Session Reactions Scale-3: Initial psychometric evidence.

Objective: This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients' session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions.

Attribution of Air Quality Benefits to Clean Winter Heating Policies in China: Combining Machine Learning with Causal Inference.

Heating is a major source of air pollution. To improve air quality, a range of clean heating policies were implemented in China over the past decade. Here, we evaluated the impacts of winter heating and clean heating policies on air quality in China using a novel, observation-based causal inference approach. During 2015-2021, winter heating causally increased annual PM2.5, daily maximum 8-h average O3, and SO2 by 4.6, 2.5, and 2.3 µg m-3, respectively. From 2015 to 2021, the impacts of winter heating on PM2.5 in Beijing and surrounding cities (i.e., "2 + 26" cities) decreased by 5.9 µg m-3 (41.3%), whereas that in other northern cities only decreased by 1.2 µg m-3 (12.9%). This demonstrates the effectiveness of stricter clean heating policies on PM2.5 in "2 + 26" cities. Overall, clean heating policies caused the annual PM2.5 in mainland China to reduce by 1.9 µg m-3 from 2015 to 2021, potentially avoiding 23,556 premature deaths in 2021.

Cross-country risk quantification of extreme wildfires in Mediterranean Europe.

We estimate the country-level risk of extreme wildfires defined by burned area (BA) for Mediterranean Europe and carry out a cross-country comparison. To this end, we avail of the European Forest Fire Information System (EFFIS) geospatial data from 2006 to 2019 to perform an extreme value analysis. More specifically, we apply a point process characterization of wildfire extremes using maximum likelihood estimation. By modeling covariates, we also evaluate potential trends and correlations with commonly known factors that drive or affect wildfire occurrence, such as the Fire Weather Index as a proxy for meteorological conditions, population density, land cover type, and seasonality. We find that the highest risk of extreme wildfires is in Portugal (PT), followed by Greece (GR), Spain (ES), and Italy (IT) with a 10-year BA return level of 50'338 ha, 33'242 ha, 25'165 ha, and 8'966 ha, respectively. Coupling our results with existing estimates of the monetary impact of large wildfires suggests expected losses of 162-439 million € (PT), 81-219 million € (ES), 41-290 million € (GR), and 18-78 million € (IT) for such 10-year return period events. SUMMARY: We model the risk of extreme wildfires for Italy, Greece, Portugal, and Spain in form of burned area return levels, compare them, and estimate expected losses.

Empathic reflections by themselves are not effective: Meta-analysis and qualitative synthesis.

Objective: We present a mixed methods systematic review of the effectiveness of therapist empathic reflections, which have been adopted by a range of approaches to communicate an understanding of client communications and experiences. Methods: We begin with definitions and subtypes of empathic reflection, drawing on relevant research and theory, including conversation analysis. We distinguish between empathic reflections, reviewed here, and the relational quality of empathy (reviewed in previous meta-analyses). We look at how empathic reflections are assessed and present examples of successful and unsuccessful empathic reflections, also providing a framework of the different criteria used to assess their effectiveness (e.g., association with session or treatment outcome, or client next-turn good process). Results: In our meta-analysis of 43 samples, we found virtually no relation between presence/absence of empathic reflection and effectiveness, both overall and separately within-session, post-session and post-treatment. Although not statistically significant, we did find weak support for reflections of change talk and summary reflections. Conclusions: We argue for research looking more carefully at the quality of empathy sequences in which empathic reflections are ideally calibrated in response to empathic opportunities offered by clients and sensitively adjusted in response to client confirmation/disconfirmation. We conclude with training implications and recommended therapeutic practices.

Efficacy of Emotion-Focused Parenting Programs for Children's Internalizing and Externalizing Symptoms: A Randomized Clinical Study.

OBJECTIVE: Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents' mental health problems. METHODS: In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6-13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. RESULTS: EFST showed efficacy in reducing parent-reported externalizing (b = -1.72, p < .001, d = 1.0) and internalizing (b = -1.71, p < .001, d = 0.9) symptoms, and teacher-reported externalizing (b = -.96, p < .001, d = 0.4), but not internalizing (b = -.13, p > .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p's > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. CONCLUSION: EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention.

Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies.

Objective: We tested qualitative metasynthesis of a series of Hermeneutic Single Case Efficacy Design (HSCED) studies as a method for comparing within-session processes that may explain good and poor therapeutic outcome. Method: We selected eight HSCED studies according to change in clients' scores on the Strathclyde Inventory (SI), a brief self-report instrument used to measure outcome in person-centered psychotherapy. Four of the case studies investigated the experience of clients whose pre-post change in SI scores showed improvement by the end of therapy, and the other four focused on clients whose change in SI scores indicated deterioration. We conducted a qualitative metasynthesis, adopting a generic descriptive-interpretive approach to analyze and compare the data generated by the HSCED studies. Results: In contrast to improvers, deteriorators appeared to be less ready to engage in therapeutic work at the beginning of therapy, and found the process more difficult; their therapists were less able to respond to these difficulties in a responsive, empathic manner; deteriorators were less able to cope successfully with changes of therapist and, eventually, gave up on therapy. Conclusion: We found that our qualitative metasynthesis of a series of HSCED studies produced a plausible explanation for the contrasting outcomes that occurred.

