New insights into the domain of unknown function (DUF) of EccC5, the pivotal ATPase providing the secretion driving force to the ESX-5 secretion system.

Type VII secretion (T7S) systems, also referred to as ESAT-6 secretion (ESX) systems, are molecular machines that have gained great attention due to their implications in cell homeostasis and in host-pathogen interactions in mycobacteria. The latter include important human pathogens such as Mycobacterium tuberculosis (Mtb), the etiological cause of human tuberculosis, which constitutes a pandemic accounting for more than one million deaths every year. The ESX-5 system is exclusively found in slow-growing pathogenic mycobacteria, where it mediates the secretion of a large family of virulence factors: the PE and PPE proteins. The secretion driving force is provided by EccC5, a multidomain ATPase that operates using four globular cytosolic domains: an N-terminal domain of unknown function (EccC5DUF) and three FtsK/SpoIIIE ATPase domains. Recent structural and functional studies of ESX-3 and ESX-5 systems have revealed EccCDUF to be an ATPase-like fold domain with potential ATPase activity, the functionality of which is essential for secretion. Here, the crystal structure of the MtbEccC5DUF domain is reported at 2.05 Šresolution, which reveals a nucleotide-free structure with degenerated cis-acting and trans-acting elements involved in ATP binding and hydrolysis. This crystallographic study, together with a biophysical assessment of the interaction of MtbEccC5DUF with ATP/Mg2+, supports the absence of ATPase activity proposed for this domain. It is shown that this degeneration is also present in DUF domains from other ESX and ESX-like systems, which are likely to exhibit poor or null ATPase activity. Moreover, based on an in silico model of the N-terminal region of MtbEccC5DUF, it is hypothesized that MtbEccC5DUF is a degenerated ATPase domain that may have retained the ability to hexamerize. These observations draw attention to DUF domains as structural elements with potential implications in the opening and closure of the membrane pore during the secretion process via their involvement in inter-protomer interactions.

Next-generation sequencing shows the genomic features of ovarian clear cell cancer and compares the genetic architectures of high-grade serous ovarian cancer and clear cell carcinoma in ovarian and endometrial tissues.

Ovarian clear cell carcinoma (OCCC) is a special histological type of epithelial ovarian cancer (EOC) that is not derived from epithelial cells of the ovarian or fallopian tube as the most common type of ovarian cancer, high-grade serous ovarian carcinoma (HGSOC), but is closely related to endometriosis and similar to endometrial clear cell carcinoma (ECCC) at morphologic and phenotypic features. However, limited data was shown in OCCC genomic features and compared with that in OCCC, HGSOC and ECCC. Herein, we utilized next-generation sequencing analysis of a panel of 1,021 genes to profile the mutational alterations in 34 OCCC and compared them to those from HGSOC (402 cases) and ECCC (30 cases). In result, the ARID1A and PIK3CA are high-frequency mutations of OCCC. Clonal architectures showed that all the mutations of genes occur in the later stage in the OCCC progress, whereas KRAS mutation is the earlier event compared with mutation of ARID1A or PIK3CA, which usually occurs in a group of ARID1A or PIK3CA mutations. The mutation frequency of main driver genes is similar between OCCC and ECCC, while TP53 is the main mutation in HGSOC and ECCC. Shared mutational signatures between OCCC and ECCC tissues with commonly observed a C>T change indicated a common carcinogens-exposed between these two carcinomas, but HGSOC and ECCC have common and distinct mutational signatures across cohorts respectively. In addition, we identified some novel CNV gains in NF1, ASXL1, TCF7L2, CREBBP and LRP1B and loss in ATM, FANCM, RB1 and FLT in OCCC. Our study offered a new perspective for OCCC tumorigenesis from two organs, the ovary and uterus, at genomic architectures and revealed novel CNV events for helping to provide theoretical support for OCCC treatment.

Online clinical supervision in couple and family therapy: A scoping review.

