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Introducing Feedback Informed Preference Accommodation (FIPA): A Case Study in Clinical Practice
Get PDFPsychotherapy is a successful modality for those who engage in and complete a course of treatment. However, attrition rates and negative outcomes make up a significant and under discussed proportion of clinicians’ case load in routine practice. Innovative and novel methods to address these issues have been identified within the extant literature. However, their uptake can be impacted by issues such as utility and brevity. The present paper seeks to establish a framework for integrating Feedback Informed Treatment (FIT) and the Cooper-Norcross Inventory of Preferences (C-NPI) in clinical practice. That is, using the C-NPI for initial preference accommodation and following this up on a session to session basis to monitor the process and outcome of therapy. An overview of both approaches is provided, and a rationale for their integration elucidated. The author terms this integration, Feedback Informed Preference Accommodation (FIPA). A Case Study is put forward to demonstrate this process in clinical practice
I Didn\u27t Know You Had a Daughter
Get PDFI have heard it said that one of the hardest genres to write is the memoir. It is definitely the most emotionally and physically draining writing I have ever done. Reliving traumatic events and finding the right balance between accuracy and forgiveness is an exercise in mental contortions. There have been many days where I felt like the world’s most impossible necklace knot by the end of writing a single page.
By completing this memoir, I am untangling a knot and freeing my true self. I\u27m sharing my story. It is not a story of trauma and child abuse, even though those things did occur, it is a story of redemption and forgiveness. It is a story of understanding. Not just of those who caused the abuse, but of myself and the journey that made me and became my story.
It is my most sincere hope and prayer that my story can help someone else who is enduring the devastating effects of emotional, spiritual, and manipulative abuse. These forms of abuse are often overlooked and discounted. But they are devastating and can become crippling. They pass from generation to generation and destroy a person’s sense of self-worth. They lead to depression, anxiety, self-destructive behavior, and in many cases suicide. It is through Divine intervention that I am here today to write my story. I never succeeded in my desire to disappear and sometimes to die. Help arrived when I least expected it and often didn’t want it. I hope this can be a form of help to someone else in need
A Comparison of Clinical Spinal Mobility Measures to Experimentally Derived Lumbar Spine Passive Stiffness
No full textSpinal stiffness and mobility assessments vary between clinical and research settings, potentially hindering the understanding and treatment of low back pain. A total of 71 healthy participants were evaluated using 2 clinical assessments (posteroanterior spring and passive intervertebral motion) and 2 quantitative measures: lumped mechanical stiffness of the lumbar spine and local tissue stiffness (lumbar erector spinae and supraspinous ligament) measured via myotonometry. The authors hypothesized that clinical, mechanical, and local tissue measures would be correlated, that clinical tests would not alter mechanical stiffness, and that males would demonstrate greater lumbar stiffness than females. Clinical, lumped mechanical, and tissue stiffness were not correlated; however, gradings from the posteroanterior spring and passive intervertebral motion tests were positively correlated with each other. Clinical assessments had no effect on lumped mechanical stiffness. The males had greater lumped mechanical and lumbar erector spinae stiffness compared with the females. The lack of correlation between clinical, tissue, and lumped mechanical measures of spinal stiffness indicates that the use of the term stiffness by clinicians may require reevaluation; clinicians should be confident that they are not altering mechanical stiffness of the spine through segmental mobility assessments; and greater resting lumbar erector stiffness in males suggests that sex should be considered in the assessment and treatment of the low back
Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery
No full textPrevious preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1-Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD
