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Meta-competencies govern the application of more basic therapeutic competencies and allow CBT therapists to know when and why particular skills are needed. Meta-competencies are particularly important when responding to the needs of complex or atypical clinical cases. We explore CBT meta-competencies through therapist reflections on complex clinical scenarios and judgements about CBT skills. Three groups of therapists were compared in their responses to four complex clinical scenarios: trainees, recently qualified and experienced therapists. Participants reflected on how they would respond in each scenario and made ratings of the importance of different skills. There was a highly significant difference between trainees and experienced therapists in the number of reflective statements made, but no differences in the number of anticipated actions. There were no group differences in judgements about CBT skills. Reflective capacity is a meta-competency and higher-order skill that CBT therapists continue to develop several years post-qualification. Further studies are needed to replicate this finding and understand its impact on clinical practice.
Key learning aims
(1) To learn about CBT meta-competencies when considering clinical complexity.
(2) To learn how to test meta-competencies in groups of therapists with differing levels of experience.
(3) To identify which meta-competencies are prioritised in clinically complex scenarios.
(4) To support the development of the scale which measures meta-competencies in therapists.
Electromagnetic radiation (EMR) has deleterious effects on sperm motility and viability, as well as oocyte membrane and organelle structure. The aim was to assess the effects of cell phone radiation on preimplantation embryo morphokinetics and blastocyst viability in mice. For superovulation, 20 female mice were treated with intraperitoneal (IP) injections of 10 IU pregnant mare’s serum gonadotropin (Folligon® PMSG), followed by 10 IU of human chorionic gonadotropin (hCG) after 48 h. The zygotes (n = 150) from the control group were incubated for 4 days. The experimental zygotes (n = 150) were exposed to a cell phone emitting EMR with a frequency range 900–1800 MHz for 30 min on day 1. Then, all embryos were cultured in the time-lapse system and annotated based on time points from the 2-cell stage (t2) to hatched blastocyst (tHDyz), as well as abnormal cleavage patterns. Blastocyst viability was assessed using Hoechst and propidium iodide staining. Significant increases (P < 0.05) were observed in the cleavage division time points of t2, t8, t10, and t12 of the experimental group compared with the controls. In terms of blastocyst formation parameters, a delay in embryo development was observed in the experimental group compared with the controls. Data analysis of the time intervals between the two groups showed a significant difference in the s3 time interval (P < 0.05). Also, the rates of fragmentation, reverse cleavage, vacuole formation, and embryo arrest were significantly higher in the experimental group (P < 0.05). Furthermore, the cell survival rate in the experimental group was lower than the control group (P < 0.05). Exposure to EMR has detrimental consequences for preimplantation embryo development in mice. These effects can manifest as defects in the cleavage stage and impaired blastocyst formation, leading to lower cell viability.
The literature investigates trade-environment relationship at the firm level, but does not focus on the environmental effect of trade policy uncertainty. In the context of de-globalization and Sino-US trade friction, trade policy uncertainty significantly increases. How does trade policy uncertainty affect firms’ pollution emissions? In this study, we incorporate energy, pollution, and trade policy uncertainty into Melitz’s (2003) framework and construct a theoretical model to reveal the relationship between trade policy uncertainty and pollution emissions. Then, we employ the event that the USA granted permanent normal trade relationship to China as a quasi natural experiment. We use difference-in-difference-in-difference model and the data of Chinese manufacturing firms for empirical analysis. Our results indicate that the decrease in trade policy uncertainty reduces emission intensity of exporting firms, but has no significant impact on emission levels. Given that these firms do not aggravate emission levels under the condition of expanding output scale, we conclude that the decrease in trade policy uncertainty can improve environmental performance. Mechanism analysis shows an interesting finding that the decrease in trade policy uncertainty reduces emission intensity mainly by improving energy efficiency rather than improving abatement technology and optimizing energy structure. In addition, pollution reductions mainly occur in pollution-intensive and capital-intensive industries as well as coastal regions. Altogether, this study contributes to the literature on trade-environment relationship and trade policy uncertainty.