Multifunctional Coordination Polymer Exhibiting Reversible Mechanical Motion Allowing Selective Uptake of Guests and Leading to Enhanced Electrical Conductivity.

A remarkably flexible, multifunctional, 2D coordination polymer exhibiting an unprecedented mode of reversible mechanical motion, enabling pores to open and close, is reported. Such multifunctional materials are highly sought after, owing to the potential to exploit coexisting electronic and mechanical functionalities that underpin useful technological applications such as actuators and ultrasensitive detectors. The coordination polymer, of composition Mn(F4TCNQ)(py)2 (F4TCNQ = 2,3,5,6-tetrafluoro-7,7,8,8-tetracycanoquinodimethane; py = pyridine), consists of Mn(II) centers bridged by F4TCNQ dianions and coordinated by py molecules that extend above and below the 2D network. Exposure of Mn(F4TCNQ)(py)2, in its collapsed state, to carbon dioxide results in a pore-opening process at a threshold pressure for a given temperature. In addition to carbon dioxide, a variety of volatile guests may be incorporated into the pores, which are lined with electron-rich F4TCNQ dianions. The inclusion of electron-deficient guests such as 1,4-benzoquinone, nitrobenzene, maleic anhydride, and iodine into the pores is accompanied by a striking color change associated with a new host-guest charge-transfer interaction and an improvement in the semiconductor behavior, with the iodine adduct showing an increase in conductivity of almost 5 orders of magnitude. Experimental and density functional theory calculations on this remarkable multifunctional material demonstrate a reduction in the optical band gap with increasing electron affinity of the guest.

A comparison of anesthetic protective barriers for the management of COVID-19 pediatric patients.

BACKGROUND: Barrier techniques, such as plastic sheets or intubation boxes, are purported to offer additional protection for healthcare workers. AIMS: To assess the functionality, perceived safety, droplet protection, and aerosol protection of several barrier techniques. METHODS: Firstly, a simulation study with 12 different laryngoscopists was conducted to assess the time taken to perform an intubation (via direct laryngoscopy, via video laryngoscopy, and via a bougie) with four different barrier techniques (personal protective equipment only, a plastic sheet, a tented plastic sheet, and an intubation box). Secondly, a cough at the time of intubation was simulated using ultraviolet dye to assess the spread of droplets; and thirdly, smoke was used to assess the spread of aerosols. RESULTS: Intubation time using the box was noninferior to using no barrier. Based on subjective ratings by the laryngoscopists, the most functional technique was no barrier followed by the intubation box, then the tented sheet, and then the plastic sheet. The technique that conferred the highest feeling of safety to the laryngoscopists was the intubation box, followed by the tented sheet, then no barrier, and then the plastic sheet. All the barriers prevented the ultraviolet dye contaminating the head and torso of the laryngoscopist. Smoke remained within the intubation box if plastics sheets were used to cover the openings and suction was ineffective at clearing it. With no barrier in place, smoke was effectively cleared away from the patient in a theater with laminar flow but tended to spread up toward the laryngoscopist in a room without laminar flow. CONCLUSIONS: A well-designed intubation box is an effective barrier against droplets and is noninferior to no barrier in relation to intubation time. However, a box interferes with laminar flow in theaters with formal ventilation systems and may result in accumulation of aerosols if it is completely enclosed.

Relational dialogue in emotion-focused therapy.

OBJECTIVES: In emotion-focused therapy (EFT) relational processes between the therapist and client are not normally an explicit focus unless the therapist and client encounter difficulties that interfere with therapeutic work. When this does happen, however, relational dialogue (including meta-communication) becomes necessary. We present the principles and stages of the EFT task Relational Dialogue for Alliance Difficulties. METHODS AND RESULTS: After describing this little-known task, we illustrate its application in the successful treatment of a severely socially anxious female client with complex trauma and emotional fragility. Using transcripts and detailed descriptions we highlight the alliance difficulty marker subtype, relational dialogue principles and the stages of EFT alliance difficulty work.

The EV revolution: The road ahead for critical raw materials demand.