Muscle fat infiltration following whiplash: A computed tomography and magnetic resonance imaging comparison
No full textHere we present a secondary analysis from a parent database of 97 acutely injured participants enrolled in a prospective inception cohort study of whiplash recovery after motor vehicle collision (MVC). The purpose was to investigate the deep and superficial neck extensor muscles with peri-traumatic computed tomography (CT) and longitudinal measures of magnetic resonance imaging (MRI) in participants with varying levels of whiplash-related disability. Thirty-six underwent standard care imaging of the cervical spine with CT at a level-1 trauma designated emergency department. All 36 participants were assessed with MRI of the cervical spine at \u3c1-week, 2-weeks, 3-, and 12-months post-injury and classified into three groups using initial pain severity and percentage scores on the Neck Disability Index (recovered (NDI of 0-8%), mild (NDI of 10-28%), or severe (NDI ≥ 30%)) at 3-months post MVC. CT muscle attenuation values were significantly correlated to muscle fat infiltration (MFI) on MRI at one-week post MVC. There was no significant difference in muscle attenuation across groups at the time of enrollment. A trend of lower muscle attenuation in the deep compared to the superficial extensors was observed in the severe group. MFI values in the deep muscles on MRI were significantly higher in the severe group when compared to the mild group at 1-year post MVC. This study provides further evidence that the magnitude of 1) deep MFI appears unique to those at risk of and eventually transitioning to chronic WAD and that 2) pre- or peri-traumatic muscular health, determined by CT muscle attenuation, may be contribute to our understanding of long-term recovery
Imperfection Measures and the Production of Poverty: A Case Study of the Use of the Asset Index in Bangladesh
No full textThis paper takes as its starting point the analytical distinction between a ‘difference-making’ approach and a ‘production approach’ to poverty, both of which relate to the causes of poverty and how it is measured. Although asset indices have been criticized for merely addressing correlates of poverty, we maintain that it can in fact provide an understanding of households’ conditions of reproduction and in turn, reflect upon relational aspects of poverty. We draw on household surveys in two selected villages in Bangladesh and use an asset index as a proxy for overall level of welfare. The asset scores were able to distinguish across sharecropper households but could not distinguish across landholdings, except in one site. Moreover, the asset scores show how migration can have transformative effects on welfare outcomes and at the same time constitute a fragile and uneven process that does not reap benefits to all. We demonstrate how the asset index, albeit an imperfect measure, when carefully constructed, can in fact shed light on the structural causes of poverty
Overcoming Barriers: Individual Experiences Obtaining Medication-Assisted Treatment for Opioid Use Disorder
No full textMedication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. Guided interviews were conducted with 20 participants. The frameworks of critical social theory, intersectionality theory, and the brain opioid theory of social attachment were used to guide data analysis and interpretation. Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural–urban MAT disparity, leading to enhanced recovery capacity and transformative policies
Ghrelin signaling contributes to fasting-induced attenuation of hindbrain neural activation and hypophagic responses to systemic cholecystokinin in rats
No full textIn rats, overnight fasting reduces the ability of systemic cholecystokinin-8 (CCK) to suppress food intake and to activate cFos in the caudal nucleus of the solitary tract (cNTS), specifically within glucagon-like peptide-1 (GLP-1) and noradrenergic (NA) neurons of the A2 cell group. Systemic CCK increases vagal sensory signaling to the cNTS, an effect that is amplified by leptin and reduced by ghrelin. Since fasting reduces plasma leptin and increases plasma ghrelin levels, we hypothesized that peripheral leptin administration and/or antagonism of ghrelin receptors in fasted rats would rescue the ability of CCK to activate GLP-1 neurons and a caudal subset of A2 neurons that coexpress prolactin-releasing peptide (PrRP). To test this, cFos expression was examined in ad libitum-fed and overnight food-deprived (DEP) rats after intraperitoneal CCK, after coadministration of leptin and CCK, or after intraperitoneal injection of a ghrelin receptor antagonist (GRA) before CCK. In fed rats, CCK activated cFos in ~60% of GLP-1 and PrRP neurons. Few or no GLP-1 or PrRP neurons expressed cFos in DEP rats treated with CCK alone, CCK combined with leptin, or GRA alone. However, GRA pretreatment increased the ability of CCK to activate GLP-1 and PrRP neurons and also enhanced the hypophagic effect of CCK in DEP rats. Considered together, these new findings suggest that reduced behavioral sensitivity to CCK in fasted rats is at least partially due to ghrelin-mediated suppression of hindbrain GLP-1 and PrRP neural responsiveness to CCK
