated by the experience of the 2019 Fête des Vignerons.

Lors d'une manifestation, l'organisateur est responsable de s'assurer du respect de toutes les normes, y compris dans le domaine médico-sanitaire. Il lui incombe donc de mettre en place un dispositif à même de prendre en charge d'éventuels patients. La planification de ce dispositif nécessite une évaluation préalable des risques, intégrant une estimation de la probabilité d'occurrence et de la gravité potentielle en cas de survenue. Il existe peu d'outils d'aide à la décision permettant de planifier un tel dispositif ; l'impact des grands événements, en particulier sur les structures de soins environnantes, ou le dimensionnement de ces dispositifs restant un domaine peu étudié. Cet article propose une mise au point sur les recommandations et tendances dans ce domaine, en l'illustrant par l'expérience de la Fête des Vignerons 2019.

Fates of Emitted Particles Depending on Mask Wearing Using an Approach Validated Across Spatial Scales.

The spread of emitted potentially virus-laden aerosol particles is known to be highly dependent on whether a mask is worn by an infected person and on the emission scenario, i.e., whether the person is coughing, speaking, or breathing. The aim of this work is to investigate in detail the fates of particles emitted by a person wearing a perfectly fitting, a naturally fitted mask with leakage, and no mask depending on the emission scenario. Therefore, a two-scale numerical workflow is proposed where parameters are carried through from a micro-scale where the fibers of the mask filter medium and the aerosol particles are resolved to a macro-scale and validated by comparison to experimental measurements of fractional filtration efficiency and pressure drop of the filter medium as well as pressure drop of the mask. It turns out that masks reduce the number of both emitted and inhaled particles significantly even with leakage. While without a mask, the person opposite of an infected person is generally at the highest risk of being infected, a mask worn by an infected person speaking or coughing will deflect the flow leading to the fact that the person behind the infected person might inhale the largest number of aerosol particles.

Development and validation of a dispatcher identification algorithm for stroke emergencies.

BACKGROUND AND PURPOSE: Recent innovations such as CT installation in ambulances may lead to earlier start of stroke-specific treatments. However, such technically complex mobile facilities require effective methods of correctly identifying patients before deployment. We aimed to develop and validate a new dispatcher identification algorithm for stroke emergencies. METHODS: Dispatcher identification algorithm for stroke emergencies was informed by systematic qualitative analysis of the content of emergency calls to ambulance dispatchers for patients with stroke or transient ischemic attack (N=117) and other neurological (N=39) and nonneurological (N=51) diseases (Part A). After training of dispatchers, sensitivity and predictive values were determined prospectively in patients admitted to Charité hospitals by using the discharge diagnosis as reference standard (Part B). RESULTS: Part A: Dysphasic/dysarthric symptoms (33%), unilateral symptoms (22%) and explicitly stated suspicion of stroke (47%) were typically identified in patients with stroke but infrequently in nonstroke cases (all <10%). Convulsive symptoms (41%) were frequent in other neurological diseases but not strokes (3%). Pain (26%) and breathlessness (31%) were often expressed in nonneurological emergencies (6% and 7% in strokes). Part B: Between October 15 and December 16, 2010, 5774 patients were admitted by ambulance with 246 coded with final stroke diagnoses. Sensitivity of dispatcher identification algorithm for stroke emergencies for detecting stroke was 53.3% and positive predictive value was 47.8% for stroke and 59.1% for stroke and transient ischemic attack. Of all 275 patients with stroke dispatcher codes, 215 (78.5%) were confirmed with neurological diagnosis. CONCLUSIONS: Using dispatcher identification algorithm for stroke emergencies, more than half of all patients with stroke admitted by ambulance were correctly identified by dispatchers. Most false-positive stroke codes had other neurological diagnoses.

[Treatment of the obese patient in the Emergency Medical Services - an increasing problem]. / Die Akuttherapie adipöser Patienten--Ein zunehmendes Problem im Rettungsdienst.

The prevalence of obesity is high in Germany, almost half of the population are overweight. Hence emergency doctors are increasingly confronted with obese patients for whom special anatomical and physiological factors need to be considered. Furthermore this could lead to poorer quality and delayed treatment as normally available emergency therapy and transport are not designed for the special needs of patients with extreme obesity. The following article describes the special factors in the emergency treatment of these patients.

