Third-Party Observation in Psychotherapy: Playing to the Audience.

OBJECTIVE: The aim of this report is to describe how trainees and instructors skew their performance of psychotherapies when sessions are observed by third parties and to discuss approaches to mitigate potentially adverse consequences. METHODS: To supplement clinical observations, a selective narrative literature review was conducted by searching PubMed and PsycInfo. RESULTS: When third-party observers were involved, therapists were likely to skew how they conducted psychotherapy. Skewing occurred regardless of whether the third parties observed in vivo or remotely, observed synchronously or asynchronously, or were instructors or trainees. Such skewing may have resulted from conscious, preconscious, or unconscious decisions by therapists as well as by patients. Despite the benefits of observed psychotherapy for therapists and patients, deleterious consequences have sometimes emerged. CONCLUSIONS: Benefits of third-party observation of psychotherapy are substantial. Nevertheless, therapists must recognize how being observed may adversely affect themselves and their patients. Mitigation strategies are available to address potential harms.

Pediatric Exposures Reported to the Toxicology Investigators Consortium, 2010-2015.

BACKGROUND AND OBJECTIVE: Poisoning is the leading cause of injury death in pediatric patients. Hospital and provider readiness, including pharmacy stocking, depends on reliable surveillance data describing local patterns of age-specific clinically significant exposures and the therapeutic modalities employed in their treatment. We aimed to characterize trends in clinically significant toxic exposures and their management. METHODS: We performed a retrospective review of patients 18 years or younger in the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, a self-reporting database completed by bedside consulting medical toxicologists. We reviewed cases from January 1, 2010, through December 31, 2015. In 2015, ToxIC included 101 health care facilities. Data collected included demographics, geographic region, encounter and exposure details, survival, and therapeutic modalities employed, including antidotes, antivenoms, gastric decontamination, enhanced elimination, hyperbaric oxygen therapy, and extracorporeal membrane oxygenation. RESULTS: From 2010 to 2015, 11,616 consults were recorded in ToxIC. Pediatric consultations increased from 934 (23.7%) in 2010 to 2425 (29.9%) in 2015 (P < 0.001). Exposures were most commonly reported in females (57.8%) and adolescents (59.4%). Intentional ingestions (55.5%) comprised the majority of cases. The most frequent agents of exposure were analgesics (21.0%). There were 38 deaths reported (0.9%). The antidote used most commonly was N-acetylcysteine (11.0%). Geographic variation was demonstrated in prevalence of envenomations and heavy metal exposures, their respective treatments, and overall use of decontamination. CONCLUSIONS: Toxicology consultations for pediatric exposures increased from 2010 to 2015. Understanding which pediatric exposures require toxicologist management, the therapies most frequently employed, and geographical patterns is paramount to facility-level planning, pharmacy stocking, and provider education.

Investigation of the quantum vacuum as an energy sink for subcritical and supercritical vaporization lasers.

In this paper, it is shown that the quantum electrodynamic vacuum particle production rate by a vaporization laser is negligible and is not a significant energy sink at electric field strengths beyond the Schwinger Limit.

A Man in His 50s With Hemoptysis, Dyspnea, and Bilateral Patchy Ground-Glass Opacities.

CASE PRESENTATION: A man in his 50s presented to the ED with a 3-day history of small-volume hemoptysis and new-onset dyspnea. The patient did not have fevers, chills, chest pain, abdominal pain, or changes in urination. His medical history included hypertension, a 35-pack-year active smoking history, and occupational hydrocarbon exposure as a mechanic in the foresting industry. He reported no recent travels, and he denied sick contacts. His medications included amlodipine, hydrochlorothiazide, lisinopril, omeprazole, and nicotine replacement therapy.

The cosmic microwave background radiation power spectrum as a random bit generator for symmetric- and asymmetric-key cryptography.

In this note, the Cosmic Microwave Background (CMB) Radiation is shown to be capable of functioning as a Random Bit Generator, and constitutes an effectively infinite supply of truly random one-time pad values of arbitrary length. It is further argued that the CMB power spectrum potentially conforms to the FIPS 140-2 standard. Additionally, its applicability to the generation of a (n × n) random key matrix for a Vernam cipher is established.

Pressure Correction is Not Required for Particulate Matter Sampling.

The Environmental Protection Agency's Reference Methods for determining particulate matter as PM10 require pressure corrections before comparison to their National Ambient Air Quality Standards. No chemical, physiological, or toxicological basis exists for correction for particulate sampling when results are expressed in weight per unit volume (fxg/m3). The implications of misapplying pressure corrections are at least twofold: a) exposure assessment comparisons at different elevations, using EPA generated data, do not use equivalent doses; and b) cities at higher elevations are held to a more stringent compliance standard.