Online clinical supervision, or telesupervision, is a growing practice in couple and family therapy. This scoping review aims to identify and synthesize the existing body of knowledge regarding the utilization, experiences, and perceptions of telesupervision among the couple and family therapists and to highlight gaps in the literature. The review followed the five-step approach proposed by Arksey et al. (2005). Fifteen articles were included and their analysis yielded four themes: 1. telesupervision competence; 2. setting and boundary management; 3. advantages of telesupervision; and 4. challenges of telesupervision. Our review clearly demonstrates the dearth of available conceptual and empirical work. The rapidly growing use of online therapy and telesupervision in couple and family therapy has created a critical need to expand this body of knowledge by collecting evidence that can later be translated into practice. Moreover, we identified several gaps in the existing body of knowledge, including a lack of reports on the efficacy of telesupervision and on the experiences, processes, and ascribed meanings of the supervisors and supervisees. We also noted a lack of practice and ethical guidelines for telesupervision. We conclude our analysis by suggesting areas and directions for further investigation.

Health utilities in Chinese patients with coronary heart disease and impaired glucose tolerance (ACE): A longitudinal analysis of a randomized, double-blind, placebo-controlled trial.

BACKGROUND: We estimate health-related quality of life and the impact of four cardiovascular events (myocardial infarction [MI], stroke, congestive heart failure, angina) and gastrointestinal events in 6522 Chinese patients with coronary heart disease (CHD) and impaired glucose tolerance (IGT) participating in the Acarbose Cardiovascular Evaluation (ACE) trial. METHODS: Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level (EQ-5D-3L), with data collected at baseline and throughout the trial. Multilevel mixed-effects linear regression with random effects estimated health-related quality of life over time, capturing variation between hospital sites and individuals, and a fixed-effects linear model estimated the impact of cardiovascular and gastrointestinal events. RESULTS: Patients were followed for a median of 5 years (interquartile range 3.4-6.0). The average baseline EQ-5D score of 0.930 (SD 0.104) remained relatively unchanged over the trial period with no evidence of statistically significant differences in EQ-5D score between randomized treatment groups. The largest decrement in the year of an event was estimated for stroke (-0.107, P < .001), followed by heart failure (-0.039, P = .022), MI (-0.021, P = .047), angina (-0.012, P = .047), and gastrointestinal events (-0.005, P = .430). MI and stroke reduced health-related quality of life beyond the year in which the event occurred (-0.031, P = .006, and -0.067, P < .001, respectively). CONCLUSIONS: Acarbose treatment had no impact on health-related quality of life in ACE trial participants with CHD and IGT. Events such as MI, stroke, heart failure, and angina reduce health-related quality of life around the time they occurred, but only MI and stroke impacted on longer-term health-related quality of life.

The wild ancestors of domestic animals as a neglected and threatened component of biodiversity.

Domestic animals have immense economic, cultural, and practical value and have played pivotal roles in the development of human civilization. Many domesticates have, among their wild relatives, undomesticated forms representative of their ancestors. Resurgent interest in these ancestral forms has highlighted the unclear genetic status of many, and some are threatened with extinction by hybridization with domestic conspecifics. We considered the contemporary status of these ancestral forms relative to their scientific, practical, and ecological importance; the varied impacts of wild-domestic hybridization; and the challenges and potential resolutions involved in conservation efforts. Identifying and conserving ancestral forms, particularly with respect to disentangling patterns of gene flow from domesticates, is complex because of the lack of available genomic and phenotypic baselines. Comparative behavioral, ecological, and genetic studies of ancestral-type, feral, and domestic animals should be prioritized to establish the contemporary status of the former. Such baseline information will be fundamental in ensuring successful conservation efforts.

Los Ancestros de Animales Domésticos como un Componente Descuidado y Amenazado de la Biodiversidad Resumen Los animales domésticos tienen un inmenso valor económico, cultural y práctico y han jugado un papel muy importante en el desarrollo de la civilización humana. Muchos animales domesticados tienen, entre sus parientes silvestres, formas no domesticadas representativas de sus ancestros. Un interés renovado en estas formas ancestarles ha destacado el estatus genético poco claro de muchas, y algunas están amenazadas de extinción por hibridación con conespecíficos domesticados. Consideramos el estatus contempóraneo de estas formas ancestrales en relación con su importancia científica, práctica y ecológica; los impactos diversos de la hibridación silvestre-domesticado; y los retos y soluciones potenciales involucrados en los esfuerzos de conservación. La identificación y conservación de formas ancestrales, particularmente en relación con desenredar patrones de flujo génicos, es compleja debido a la carencia de líneas de base genómicas y fenotípicas. Se deben priorizar estudios conductuales, ecológicos y genéticos comparativos de los animales ancestrales, ferales y domésticos para establecer el estatus contemporáno de los primeros. Tal información de base será fundamental para asegurar esfuerzos de conservación exitosos.