Although chemical and radiological agents cause toxicity through different mechanisms, the multiorgan injuries caused by these threats share similarities that convene on the level of basic biological responses. This publication will discuss these areas of convergence and explore “multi-utility” approaches that could be leveraged to address common injury mechanisms underlying actions of chemical and radiological agents in a threat-agnostic manner. In addition, we will provide an overview of the current state of radiological and chemical threat research, discuss the US Government’s efforts toward medical preparedness, and identify potential areas for collaboration geared toward enhancing preparedness and response against radiological and chemical threats. We also will discuss previous regulatory experience to provide insight on how to navigate regulatory paths for US Food and Drug Administration (FDA) approval/licensure/clearance for products addressing chemical or radiological/nuclear threats. This publication follows a 2022 trans-agency meeting titled, “Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures,” sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health (NIH). Discussions from this meeting explored the overlapping nature of radiation and chemical injury and spurred increased interest in how preparedness for one threat leads to preparedness for the other. Herein, subject matter experts from the NIAID and the Biomedical Advanced Research and Development Authority (BARDA), a part of the Administration for Strategic Preparedness and Response (ASPR), summarize the knowledge gained from recently funded biomedical research, as well as insights from the 2022 meeting. These topics include identification of common areas for collaboration, potential use of biomarkers of injury to identify injuries caused by both hazards, and common and widely available treatments that could treat damage caused by radiological or chemical threats.
Dicarbonyl compounds are highly reactive precursors of advanced glycation end products (AGE), produced endogenously, present in certain foods and formed during food processing. AGE contribute to the development of adverse metabolic outcomes, but health effects of dietary dicarbonyls are largely unexplored. We investigated associations between three dietary dicarbonyl compounds, methylglyoxal (MGO), glyoxal (GO) and 3-deoxyglucosone (3-DG), and body weight changes in European adults. Dicarbonyl intakes were estimated using food composition database from 263 095 European Prospective Investigation into Cancer and Nutrition–Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home in Relation to Anthropometry participants with two body weight assessments (median follow-up time = 5·4 years). Associations between dicarbonyls and 5-year body-weight changes were estimated using mixed linear regression models. Stratified analyses by sex, age and baseline BMI were performed. Risk of becoming overweight/obese was assessed using multivariable-adjusted logistic regression. MGO intake was associated with 5-year body-weight gain of 0·089 kg (per 1-sd increase, 95 % CI 0·072, 0·107). 3-DG was inversely associated with body-weight change (–0·076 kg, −0·094, −0·058). No significant association was observed for GO (0·018 kg, −0·002, 0·037). In stratified analyses, GO was associated with body-weight gain among women and older participants (above median of 52·4 years). MGO was associated with higher body-weight gain among older participants. 3-DG was inversely associated with body-weight gain among younger and normal-weight participants. MGO was associated with a higher risk of becoming overweight/obese, while inverse associations were observed for 3-DG. No associations were observed for GO with overweight/obesity. Dietary dicarbonyls are inconsistently associated with body weight change among European adults. Further research is needed to clarify the role of these food components in overweight and obesity, their underlying mechanisms and potential public health implications.
We show that the conceptual distance between any two theories of first-order logic is the same as the generator distance between their Lindenbaum–Tarski algebras of concepts. As a consequence of this, we show that, for any two arbitrary mathematical structures, the generator distance between their meaning algebras (also known as cylindric set algebras) is the same as the conceptual distance between their first-order logic theories. As applications, we give a complete description for the distances between meaning algebras corresponding to structures having at most three elements and show that this small network represents all the possible conceptual distances between complete theories. As a corollary of this, we will see that there are only two non-trivial structures definable on three-element sets up to conceptual equivalence (i.e., up to elementary plus definitional equivalence).