Mass adoption of electric vehicles (EVs) is anticipated in the years ahead, driven primarily by policy incentives, rising incomes, and technological advancements. However, mass adoption is predicated on the availability and affordability of the raw materials required to facilitate this transformation. The implications of material shortages are currently not well understood and previous research tends to be limited by weak representation of technological change, a lack of regional disaggregation, often inflexible and opaque assumptions and drivers, and a failure to place insights in the broader context of the raw materials industries. This paper proposes a CoMIT (Cost, Macro, Infrastructure, Technology) model that can be used to analyse the impact of mass EV adoption on critical raw materials demand and forecasts that, by 2030, demand for vehicles will increase by 27.4%, of which 13.3% will be EVs. The model also predicts large increases in demand for certain base metals, including a 37 and 18-fold increase in demand for cobalt and lithium (relative to 2015 levels), respectively. Without major changes in certain technologies, the cobalt and lithium supply chains could seriously constrain the widespread deployment of EVs. Significant demand increases are also predicted for copper, chrome and aluminium. The results also highlight the importance of China in driving demand for EVs and the critical materials needed to produce them.

Suggestions for a Covid-19 Post-Pandemic Research Agenda in Environmental Economics.

In this article we draw upon early lessons from the 2020 Covid-19 crisis and discuss how these may relate to a future research agenda in environmental economics. In particular, we describe how the events surrounding the Covid-19 crisis may inform environmental research related to globalization and cooperation, the green transition, pricing carbon externalities, as well as the role of uncertainty and timing of policy inventions. We also discuss the implications for future empirical research in this area.

The Impact of the Wuhan Covid-19 Lockdown on Air Pollution and Health: A Machine Learning and Augmented Synthetic Control Approach.

We quantify the impact of the Wuhan Covid-19 lockdown on concentrations of four air pollutants using a two-step approach. First, we use machine learning to remove the confounding effects of weather conditions on pollution concentrations. Second, we use a new augmented synthetic control method (Ben-Michael et al. in The augmented synthetic control method. University of California Berkeley, Mimeo, 2019. https://arxiv.org/pdf/1811.04170.pdf) to estimate the impact of the lockdown on weather normalised pollution relative to a control group of cities that were not in lockdown. We find NO 2 concentrations fell by as much as 24  µ g/m 3 during the lockdown (a reduction of 63% from the pre-lockdown level), while PM10 concentrations fell by a similar amount but for a shorter period. The lockdown had no discernible impact on concentrations of SO 2 or CO. We calculate that the reduction of NO 2 concentrations could have prevented as many as 496 deaths in Wuhan city, 3368 deaths in Hubei province and 10,822 deaths in China as a whole.

COVID-19 Related Mortality During Management of a Hepatic Abscess.

The coronavirus disease (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in the capital city of the Hubei Province, Wuhan, China, in late 2019. Declared a pandemic by the World Health Organization on March 11th, 2020, COVID-19 has challenged healthcare systems to limit the spread of community and hospital-acquired disease. This article uses a patient case to highlight the importance of infection control during the height of the SARS-CoV-2 surge at a Level I affiliated community hospital in Western New York.

The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis.

BACKGROUND: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time. METHODS: Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated. RESULTS: We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital. CONCLUSIONS: The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.

The Role of Sodium Hydrogen Exchanger 1 in Dysregulation of Proton Dynamics and Reprogramming of Cancer Metabolism as a Sequela

Cancer cells have an unusual regulation of hydrogen ion dynamics that are driven by poor vascularity perfusion, regional hypoxia, and increased glycolysis. All these forces synergize/orchestrate together to create extracellular acidity and intracellular alkalinity. Precisely, they lead to extracellular pH (pHe) values as low as 6.2 and intracellular pH values as high as 8. This unique pH gradient (∆pHi to ∆pHe) across the cell membrane increases as the tumor progresses, and is markedly displaced from the electrochemical equilibrium of protons. These unusual pH dynamics influence cancer cell biology, including proliferation, metastasis, and metabolic adaptation. Warburg metabolism with increased glycolysis, even in the presence of Oxygen with the subsequent reduction in Krebs' cycle, is a common feature of most cancers. This metabolic reprogramming confers evolutionary advantages to cancer cells by enhancing their resistance to hypoxia, to chemotherapy or radiotherapy, allowing rapid production of biological building blocks that support cellular proliferation, and shielding against damaging mitochondrial free radicals. In this article, we highlight the interconnected roles of dysregulated pH dynamics in cancer initiation, progression, adaptation, and in determining the programming and re-programming of tumor cell metabolism.

Interligand Charge-Transfer Interactions in Electroactive Coordination Frameworks Based on N, N'-Dicyanoquinonediimine (DCNQI).