Structural and ATPase activity analysis of nucleotide binding domain of Rv3870 enzyme of M. tuberculosis ESX-1 system.

The EccC enzyme of ESX-1 system contains (i) a membrane bound Rv3870 with single ATPase domain and (ii) a cytoplasmic Rv3871 with two ATPase domains and involved in secretion of ESAT6/CFP10 factor out of the cell. In current study, we have structurally and biochemically characterized the ATPase domain (442-747 residues) of Rv3870 enzyme. The ΔRv3870 eluted as oligomer (~813 kDa) from Superdex 200 (16/60) column, as identified based on molecular mass standard and dynamics light scattering. The SAXS analysis yielded a tetrameric ring envelope of ΔRv3870, quite consistent to dynamic light scattering data. The ΔRv3870 exhibited ATPase activity having kinetic parameters, Km ~ 100 ± 40 µM, kcat ~ 1.81 ± 0.27 min-1 and Vmax ~ 54.41 µM/min/mg. ATPase activity using nine ΔRv3870 mutants showed 70-91% decrease in catalytic efficiency of the enzyme. ΔRv3870 binds Rv3871 with KD ~ 484.0 ± 10.3 nM and its catalytic efficiency is enhanced ~6.7-fold in presence of Rv3871. CD data revealed the high TM ~ 82.2 ± 0.5 °C for ΔRv3870 and enhanced in presence of ATP + Mg2+, as observed in dynamics simulation on ΔRv3870 hexameric models. Overall, our structural and biochemical studies on ΔRv3870 have explained the mechanism, which will contribute in development of antivirulence inhibitors against M. tuberculosis.

Trends and knowledge gaps in field research investigating effects of anthropogenic noise.

Anthropogenic noise is a globally widespread sensory pollutant, recognized as having potentially adverse effects on function, demography, and physiology in wild animals. Human population growth and associated changes in urbanization, transportation, and resource extraction all contribute to anthropogenic noise and are predicted to increase in the coming decades. Wildlife exposure to anthropogenic noise is expected to rise correspondingly. Data collected through field research are uniquely important in advancing understanding of the real-world repercussions of human activity on wildlife. We, therefore, performed a systematic review of literature published from 2008 to 2018 that reported on field investigations of anthropogenic noise impacts. We evaluated publication metrics (e.g., publication rates and journal type), geographical distribution of studies, study subject, and methods used. Research activity increased markedly over the assessment period. However, there was a pronounced geographical bias in research, with most being conducted in North America or Europe, and a notable focus on terrestrial environments. Fewer than one-fifth of terrestrial studies were located in rural areas likely to experience urbanization by 2030, meaning data on ecosystems most likely to be affected by future changes are not being gathered. There was also bias in the taxonomic groups investigated. Most research was conducted on birds and aquatic mammals, whereas terrestrial mammals, reptiles, amphibians, fish, and invertebrates received limited attention. Almost all terrestrial studies examined diurnal species, despite evidence that nocturnality is the prevailing animal activity pattern. Nearly half the studies investigated effects of road or urban noise; the bulk of research was restricted to functional, rather than physiological or demographic consequences. Few experimental studies addressed repercussions of long-term exposure to anthropogenic noise or long-term postexposure effects, and multiple noise types or levels were rarely compared. Tackling these knowledge gaps will be vital for successful management of the effects of increasing wildlife exposure to anthropogenic noise.