Urate Oxidase produced by Lucilia sericata medical maggots is localized in Malpighian tubes and facilitates allantoin production.

Lucilia sericata maggots are the only species currently approved for maggot debridement therapy (MDT), an alternative treatment for chronic and recalcitrant wounds. Maggots promote wound debridement, disinfection and healing by producing a complex mixture of proteins, peptides and low-molecular-weight compounds in their secretions and excretions, but the individual components are not well characterized at the molecular level. Here we investigated the purine catabolism pathway in L. sericata, focusing on the production of allantoin by Urate Oxidase (UO), which is thought to promote wound healing. We produced recombinant L. sericata UO in Escherichia coli, and characterized the properties of the pure enzyme in terms of the optimum pH (7-10) and temperature (20-25 °C), its stability, sensitivity to inhibition and ion dependency. We used quantitative RT-PCR and RNA in situ hybridization to monitor the expression of the UO gene, and we used a guinea pig anti-UO antibody to detect the native enzyme by western blot and by florescence immunohistochemistry in larval tissues. We found that L. sericata UO is exclusively present in the larval excretion organ (the Malpighian tubes) and is freely available in the cytoplasm rather than restricted to a specific subcellular compartment. Allantoin is a final product of L. sericata purine catabolism. It is produced by UO in the Malpighian tubes to remove uric acid from the hemolymph and is consequently excreted via the hindgut. Our findings confirm the hypothesis that both actively secreted molecules and excretion products contribute to the beneficial effects of MDT.

A Jonah-like chymotrypsin from the therapeutic maggot Lucilia sericata plays a role in wound debridement and coagulation.

Lucilia sericata larvae are used in maggot debridement therapy, a traditional wound healing approach that has recently been approved for the treatment of chronic wounds. Maggot excretion products (MEP) contain many different proteases that promote disinfection, debridement and the acceleration of wound healing, e.g. by activating the host contact phase/intrinsic pathway of coagulation. In order to characterise relevant procoagulant proteases, we analysed MEP and identified a chymotrypsin-like serine protease with similarities to Jonah proteases from Drosophila melanogaster and a chymotrypsin from Lucilia cuprina. A recombinant form of the L. sericata Jonah chymotrypsin was produced in Escherichia coli. The activated enzyme (Jonahm) had a pH optimum of 8.0 and a temperature optimum of 37 °C, based on the cleavage of the chromogenic peptide s-7388 and casein. Jonahm reduced the clotting time of human plasma even in the absence of the endogenous protease kallikrein, factor XI or factor XII and digested the extracellular matrix proteins fibronectin, laminin and collagen IV, suggesting a potential mechanism of wound debridement. Based on these characteristics, the novel L. sericata chymotrypsin-like serine protease appears to be an ideal candidate for the development of topical drugs for wound healing applications.

Selection and Evaluation of Tissue Specific Reference Genes in Lucilia sericata during an Immune Challenge.

The larvae of the common green bottle fly Lucilia sericata (Diptera: Calliphoridae) have been used for centuries to promote wound healing, but the molecular basis of their antimicrobial, debridement and healing functions remains largely unknown. The analysis of differential gene expression in specific larval tissues before and after immune challenge could be used to identify key molecular factors, but the most sensitive and reproducible method qRT-PCR requires validated reference genes. We therefore selected 10 candidate reference genes encoding products from different functional classes (18S rRNA, 28S rRNA, actin, ß-tubulin, RPS3, RPLP0, EF1α, PKA, GAPDH and GST1). Two widely applied algorithms (GeNorm and Normfinder) were used to analyze reference gene candidates in different larval tissues associated with secretion, digestion, and antimicrobial activity (midgut, hindgut, salivary glands, crop and fat body). The Gram-negative bacterium Pseudomonas aeruginosa was then used to boost the larval immune system and the stability of reference gene expression was tested in comparison to three immune genes (lucimycin, defensin-1 and attacin-2), which target different pathogen classes. We observed no differential expression of the antifungal peptide lucimycin, whereas the representative targeting Gram-positive bacteria (defensin-1) was upregulated in salivary glands, crop, nerve ganglion and reached its maximum in fat body (up to 300-fold). The strongest upregulation in all immune challenged tissues (over 50,000-fold induction in the fat body) was monitored for attacin-2, the representative targeting Gram-negative bacteria. Here we identified and validated a set of reference genes that allows the accurate normalization of gene expression in specific tissues of L. sericata after immune challenge.