Bamako, March 1991. 100,000 protesters took to the street challenging Mali's military regime. Both men and women participated in six months of protests, their actions shaped by class, gender, and generation. The press, in its reporting, produced a specific, gendered, image of protest, involving young men protesters and their exceptional mères indociles (rebellious mothers) motivated to protest by the risk of bodily harm to their children.1
Despite her current marginal position, the nineteenth-century pianist and composer Delphine von Schauroth (1813–1887) once ranked among the most prominent virtuosos of the nineteenth century and had connections with Fanny Hensel, Ferdinand Hiller, Josephine Lang, Franz Liszt, Felix Mendelssohn, Robert Schumann and others. Drawing on large body of music criticism, as well as compositions, letters, images and literary works, this article presents a portrait of Schauroth as an artist, with an emphasis on the role of improvisation and the improvisatory in her pianism. In particular, the article fleshes out Robert Schumann's characterization of Schauroth as a ‘Corinna-sister’, a reference to the improvising poetess of Madame de Stäel's novel Corinne, or Italy. The article suggests that Schumann's comparison highlights key facets of Schauroth's status and character as a pianist and composer. Firstly, like Corinne, Schauroth was widely renowned as an eminent performer and was celebrated as a genius by critics, which was particularly notable for a woman musician in the early nineteenth century. Secondly, Schauroth was received as a creator, not only for her compositions, but also for her performances: in the late 1820s and early 1830s, in particular, critics responded to these performances with images of magical creation and an emphasis on the newness of her performance over the composer's work. Thirdly, Schauroth displayed a varied practice of improvisation, and her compositions were understood as having an improvisatory character.
To evaluate the impact of an intervention to limit dispersal from wastewater drain (WWD) sites on meropenem-nonsusceptible Pseudomonas aeruginosa patient and environmental colonization and bloodstream infection (BSI) on a hematopoietic cell transplant (HCT) and hematologic malignancy (HM) unit.
Design:
This quasi-experimental study included pre/postintervention point-prevalence surveys in July 2019 and June 2020, respectively. The retrospective cohort included HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.
Setting:
Adult HCT/HM unit at an academic center.
Participants:
This study included consenting HCT/HM patients on the unit at the time of the point-prevalence surveys. HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.
Methods:
A quality improvement intervention targeting WWD sites was conceived and implemented on a HCT/HM unit. Pre and postintervention colonization samples were obtained from patients and environmental sites, cultivated on selective media, then characterized by susceptibility testing. Whole-genome sequencing and phylogenetic analysis were performed on select isolates. The impact of the intervention on colonization and BSI was evaluated, as was relatedness among isolates.
Results:
Although colonization of WWD sites with meropenem-nonsusceptible P. aeruginosa was widespread before and after this intervention, we observed a substantial decline in patient colonization (prevalence rate ratio, 0.35; 95% confidence interval [CI], 0.04–3.12) and BSI (incidence rate ratio, 0.67; 95% CI, 0.31–1.42) after the intervention. Among 3 predominant sequence types (ST-111, ST-446, and ST-308), there was striking genetic conservation within groups and among environmental colonization, patient colonization, and BSI isolates.
Conclusions:
An intervention targeting WWD sites on a HCT/HM unit had a meaningful impact on meropenem-nonsusceptible P. aeruginosa patient colonization and BSI.
Pralidoxime is the only oxime antidote to organophosphate poisoning stocked in the United Kingdom, produced by rational drug design in the 1950s. Typically, it is used alongside atropine, to reverse the effects of acetylcholinesterase inhibition. However, its efficacy has been questioned by recent meta-analyses of use treating attempted suicides in less economically developed countries, where organophosphate poisoning is more common. This policy analysis assesses the likely efficacy of pralidoxime in the United Kingdom, in scenarios largely different from those evaluated in meta-analyses. In all scenarios, the UK delay in antidote administration poses a major problem, as pralidoxime acts in a time-critical reactivation mechanism before “ageing” of acetylcholinesterase occurs. Additionally, changes in the organophosphates used today versus those pralidoxime was rationally designed to reverse, have reduced efficacy since the 1950s. Finally, the current dosage regimen may be insufficient. Therefore, one must re-evaluate our preparedness and approach to organophosphate poisoning in the United Kingdom.