Tendencias y Vacíos de Conocimiento en el Trabajo de Campo que Investiga los Efectos del Ruido Antropogénico Resumen El ruido antropogénico es un contaminante sensorial con amplia distribución global. Se le reconoce como un contaminante con efectos adversos potenciales sobre la función, demografía y fisiología de la fauna silvestre. El crecimiento de las poblaciones humanas y los cambios asociados a la urbanización, transporte y extracción de recursos contribuyen al ruido antropogénico y se pronostica que todos incrementarán en las siguientes décadas. Se espera que la exposición de la fauna al ruido antropogénico aumente en correspondencia. Los datos recolectados por medio del trabajo de campo tienen una importancia única en el avance del entendimiento de las repercusiones reales de la actividad humana en la fauna. Por lo tanto realizamos una revisión sistémica de la literatura publicada de 2008 a 2018 en la que se reportaron investigaciones en campo de los impactos del ruido antropogénico. Evaluamos las medidas de publicación (p. ej.: las tasas de publicación y el tipo de revista), la distribución geográfica de los estudios, el sujeto del estudio y los métodos que se utilizaron. La actividad de investigación aumentó de manera marcada a lo largo del periodo de evaluación. Sin embargo, hubo un sesgo geográfico pronunciado en las investigaciones pues la mayoría se realizó en América del Norte o en Europa y hubo un enfoque notable sobre los ambientes terrestres. Menos de la quinta parte de los estudios terrestres estuvieron ubicados en áreas rurales con una probabilidad de sufrir urbanización para el 2030, lo que significa que no se están recopilando datos para los ecosistemas con mayor probabilidad de ser afectados en el futuro. También hubo un sesgo en los grupos taxonómicos investigados. La mayoría de las investigaciones se realizó en aves y en mamíferos acuáticos, mientras que los mamíferos terrestres, los reptiles, los anfibios, los peces y los invertebrados recibieron una atención limitada. Casi todos los estudios terrestres trabajaron con especies diurnas, a pesar de la evidencia existente de que los hábitos nocturnos son el patrón prevaleciente de actividad animal. Casi la mitad de los estudios investigaron los efectos del ruido urbano o de las carreteras; el grueso de las investigaciones estuvo restringido a las consecuencias funcionales y no tanto a las fisiológicas o demográficas. Pocos estudios experimentales trataron el tema de las repercusiones a largo plazo de la exposición al ruido antropogénico o el de los efectos post-exposición a largo plazo. Tampoco encontramos muchos estudios en los que se compararan los tipos o niveles de ruido. Será vital lidiar con estos vacíos de conocimiento para el manejo exitoso de los efectos de la creciente exposición de la fauna al ruido antropogénico.

How is Systemic and Constructionist Therapy Change Process Narrated in Retrospective Accounts of Therapy? A Systematic Meta-synthesis Review.

Despite the considerable potential of qualitative approaches for studying the systemic and constructionist therapy process due to shared theoretical and epistemological premises, to date there is lack of a comprehensive qualitative synthesis of how change process is experienced and conceptualized by clients and therapists. To address this evidence gap, we performed a systematic meta-synthesis review of 30 studies reporting clients' and therapists' retrospective narratives of change process across systemic and constructionist models and across a range of client configurations, including individuals, couples, families, and groups. The studies were identified following a systematic search in PsycINFO and MEDLINE resulting in 2,977 articles, which were screened against eligibility criteria. Thematic analysis led to the identification of four main themes: (1) navigating through differences, (2) toward nonpathologizing construction of problems, (3) navigating through power imbalances, and (4) toward new and trusting ways of relating. Findings illustrate the multifaceted aspects of systemic and constructionist change process, the importance for their reflexive appraisal, and the need for further research contributing to the understanding of the challenges inherent in the systemic and constructionist therapeutic context.

A pesar del potencial considerable de los enfoques cualitativos para estudiar el proceso de la terapia sistémica y construccionista debido a premisas teóricas y epistemológicas compartidas, hasta la fecha hay una escasez de síntesis cualitativas completas de cómo los pacientes y los terapeutas viven y conceptualizan el proceso de cambio. Para abordar esta falta de datos, realizamos una revisión sistemática de la metasíntesis de 30 estudios que informan historias retrospectivas de los pacientes y los terapeutas del proceso de cambio entre modelos sistémicos y construccionistas y entre una variedad de configuraciones de pacientes, entre ellas, individuos, parejas, familias y grupos. Los estudios se identificaron después de una búsqueda sistemática en PsycINFO y MEDLINE, de donde se obtuvieron 2,977 artículos, que se analizaron según los criterios de elegibilidad. El análisis temático condujo a la identificación de cuatro temas principales: 1) orientarse entre las diferencias, 2) hacia una construcción no patologizante de los problemas, 3) orientarse entre los desequilibrios de poder, 4) hacia formas nuevas y confiables de relacionarse. Los resultados ilustran los aspectos multifacéticos del proceso de cambio sistémico y construccionista, la importancia para su valoración reflexiva y la necesidad de más investigaciones que contribuyan a la comprensión de los desafíos inherentes en el contexto terapéutico sistémico y construccionista.

