Changes in Object Relations over the Course of Psychodynamic Psychotherapy.

This study explores whether object relations (OR) functioning improves over the course of psychodynamic psychotherapy, and whether this improvement is related to symptom decrease as well as therapist technique. The sample consisted of 75 outpatients engaged in short-term psychodynamic psychotherapy at a university-based psychological service clinic. OR functioning was assessed pre- and post-treatment by independent raters using the Social Cognition and Object Relations Scale from in-session patient relational narratives. The Comparative Psychotherapy Process Scale was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of global OR and psychotherapy techniques were conducted, and rater agreement was found to be in the excellent range. Regarding the results, global OR (overall quality and level of interpersonal functioning) significantly improved with large effect size after psychodynamic therapy. Change in global OR functioning was significantly and positively related to the incidence of psychodynamic techniques in early sessions, as were number of psychotherapy sessions attended. Patient self-reported reliable change in symptomatology and reliable change in global OR were significantly related as well. Multilevel model analyses confirmed pairwise correlations accounting for therapist effects on a variety of process-outcome measures, number of sessions attended, initial levels of psychiatric symptoms, employment of therapeutic techniques as well overall OR functioning at outcome. Limitations of the present study, future research directions and implications for clinical practice are also discussed. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Psychodynamic psychotherapy seems to be effective in improving object relations functioning. Consider use of psychodynamic techniques early in treatment with patients expressing more pathological object representations. Improvements in object relations functioning during psychodynamic psychotherapy are also related to adaptive changes in patient self-reported symptomatology. Therapist effects were also present for the study. As such therapists should be mindful to assess patient change and their use of technique at several points in treatment and flexibly adjust their approach as necessary.

Quasi-life self-organizing systems: based on ensembles of succinylated derivatives of interferon-gamma.

Research has been conducted on the chemical and biological properties of combinatorial succinylated derivatives of interferon-γ with various levels of acylation, which create quasi-life, self-organizing ensembles. As a result of the research, it has been established that acylation by succinic anhydride of two lysines in the structure of interferon-γ (Gammaferon) leads to both an increase in its affinity to cell receptors and a decrease in the time of maximum effect from 48 hours to 15 minutes. Moreover, treatment of cells with these interferon ensembles led to the shielding of 100% of the cells after a 15-minute incubation period, whereas native interferon shielded no more than 80% of the cells after 48 hours. Other ensembles also protected cells from viral action, but this protective effect did not exceed two hours in duration. The ensemble of succinylated interferon- γ with two modified lysines may hold promise for the treatment of severe viral infections with fast courses, such as influenza and the diseases caused by the Ebola, Marburg, SARS, and other viruses.

Isolation of Mycobacterium bolletii from human omentum after laparoscopic gastric banding.

Mycobacterium bolletii infection with band erosion complicating laparoscopic gastric banding is reported. A 33-year-old man developed right upper quadrant pain and an epigastric discharging lesion 4 weeks after revision of gastric banding for morbid obesity. Investigation revealed band erosion with infection of the omentum and the abdominal wall. The band was removed and M. bolletii was isolated and identified after DNA sequence analysis. To the best of our knowledge, this is the first case in which M. bolletii was isolated from a human omentum after complicated gastric banding surgery.

Point-of-use water filtration reduces healthcare-associated infections in bone marrow transplant recipients.

Outbreaks of infection with gram-negative bacteria (GNB) have been linked to hospital water. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in hospitalized bone marrow transplant (BMT) recipients in the absence of any recognized outbreak. Unfiltered water was sampled from taps in the BMT unit of a major US teaching hospital, and cultured at a reference laboratory. POU bacterial-retentive filters (0.2 mum) were installed throughout the unit, and replaced every 14 days. Infection rates were tracked over a 9-month period, and compared with rates for a 16-month period before POU filtration. Unfiltered water samples from 50% (2 of 4) outlets sampled grew P. aeruginosa (2 of 4) and Stenotrophomonas maltophilia (1 of 4). Clinical infection rates in the unit were significantly reduced from 1.4 total and 0.4 GNB infections per 100 patient days in the period before POU filtration to 0.18 total and 0.09 GNB infections per 100 patient days (P=0.0068 and 0.0431, respectively) in the 9-month period for which filters were in place. Infections during the POU filtration period were due to non-waterborne organisms. Point-of-use (POU) water filtration may significantly reduce infection rates in BMT recipients in the absence of any recognized outbreak.

[Experience of obesity's treatment by an interdisciplinary team]. / Expérience d'une prise en charge interdisciplinaire de l'obésité.

Owing to the multifactorial origin of obesity, we have created an interdisciplinary team devoted to a limited-in-time treatment, following three axles : nutritional education, body self-perception and emotions expression. The philosophy of this approach and some results are presented.

Parameters influencing membrane CD14 expression and soluble CD14 levels in sepsis.

INTRODUCTION: Membrane (mCD14) and soluble (sCD14) CD14 are pattern recognition receptors for bacterial cell wall fragments. They play an important role in the generation of the innate immune response against bacterial pathogens. Differential expression of these receptors may be relevant for the clinical course of patients with sepsis. PATIENTS AND METHODS: 32 patients with an early onset of sepsis (duration of symptoms < 24h) were examined repeatedly by flow cytometry for expression of mCD14, and by ELISA for levels of sCD14, leukocyte elastase and C-reactive Protein (CRP). RESULTS: At study entry, mCD14 expression was reduced in all patients with sepsis, but returned to normal levels during the course of the disease in survivors only. mCD14 was found to be inversely correlated with severity of disease, leukocyte elastase, and C-reactive protein. Among patients with severe disease and Apache II scores >or= 20, sCD14 levels at study entry were significantly higher in those who survived by day 28, as compared to non-survivors (p = 0.02). CONCLUSION: The data presented are compatible with a recently published hypothesis derived from in vitro experiments suggesting that leukocyte elastase may be responsible for cleavage of mCD14 from the monocyte surface. The data also suggest that higher sCD14 levels may be beneficial in sepsis. Persistently reduced mCD14 expression seems to be a marker for severity of disease in patients with sepsis.