Down by the riverside: Riparian edge effects on three monkey species in a fragmented Costa Rican forest
No full textRivers represent natural edges in forests, serving as transition zones between landscapes. Natural edge effects are important to study to understand how intrinsic habitat variations affect wildlife as well as the impact of human-induced forest fragmentation. We examined the influence of riparian and anthropogenic edge on mantled howler, white-faced capuchin, Central American spider monkeys, and vegetation structure at La Suerte Biological Research Station (abbreviated as LSBRS), Costa Rica. We predicted lower monkey encounter rate, tree species richness, and median dbh at both edge types compared to interior and that monkeys would show species-specific responses to edge based on size and diet. We expected large, folivorous–frugivorous howler monkeys and small, generalist capuchins would be found at increased density in forest edge, while large, frugivorous spider monkeys would be found at decreased density in forest edge. We conducted population and vegetation surveys along interior, riparian, and anthropogenic edge transects at LSBRS and used GLMM to compare vegetation and monkey encounter rate. Tree species richness and median dbh were higher in forest interior than anthropogenic edge zones. Although spider monkey encounter rate did not vary between forest edges and interior, howler monkeys were encountered at highest density in riparian edge, while capuchins were encountered at highest density in anthropogenic edge. Our results indicate that diverse forest edges have varying effects on biota. Vegetation was negatively affected by forest edges, while monkey species showed species-specific edge preferences. Our findings suggest that riparian zones should be prioritized for conservation in Neotropical forests. Abstract in Spanish is available with online material
Exploring factors associated with health disparities in asthma and poorly controlled asthma among school-aged children in the U.S.
No full textObjective: Certain populations suffer disproportionately from asthma and asthma morbidity. The objective was to provide a national descriptive profile of asthma control and treatment patterns among school-aged children (SAC: aged 6–17) in the U.S. Methods: This was a cross-sectional analysis using the nationally representative 2007–2014 Medical Expenditure Panel Survey. Among SAC with asthma, indicators of poor control included: exacerbation/asthma attack; \u3e3 canisters short-acting beta agonist (SABA)/3 months; and asthma-specific Emergency Department or inpatient visits (ED/IP). Results: Non-Hispanic black, non-Hispanic multiple races, Puerto Rican, obese, Medicaid, poor, ≥2 non-asthma chronic comorbidities (CC), and family average CC ≥ 2 were associated with higher odds of having asthma. The following had significantly higher odds ratios (OR) of excessive SABA use compared to non-Hispanic whites [OR; CI; p \u3c 0.05]: Puerto Rican (3.8; 2.1–6.9), Mexican (3.6; 2.0–6.4), Central/South American (3.0; 1.2–7.7), Hispanic-other (3.1; 1.1–9.0), non-Hispanic black (2.5; 1.6–3.9), and non-Hispanic Asian (4.0; 1.7–9.2). SABA OR were also significant for Spanish spoken at home (2.5; 1.6–3.8), obese (2.1; 1.3–3.3), Medicaid (2.9; 2.0–4.1), no medical insurance (2.1; 1.1–4.1), no prescription insurance (2.5; 1.8–3.5), poor (2.8; 1.7–4.7), CC ≥ 2 (2.1; 1.6–2.8), parent-without high-school degree (2.5; 1.8–3.6), parent-SF-12 Physical Component Scale \u3c50 (1.6; 1.2–2.1) and Mental Component Scale \u3c50 (1.5; 1.1–2.0). Significant differences also existed across subgroups for ED/IP visits. Conclusions: There are disparities in asthma control and prevalence among certain populations in the U.S. These results provide national data on disparities in several indicators of poor asthma control beyond the standard race/ethnicity groupings