Effects of spatial autocorrelation and sampling design on estimates of protected area effectiveness.

Estimating the effectiveness of protected areas (PAs) in reducing deforestation is useful to support decisions on whether to invest in better management of areas already protected or to create new ones. Statistical matching is commonly used to assess this effectiveness, but spatial autocorrelation and regional differences in protection effectiveness are frequently overlooked. Using Colombia as a case study, we employed statistical matching to account for confounding factors in park location and accounted for for spatial autocorrelation to determine statistical significance. We compared the performance of different matching procedures-ways of generating matching pairs at different scales-in estimating PA effectiveness. Differences in matching procedures affected covariate similarity between matched pairs (balance) and estimates of PA effectiveness in reducing deforestation. Independent matching yielded the greatest balance. On average 95% of variables in each region were balanced with independent matching, whereas 33% of variables were balanced when using the method that performed worst. The best estimates suggested that average deforestation inside protected areas in Colombia was 40% lower than in matched sites. Protection significantly reduced deforestation, but PA effectiveness differed among regions. Protected areas in Caribe were the most effective, whereas those in Orinoco and Pacific were least effective. Our results demonstrate that accounting for spatial autocorrelation and using independent matching for each subset of data is needed to infer the effectiveness of protection in reducing deforestation. Not accounting for spatial autocorrelation can distort the assessment of protection effectiveness, increasing type I and II errors and inflating effect size. Our method allowed improved estimates of protection effectiveness across scales and under different conditions and can be applied to other regions to effectively assess PA performance.

Efectos de la Autocorrelación Espacial y el Diseño del Muestreo sobre las Estimaciones de la Efectividad de Áreas Protegidas Resumen La estimación de la efectividad de las áreas protegidas (AP) para reducir la deforestación es útil al momento de respaldar las decisiones que eligen entre invertir en un mejor manejo de las áreas ya protegidas o crear áreas nuevas. El emparejamiento estadístico es la herramienta utilizada con mayor frecuencia para evaluar esta efectividad, pero casi siempre se ignora la autocorrelación especial y las diferencias regionales en la efectividad de la protección. Con Colombia como caso de estudio, empleamos un emparejamiento estadístico para controlar el efecto de factores relacionados con la ubicación la ubicación de los parques y he incluimos el efecto de la autocorrelación especial para determinar la significancia estadística. Comparamos el desempeño de los diferentes procedimientos de emparejamiento - las maneras de generar pares a diferentes escalas - en la estimación de la efectividad de las AP. Las diferencias en los procedimientos de emparejamiento afectaron la similitud de la covarianza entre los pares emparejados (balance) y la estimación de la efectividad de las AP en la reducción de la deforestación. El emparejamiento independiente produjo el mayor balance. En promedio, el 95% de las variables en cada región estuvo balanceado con el emparejamiento independiente, mientras que el 24% de las variables estuvo balanceado cuando se usó el método con el peor desempeño. Las mejores estimaciones sugieren que la deforestación media dentro de las áreas protegidas en Colombia era 40% menor que en los sitios emparejados emparejados. La protección redujo significativamente la deforestación, aunque la efectividad de las AP difirió entre las regiones. Las AP en la región Caribe fueron las más efectivas, mientras que aquellas en la Orinoquía y el Pacífico fueron las menos efectivas. Nuestros resultados demuestran que se necesita considerar la autocorrelación espacial y usar el emparejamiento independiente para cada subconjunto de datos para inferir la efectividad de la protección en la reducción de la deforestación. Si no se considera la autocorrelación espacial, se pueden distorsionar los estimativos de la efectividad de la protección, incrementando los errores de tipo I y II e inflando el tamaño del efecto. Nuestro método permitió obtener mejores estimaciones de la efectividad de la protección en todas las escalas y bajo diferentes condiciones y puede aplicarse a otras regiones para evaluar de manera efectiva el desempeño de las AP.

Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation.

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers' experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers' belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.

Los sistemas de asistencia de menores de todo el mundo demuestran cada vez más interés en adoptar estrategias clínicas empíricamente informadas para aumentar la eficacia de los tratamientos. Existen muchos tratamientos respaldados empíricamente, pero se sabe poco acerca de los elementos obstaculizadores y facilitadores para la implementación de dichos tratamientos en los sistemas de asistencia de menores. Este estudio analizó las experiencias de los prestadores de sistemas de asistencia de menores a la hora de implementar la terapia familiar basada en el apego en los servicios domiciliarios del sistema flamenco de asistencia de menores (en Bélgica). Se entrevistó a dieciséis prestadores de sistemas de asistencia de menores (doce terapeutas y cuatro supervisores) implicados en tres servicios domiciliarios. Se utilizó el "Marco Consolidado para la Investigación de Implementación" (Consolidated Framework for Implementation Research,CFIR) para guiar la recopilación, la codificación y el análisis de los datos de las entrevistas. Los resultados revelaron que el éxito de la implementación estuvo relacionado con la adecuación de la terapia familiar basada en el apego con la misión, la filosofía y las prácticas existentes de los sistemas de asistencia de menores. La confianza de los prestadores de sistemas de asistencia de menores en la compatibilidad entre la terapia familiar basada en el apego y los sistemas de asistencia de menores aumentó la inversión en los esfuerzos de implementación y en la perseverancia para superar dificultades y contratiempos. Algunos obstáculos estuvieron relacionados con el aprendizaje de la terapia familiar basada en el apego y algunos otros con dificultades a nivel de los sistemas, como la falta de liderazgo y apoyo, la mala coordinación con fuentes de derivaciones y con otros acompañantes en el cuidado de los jóvenes, y con la falta de apoyo a las políticas. Para diseminar satisfactoriamente los tratamientos respaldados empíricamente en el marco de los sistemas de asistencia de mejores es necesario abordar diferentes obstáculos en múltiples niveles sistémicos.

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study.

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees' participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees' experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees' development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.

Este estudio exploratorio cualitativo analiza las experiencias y los significados asociados con la participación de practicantes de terapia familiar en la práctica narrativa con grupos de testigos externos (OWG; White, 2007). En el Barcai Institute de Tel Aviv, incorporamos grupos de testigos externos en nuestros cursos de supervisión clínica en vivo. En algunas sesiones, ofrecemos a las familias que están en terapia la oportunidad de escuchar las reflexiones del grupo de practicantes con respecto a lo que observaron durante la sesión. Veintinueve practicantes de terapia familiar participaron en el estudio en cinco entrevistas de grupos focales. Los análisis de las entrevistas arrojaron cuatro temas principales relativos a las experiencias de los practicantes: (a) el análisis de la postura del terapeuta; (b) el arte de escuchar; (c) la reflexión sobre la jerarquía y la fijación de límites; y (d) la negociación de la autorrevelación. Los resultados indican que los practicantes de terapia familiar salen ganando considerablemente en su recorrido, desarrollo y crecimiento profesional como consecuencia de la integración de las prácticas de grupos de testigos externos en su formación. Los grupos de testigos externos fomentan el desarrollo de la reflexividad crítica en los practicantes, incluida la deconstrucción de los supuestos comunes y dados por sentado. También promueven las prácticas relacionadas con la terapia familiar, y quizá también con la terapia en general. Los resultados también sugieren que formar parte de los grupos de testigos externos durante la formación puede contribuir al desarrollo de la reflexividad crítica de los practicantes de terapia familiar como forma de incorporar un enfoque más crítico y político de la terapia y desarrollar sus propias historias preferidas como terapeutas.

Latinx Mental Health Scholars' Experiences with Cultural Adaptation and Implementation of Systemic Family Interventions.

An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families.