Coordination frameworks containing DCNQI2- (DCNQI = N, N'-dicyanoquinonediimine ligand) are produced by deprotonation of DCNQIH2 in the presence of a metal center and a co-ligand. This approach has yielded two-dimensional (2D) sheet compounds [Cd(DCNQI)(L)2] (where L = pyridine (py) or isoquinoline (isoquin)) that can be partially oxidized via solid-state electrochemical and in situ spectroelectrochemical methods to materials that contain DCNQI as its radical monoanion. The new frameworks display charge-transfer bands that are indicative of interligand charge-transfer interactions as supported by TD-DFT computational calculations. The redox-state dependent spectral properties of the frameworks have been probed using a newly developed solid-state spectroelectrochemical cell. Coupled with computational calculations, the experimental data provide an understanding of the fundamental charge-transfer processes that may underpin long-range functional properties such as conductivity in framework materials.

Impact of acute dynamic exercise on radial artery low-flow mediated constriction in humans.

PURPOSE: A "low-flow mediated constriction" (L-FMC) is evoked in the radial artery by the inflation of an ipsilateral wrist cuff to a supra-systolic pressure. We sought to test the hypothesis that the radial artery L-FMC response is augmented immediately following acute dynamic leg exercise in young healthy individuals. METHODS: Ten healthy and recreationally active men (23 ± 4 years) undertook a 30-min trial of incremental dynamic leg cycling exercise (10 min at 50, 100 and 150 W) and a 30-min time control trial (seated rest). Trials were randomly assigned and performed on separate days. Radial artery characteristics (diameter, blood flow and shear rate) were assessed throughout each trial, with L-FMC and flow-mediated vasodilatation (FMD) assessments conducted prior to and immediately following (10 min) trials. RESULTS: Dynamic leg cycling exercise increased radial artery blood flow, along with mean, retrograde and anterograde shear rate (P < 0.05). Blood flow profiles were unchanged during the time control trial (P > 0.05). Following exercise L-FMC was increased (mean [SD]; - 5.6 [3.3] vs. - 10.1 [3.8] %, P < 0.05), while it was not different in the time control condition (- 8.1 [3.2] vs. - 6.7 [3.4] %, P > 0.05). FMD was not different following either the exercise or time control trials (P > 0.05), but the composite end-point of L-FMC + FMD was enhanced post-exercise (P < 0.05). CONCLUSIONS: Dynamic exercise with a large muscle mass acutely augments the vasoconstrictor response of the radial artery in response to a reduction in blood flow (L-FMC) in young healthy individuals. The time course of this post-exercise response and the underlying vasoregulatory mechanisms require elucidation.

Assessing the Economic Benefits of Flood Defenses: A Repeat-Sales Approach.

In this article we identify the impact of the construction of flood defenses on property prices using a difference-in-differences repeat-sales methodology. Our data set contains information on over 12 million individual property transactions, which is merged with GIS data identifying the spatial location and main characteristics of 1,666 flood defenses built in England between 1995 and 2014. Results suggest that at the finer 6-digit postcode level the construction of flood defenses raises urban house prices by 12.6% to 16.7%. However, for rural properties at the slightly coarser 5-digit postcode level the construction of defenses reduces house prices by 0.8% to 5.0%. This suggests that in certain locations the disamenity impact of flood defenses and the perceived threat of redirected flooding outweigh the benefits of reduced flood risk.

Mortality of Solenopsis invicta Workers (Hymenoptera: Formicidae) After Indirect Exposure to Spores of Three Entomopathogenic Fungi.

Mortality caused by indirect exposure to Metarhizium brunneum and Beauveria bassiana (GHA and NI8) to the red imported fire ant, Solenopsis invicta Buren (Hymenoptera: Formicidae), workers was evaluated. Groups of 50 workers were placed in one side of dual-box arenas. The opposite side of the arenas was lined with filter paper squares previously sprayed with unformulated purified spores (106 spores/ml) suspended in 0.2% Ethal TDA 3, HLB 8 of the three fungal strains, or untreated filter paper squares as the control. Daily observations were done for 1 wk to determine mortality. Dead ants from each treatment and control were collected, surface cleaned, and placed in PDA media and incubated at 27°C, 60% RH for 7 d to detect fungal growth. The presence of fungal growth in the dead ants confirmed that fungal spores infected workers while walking on the treated paper. In the M. brunneum and B. bassiana GHA treatments, 51.35 and 56.68% of the workers died, respectively, during days 1 and 2. However, only 9.47 and 35.96% of the mortality could be explained by fungal infection by M. brunneum and B. bassiana GHA, respectively. Most of the mortality observed in the B. bassiana NI8 treatment (84.48%) occurred later (between days 4-6) and most of this mortality occurring during day 4 (89.06%) could be explained by B. bassiana infection. Overall mortality was significantly higher in the B. bassiana NI8 treatment than the other two fungi tested and control. Potential application of these fungal strains for fire ant control are discussed.