解脲支原体致病性与治疗决策

解脲支原体,是女性泌尿生殖道常见的一种介于细胞和病毒之间的微生物,可以通过性接触传播,在一定的条件下可以成为致病病原体。由于对其致病性认识不清,临床上对宫颈分泌物解脲支原体检测阳性的女性,存在不规范大剂量滥用抗生素,导致其耐药性日趋严量,因此对解脲支原体致病性和治疗的研究已成为目前研究的热点。现简要讨论其生物学特性、致病性与治疗。     

Supervision in Community Mental Health: Understanding Intensity of EBT Focus

The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision.     

Willingness to Seek Treatment Among Black Students With Anxiety or Depression: The Synergistic Effect of Sociocultural Factors With Symptom Severity and Intolerance of Uncertainty

Anxiety and depressive disorders are among the most commonly diagnosed psychiatric disorders, yet they remain largely undertreated in the U.S. and Black adults are especially unlikely to seek or receive mental health services. Symptom severity has been found to impact treatment-seeking behaviors as have sociocultural factors. Yet no known research has tested whether these factors work synergistically to effect willingness to seek treatment. Further, emerging data point to the importance of transdiagnostic risk factors such as intolerance of uncertainty (IU). IU may be negatively related to seeking treatment given that Black adults may be uncertain whether treatment might benefit them. Thus, the current study examined the relations between symptom severity/IU and willingness to seek treatment for anxiety/depression problems and the impact of key sociocultural variables (i.e., cultural mistrust–interpersonal relations [CMI-IR], perceived discrimination [PED]) on these relations among 161 (85% female) Black undergraduates. Consistent with prediction, symptom severity was positively related to willingness, but unexpectedly, IU was positively related. There was a significant Symptom Severity × CMI-IR interaction such that severity was positively related to willingness among students with lower cultural mistrust, but not higher mistrust. There were also significant IU × PED interaction such that IU was positively related to willingness among students with lower PED, but not higher PED. Results highlight the importance of considering the interplay between symptom severity, transdiagnostic vulnerability factors, and sociocultural variables when striving to identify factors related to treatment seeking behaviors among anxious and/or depressed Black students.     

Unfair treatment and self-regulatory focus

Ample correlational evidence exists that perceived unfair treatment is negatively related to well-being, health, and goal striving but the underlying process is unclear. We hypothesized that effects are due in part to contextual priming of prevention focus and the negative consequences of chronic prevention-focused vigilance. Indeed, reasonable responses to unfair treatment—to avoid situations in which it occurs or if this is not possible, confront it head on—fit prevention self-regulatory focus response patterns. Results from three experiments support this notion. Priming stigmatized social category membership heightened students’ prevention (not promotion) focus (n = 117). Priming non-stigmatized social category membership (i.e., white) did not change prevention focus (n = 46). Priming prevention (not promotion) increased perceptions of unfair treatment (and aroused prevention-relevant fight or flight responses) in response to a negative ambiguous job situation among low and moderate income adults (n = 112).     

自由基与脑卒中治疗决策的系统思维

脑卒中是神经系统疾病中最常见的危重急症,为全世界人口死亡的三大原因之一。脑卒中的早期治疗及其细节正确与否直接决定患者的预后。近年来,自由基在脑卒中后继发性脑损害的作用日益受到重视,自由基损害贯穿于脑卒中早期治疗的整个过程,脑卒中的治疗决策有必要着眼于机体内自由基的系统特征,从系统整体出发进行最优化的科学思维。     

足踝部创伤后畸形的修复决策

足踝部创伤后遗畸形是临床上最常见也是最棘手的病症之一。作为人体活动的支撑和力学传导支柱,足踝创伤后畸变将造成连锁的踝关节、膝关节、髋关节和脊柱的退变,最后严重影响患者的生活质量。因此,需要运用哲学体系的思路和理念来指导此类病症的临床诊治,以求获得最佳的远期疗效。本文根据足踝部不同部位创伤后遗畸形的治疗作一综合性论述,为临床作基本的指导。     

A Single-Subject Evaluation of the Treatment of Morphing Fear

We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.     

Acceptability,Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.     

‘Age-hardened alloy’ based on bulk polycrystalline oxide ceramic

We report here for the first time the development of ‘age-hardened/toughened’ ceramic alloy based on MgO in the bulk polycrystalline form. This route allows for the facile development of a ‘near-ideal’ microstructure characterized by the presence of nanosized and uniformly dispersed second-phase particles (MgFe₂O₄) within the matrix grains, as well as along the matrix grain boundaries, in a controlled manner. Furthermore, the intragranular second-phase particles are rendered coherent with the matrix (MgO). Development of such microstructural features for two-phase bulk polycrystalline ceramics is extremely challenging following the powder metallurgical route usually adopted for the development of bulk ceramic nanocomposites. Furthermore, unlike for the case of ceramic nanocomposites, the route adopted here does not necessitate the usage of nano-powder, pressure/electric field-assisted sintering techniques and inert/reducing atmosphere. The as-developed bulk polycrystalline MgO–MgFe₂O₄ alloys possess considerably improved hardness (by ~52%) and indentation toughness (by ~35%), as compared to phase pure MgO.