Un número cada vez mayor de intervenciones adaptadas culturalmente a nivel familiar abordan las desigualdades en la salud mental con poblaciones marginadas en los Estados Unidos. Sin embargo, con estos avances han surgido muchos obstáculos, como las dificultades con el grado de integración cultural, la participación y la sostenibilidad. Realizamos veinte entrevistas fenomenológicas selectas con investigadores de la salud mental dedicados a la investigación familiar en materia de prevención e intervenciones con varias comunidades latinas dentro y fuera de los Estados Unidos. Estos investigadores comentaron sus experiencias de superación de los obstáculos en su investigación. Utilizamos el análisis temático para decodificar y analizar las respuestas de los participantes; nuestros resultados respaldan la falta de datos en publicaciones previas y destacan las posibles vías para superar los obstáculos en la investigación sobre la adaptación cultural. Los temas incluyeron la nacesidad de: (a) una mejor comprensión del enlace entre la cultura y el contexto; (b) enfoques centrados en la comunidad para abordar las dificultades de implementación; y (c) cambios estructurales dentro de los niveles institucionales, gubernamentales y políticos. Debatimos las implicancias para los investigadores y los profesionales que trabajan con familias latinas.

Five Phases of Dyadic Analysis: Stretching the Boundaries of Understanding of Family Relationships.

In the last decade, an increasing number of qualitative studies sought to investigate the dynamics of various dyads by conducting in-depth, multiple family member interviews. The emphasis in the methodological literature dealing with this type of research is primarily on the data collection process, and much less on the development of methods suitable for the analysis of the data thus derived, especially with regard to dyads consisting of family members belonging to different systems: families of origin or nuclear families. The purpose of this paper is to propose a model for dyadic analysis based on examining the dynamics of the evolving relationships between key caregivers of a family member with brain injury. The model includes inductive and abductive phases of analysis, and it is based on an ecological-systemic perspective. The benefits of this model are highlighted, and its potential contribution is further discussed.

En la última década, un número cada vez mayor de estudios cualitativos tuvo como finalidad investigar la dinámica de varias díadas realizando entrevistas detalladas a numerosas familias. El énfasis en la bibliografía metodológica que trata de este tipo de investigación se pone principalmente en el proceso de recopilación de datos, pero mucho menos en el desarrollo de métodos adecuados para el análisis de datos así derivados, especialmente con respecto a las díadas que consisten en familiares pertenecientes a diferentes sistemas: familias de origen o familias nucleares. El propósito de este artículo es proponer un modelo para el análisis diádico sobre la base de la dinámica de las relaciones que surgen entre los principales cuidadores de un miembro de la familia con daño cerebral. El modelo incluye fases inductivas y abductivas de análisis y está basado en una perspectiva ecológico-sistémica. Se destacan los beneficios de este modelo y se debate además su posible aporte.

Reach and messages of the world's largest ivory burn.

Recent increases in ivory poaching have depressed African elephant populations. Successful enforcement has led to ivory stockpiling. Stockpile destruction is becoming increasingly popular, and most destruction has occurred in the last 5 years. Ivory destruction is intended to send a strong message against ivory consumption, both in promoting a taboo on ivory use and catalyzing policy change. However, there has been no effort to establish the distribution and extent of media reporting on ivory destruction events globally. We analyzed media coverage of the largest ivory destruction event in history (Kenya, 30 April 2016) across 11 nation states connected to ivory trade. We used an online-media crawling tool to search online media outlets and subjected 5 of the largest print newspapers (by circulation) in 5 nations of interest to content analysis. Most online news on the ivory burn came from the United States (81% of 1944 articles), whereas most of the print news articles came from Kenya (61% of 157 articles). Eighty-six to 97% of all online articles reported the burn as a positive conservation action, whereas 4-50% discussed ivory burning as having a negative impact on elephant conservation. Most articles discussed law enforcement and trade bans as effective for elephant conservation. There was more relative search interest globally in the 2016 Kenyan ivory burn than any other burn in 5 years. Ours is the first attempt to track the reach of media coverage relative to an ivory burn and provides a case study in tracking the effects of a conservation-marketing event.

Dyadic Coping in Couple Therapy Process: An Exploratory Study.