Differences in self-disclosure in psychotherapy between American and Israeli patients.

This study investigated differences in extent and patterns of disclosure in psychotherapy between American (n = 164) and Israeli (n = 45) patients. Participants completed the Disclosure to Therapist Inventory-R, an 80-item measure that uses a rating scale to assess the extent to which psychotherapy patients have discussed each of 80 moderately to highly intimate topics with their most recent therapist. Analysis yielded no significant difference between groups in overall disclosure and high overlap in the topics most and least discussed. Both groups frequently discussed aspects of their personalities they disliked, feelings of desperation or depression, and feelings of rage or anger towards parents. Findings suggest universal concerns may outweigh the cultural context in which therapy occurs.

[New vehicle technologies for supporting the mobility of the elderly]. / Neue Fahrzeugtechnologien zur Unterstützung der Mobilität Alterer.

Starting point for this analysis are the mobility needs and requirements of elderly, as well as problems concerning access and use of public transport. Elderly people as car drivers suffer from several performance deficits which are currently compensated by mobility restrictions and changed driving behaviour. Driver assistance systems, just available or soon on the market, are demonstrated and analysed with respect to their impact on elderly drivers. An expert evaluation comes to the conclusion that the most important systems for elderly are: emergency systems, enhanced vision systems and parking aids. Emergency systems can call rescue teams automatically or at driver's request, and direct them to the emergency location. Self imposed restrictions of elderly concerning night driving can partly be compensated by means of curve lightning and automatic dipping. Parking aids, using cameras or infrared technique are especially helpful for persons with moveability problems. The group of helpful, but not highly important driver assistance systems covers several means for longitudinal and lateral control of the car, comprising autonomous cruise control, antilock systems and electronic stability programmes. The value and impact of these systems are analysed in the light of risk homeostasis theory. Reduced work load and ease of mobility will at last result from user centered navigation systems, helping the elder driver also to move to new areas without orientational problems. The article demonstrates the particular importance of specific layouts of the man-machine-interface for elderly, to guarantee high acceptance and minimal distraction from traffic.

Treatment strategies for different types of teacher burnout.

Using teachers as a prototype, this article suggests that there are three types of burnout: "wearout," wherein an individual gives up, feeling depleted in confronting stress; "classic" burnout, wherein an individual works increasingly hard in the face of stress; and an "underchallenged" type, wherein an individual is faced not with excessive degrees of stress per se (e.g., overload), but rather with monotonous and unstimulating work conditions. The major arguments put forward are that: a) clinicians should avoid treating teacher burnout as if it were a single phenomenon, and instead tailor their treatment to the specific type of burnout manifested by their client; and b) these treatments, while embodying different elements, should be essentially integrative in nature. Psychoanalytic insight, cognitive restructuring, empathic concern, and stress-reduction techniques may all be necessary, albeit in different combinations, to treat successfully burnout of each type.

Reality testing in adult women who report childhood sexual and physical abuse.

OBJECTIVE: To better understand how neighborhood and individual factors are related to child maltreatment. METHOD: Using an ecological framework, a multi-level model (Hierarchical Linear Modeling) was used to analyze neighborhood structural conditions and individual risk factors for child abuse and neglect. Parents (n = 400) of children under the age of 18 were systematically selected from 20 randomly selected census-defined block groups with different risk profiles for child maltreatment report rates. Parents were administered the Neighborhood Environment for Children Rating Scales, the Child Abuse Potential Inventory, the Zimet measure of social support, and the Conflict Tactics Scales as a measure of childhood experience with violence. RESULTS: Neighborhood factors of improverishment and child care burden significantly affect child abuse potential after controlling for individual risk factors. However, neighborhood effects are weaker than they appear to be in aggregate studies of official child maltreatment reports. Variation in child abuse potential within neighborhoods is greater than between neighborhoods. However, adverse neighborhood conditions weakened the effects of known individual risk and protective factors, such as violence in the family of origin. CONCLUSIONS: If individual potential for child maltreatment is more evenly distributed across neighborhoods than reported maltreatment, then neighborhood and community play an important, if as yet unspecified, role in child maltreatment. Multi-level models are a promising research strategy for disentangling the complex interactions of individual and contextual factors in child maltreatment.

Blaming the helpers: the marginalization of teachers and parents of the urban poor.

The nature and origins of the current tendency toward disparaging parents and teachers of the urban poor are examined. It is suggested that the influence of parents and teachers must be understood in the context of multiple intervening variables. Several explanations are offered for the phenomenon of blame, including the fact that women constitute the great majority of teachers and are often the primary agents of parenting.

The relationship of psychological-mindedness to adult perceptions of early parental rejection.

We tested the hypothesis that highly psychologically minded individuals perceive having grown up with rejecting parents. A Psychological Mindedness (PM) Scale, and the Parent-Child Relations Questionnaire II (PCR), were administered to 120 college students. Contrary to prediction, a significant negative correlation was found between PM and perceptions of early maternal rejection. Psychological-mindedness, it was suggested, may be attributable to "good enough mothering" and may be learned through modeling and imitation of mothers' empathic perceptions, affective responses, and behavior.