Two c-type lysozymes boost the innate immune system of the invasive ladybird Harmonia axyridis.

The invasive ladybird beetle Harmonia axyridis has a two-layered immune system, featuring the constitutive production of the low-molecular-mass antimicrobial compound harmonine and the inducible production of a broad range of antimicrobial peptides (AMPs). Here we show that the immune system also features two c-type lysozymes, the acidic c-lys3 (pI = 5.46) and the basic c-lys4 (pI = 8.18). The injection of bacteria into H.axyridis boosted c-lys4 gene expression 8-fold in the gut, whereas the c-lys3 gene was expressed at comparable levels in both naïve and challenged beetles. Both c-lys3 and c-lys4 were expressed in Pichia pastoris and the bacteriolytic activity of the recombinant proteins was found to be calcium-dependent with pH maxima of 6.0 and 6.5, respectively. In a Bacillus subtilis growth inhibition assay, the antimicrobial activity of harmonine and two highly-inducible H.axyridis AMPs (coleoptericins) was potentiated in the presence of c-lys4 but not c-lys3, resulting in 4-fold (harmonine) and up to 16-fold (AMP) lower minimum inhibitory concentrations. Our results suggest that two structurally and functionally distinct lysozymes contribute to innate immune responses of H.axyridis and augment the harmonine and AMP components of the immune response.

Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study.

OBJECTIVE: Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time. METHODS: The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system. It was deployed by the dispatch center whenever a specific emergency call algorithm indicated an acute stroke situation. Study-specific procedures were restricted to patients able to give informed consent. We report feasibility, safety, and duration of procedures regarding prehospital tPA administration. RESULTS: From February 8 to April 30, 2011, 152 subjects were treated in STEMO. Informed consent was given by 77 patients. Forty-five (58%) had an acute ischemic stroke and 23 (51%) of these patients received tPA. The mean call-to-needle time was 62 minutes compared with 98 minutes in 50 consecutive patients treated in 2010. Two (9%) of the tPA-treated patients had a symptomatic intracranial hemorrhage and 1 of these patients (4%) died in hospital. Technical failures encountered were 1 CT dysfunction and 2 delayed CT image transmissions. CONCLUSIONS: The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.

PHANTOM-S: the prehospital acute neurological therapy and optimization of medical care in stroke patients - study.

RATIONALE: Time from symptom onset to treatment is closely associated with the effectiveness of intravenous thrombolysis in acute ischemic stroke patients. Hospitals are encouraged to take every effort to shorten delay of treatment. Despite combined efforts to streamline procedures in hospitals to provide treatment as soon as possible, most patients receive tissue plasminogen activator with considerable delay and very few of them within 90 mins. Germany has an internationally acknowledged prehospital emergency care system with specially trained doctors on ambulances. We developed an ambulance equipped with a Computed Tomography (CT) scanner, point-of-care laboratory, teleradiological support, and an emergency-trained neurologist on board. In the Pre-Hospital Acute Neurological Therapy and Optimization of Medical care in Stroke Patients study, we aim at a reduction of the current alarm-to-needle time by prehospital use of tissue plasminogen activator in an ambulance. AIMS: We hypothesized that compared with regular care, we will reduce alarm-to-needle time by a minimum of 20 mins by implementation of the stroke emergency mobile unit. DESIGN: Prospective study comparing randomly allocated periods with and without stroke emergency mobile unit availability. STUDY OUTCOMES: Primary end point of the study is alarm-to-needle time. Secondary outcomes include thrombolysis treatment rates, modified Rankin scale after three-months, and alarm-to-imaging or alarm-to-laboratory time; safety aspects to be evaluated are mortality and rates of (symptomatic) intracerebral hemorrhage.