This study aimed at moving beyond previous research on couple therapy efficacy by examining moment-by-moment proximal couple and therapist interactions as well as final treatment outcomes and their reciprocal association. Seven hundred four episodes of dyadic coping within 56 early therapy sessions, taken from 28 married couples in treatment, were intensively analyzed and processed using a mixed-methods software (T-LAB). Results showed that negative dyadic coping was self-perpetuating, and therapists tended to passively observe the negative couple interaction; on the contrary, positive dyadic coping appeared to require a therapist's intervention to be maintained, and successful interventions mainly included information gathering as well as interpreting. Couples who dropped out of treatment were not actively engaged from the outset of therapy, and they used more negative dyadic coping, whereas couples who successfully completed treatment showed more positive dyadic coping very early in therapy. Results highlight the role of therapist action and control as critical to establishing rapport and credibility in couple therapy and suggest that dyadic coping patterns early in therapy may contribute to variable treatment response.

Autistic phenomena in The Adventures of Pinocchio.

This paper seeks to demonstrate that the protagonist of Carlo Collodi's The Adventures of Pinocchio illustrates numerous autistic phenomena such as communication difficulties, sensory and perceptual distortions and mindblindness. While Pinocchio is viewed as a literary construct with contraindications of autism, it will be argued that his autistic traits are sufficient to suggest the possibility that Collodi had a partial intuition of the syndrome 60 years before it was identified by Leo Kanner. Approaching Collodi's text in this manner is taken as an opportunity to survey and reflect upon the psychoanalytic literature on autism and to position it in relation to contemporary theories from cognitive neuroscience.

Prognostic factors in endometrial clear cell carcinoma.

OBJECTIVE: To document the experience regarding patients treated for endometrial clear cell carcinoma (ECCC), with reference to clinical, biochemical, histopathologic, and prognostic features. MATERIAL AND METHODS: Twenty-six ECCC patients, diagnosed and treated between 2008 and 2014, were reviewed retrospectively. From the hospital records, all data related to patients' demographic, clinical, biochemical, and histopathologic assessments and adjuvant therapy adjustments were evaluated. Disease-free survival (DFS), overall survival (OS), and 5-year cumulative survival rates (CSR) were estimated as well as prognostic factors associated with OS. RESULTS: The median follow-up time was 22.7 months, and the mean age at diagnosis was 64.0 years. Fourteen (53.8 %) women had early stage and 12 (46.2 %) women had advanced-stage disease. There were 17 (65.3 %) patients with pure clear cell carcinoma and 8 (30.7 %) patients with mixed histology on the hysterectomy specimen. Extra-uterine disease occurred more frequently in patients with pure ECCC and elevated CA-125 concentrations. Seventeen (65.3 %) patients received adjuvant platinum and taxane chemotherapy with (n: 13/17, 76.4 %) or without radiotherapy in the form of external beam radiotherapy (ERT) and/or vaginal brachytherapy (BRT). The rest of the patients (n: 9/26, 34.6 %), who had tumor with no or limited myometrial invasion without LVSI, impaired general health status, and non-compliance-to-post-operative treatment proposal received no adjuvant therapy. The mean DFS and OS were 49.54 and 50.01 months, respectively, with the 5-year CSR of 46.4 %. The mean OS was significantly shorter in patients with higher pre-operative CA-125 values, >2 cm tumor diameter, myometrial invasion ≥1/2, cervical involvement, uterine serosal and/or adnexal invasion, lymph node metastasis, and, thus, with advanced-stage disease. Uterine serosal invasion was the only significant prognostic factor associated with OS in the multivariate analysis. CONCLUSION: Increased pre-operative serum CA-125 levels are associated with advanced-stage disease, and uterine serosal involvement is a significant prognostic factor associated with OS in women with ECCC.

A Video Recall Study of In-session Changes in Sentiment Override.

This study examines in-session changes in sentiment override over the first three sessions of couple therapy. Couples viewed a video recording of therapy sessions immediately after each of the first three sessions and continuously rated their level of sentiment override. Ninety-eight changes were randomly chosen for analysis. Three talk turns prior to each change was coded using the Family Relational Communication Control Coding System. Results show that changes in sentiment override occur frequently. Repeated incidents of communication control were related to negative change in sentiment override for females. Repeated incidents of being left out of the conversation were related to negative changes in sentiment override for females and positive changes for males.