How Connections Heal Walker, Maureen; Rosen, Wendy B; Miller, Jean Baker
2004
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From faculty and associates of the Stone Center's Jean Baker Miller Training Institute, this practice-oriented casebook shows how relational-cultural theory (RCT) translates into therapeutic action. ...Richly textured chapters-all written especially for this volume-explain key concepts of RCT and demonstrate their application with diverse individuals, couples, families, and groups, as well as in institutional settings. Emphasizing that relationship is the work of therapy, case narratives illuminate both the therapist and client factors that promote or interfere with movement toward connection. Highlighted are the ways in which cultural contexts profoundly influence relationships; how growthful connection inevitably includes conflict; and how experienced therapists work on a moment-by-moment basis to engage with and counteract personal and cultural forces of disconnection.
The red-footed booby,
Sula sula, has been hunted in the Cocos (Keeling) Islands, eastern Indian Ocean, since first settlement in 1827. Formerly present throughout the islands, an estimated 30,000 ...pairs now breed only on isolated and uninhabited North Keeling Island. Despite legislative protection, illegal hunting for food remains a major conservation threat. Informants estimated that 2000–3000 birds are killed in most years and possibly as many as 10,000 in some years. Analysis of nest count data collected between 1985 and 2002 to assess long-term population trends showed no evidence of decline in nesting density. There was large inter-annual variation with substantial fluctuations which tended to be greater following significant cyclonic events. These results indicate that the level of illegal harvest during the study period has not negatively impacted the booby nesting population. Future management of seabird harvesting requires improved knowledge on the population's capacity to sustain harvesting, together with increased enforcement activity to control illegal harvest, and enhanced education programs to encourage change in community attitudes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract
The purpose of this paper is to illustrate the application of music therapy intervention in neurobehavioral treatment programs with pediatric, adolescent and adult populations through the ...presentation of six case reports, with special reference to post-traumatic amnesia. Severe behavioral disorders stemming from brain injury are challenging for both the affected individual and their support network. Managing neurobehavioral disorders requires specialist skills and knowledge of various strategies to minimize behavioral incidents and decrease episodes of agitation. Music therapy interventions are effective in increasing orientation and decreasing agitation in people with post-traumatic amnesia following brain injury (Baker, 2001). However, there is little published guidance or research on music therapy interventions for use in interdisciplinary rehabilitation programs for patients with short-term or chronic neurobehavioral disorders following traumatic brain injury. Music therapy is well-placed as a part of interdisciplinary rehabilitation with this population, offering opportunities to enable emotional expression and improve pragmatic communication skills and social interaction. This case material provided illustrates how music therapists integrate family members into treatment programs, and work with others to enable multidisciplinary and interdisciplinary outcomes.
Correspondence: 1 Corresponding Author: Ling Jin, Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331. ling.jin{at}oregonstate.edu
The ...present report describes the analysis of 4 Deerpox virus isolates from California, Oregon, and Ontario, Canada. All 4 isolates were associated with cutaneous crusting lesions. Examination of selected samples by electron microscopy demonstrated that the viruses were morphologically similar to orthopoxviruses. Phylogenetic analysis of the A21 gene, which is found in all poxviruses, indicated that the 4 isolates form a lineage distinct from other members except for those belonging to the genus Cervidpoxvirus of the subfamily Chordopoxvirinae . Members of the Cervidpoxvirus lineage encode a set of genes not found in other poxviruses. These include homologs of genes encoding interleukin 1 receptor antagonists (IL-1Ra) and C-type lectin-like receptors (CTLR). In the current investigation, genes encoding homologs of IL-1Ra and CTLR were amplified from all the isolates and were found to be closely related to orthologs found in the Cervidpoxvirus genus, which further supports the inclusion of these isolates in the Cervidpoxvirus genus.
Key Words: Cervidpoxvirus Deerpox virus poxvirus Reindeerpox virus
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Objective:
To determine if preoperative heparin therapy causes an increase in the incidence of intraoperative heparin resistance by reducing the concentration of antithrombin in plasma.
Design:
...Prospective laboratory investigation of clinical samples.
Setting:
Public tertiary care hospital and public pathology service.
Participants:
Forty-six patients undergoing cardiac surgery involving cardiopulmonary bypass.
Interventions:
Fourteen patients received preoperative heparin therapy (POHI group) and 32 patients were controls (CONT group).
Measurements and Main Results:
The concentration of antithrombin, activated coagulation time (ACT), and clinical parameters were measured at intervals. More POHI patients had on-bypass heparin resistance than CONT (43% and 3%, respectively,
p < 0.01). The POHI group had a lower concentration of antithrombin than the CONT group before (80.9% and 92.6%, respectively,
p < 0.01) and while on cardiopulmonary bypass (51.6% and 57.5%, respectively,
p = 0.04). Comparison of heparin-resistant and heparin-responsive POHI patients showed that the concentration of antithrombin did not differ before bypass (82.4% and 79.8%, respectively,
p = 0.53) or during bypass (51.8% and 51.4%, respectively,
p = 0.91). In fact, antithrombin concentrations were slightly higher in the heparin-resistant POHI patients (not significant). POHI patients received more heparin than CONT patients (medians 787 U/kg and 600 U/kg, respectively,
p = 0.01) and were transfused with more fresh frozen plasma on bypass (
p = 0.03).
Conclusions:
Preoperative heparin causes an increased incidence of heparin resistance and reduced antithrombin concentrations. However, heparin resistance was not causally related to reduced antithrombin because antithrombin concentrations were not different between heparin-resistant and heparin-responsive patients in the POHI group.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Human lactoferrin is an iron‐binding protein with a bilobal structure. Each lobe contains a high‐affinity binding site for a single Fe3+ ion and an associated ion. Although iron binds very tightly, ...it can be released at low pH, with an accompanying conformational change in which the two domains move apart. The Arg121Asp (R121D) mutant of the N‐lobe half‐molecule of human lactoferrin was constructed in order to test whether the Asp121 side chain could substitute for the ion at the iron‐binding site. The R121D mutant protein was crystallized in its apo form as it lost iron during crystallization. The crystals were also merohedrally twinned, with a twin fraction close to 0.5. Starting from the initial molecular‐replacement solution Breyer et al. (1999), Acta Cryst. D55, 129–138, the structure has been refined at 3.0 Å resolution to an R factor of 13.9% (Rfree of 19.9%). Despite the moderate resolution, the high solvent content and non‐crystallographic symmetry contributed to electron‐density maps of excellent quality. Weakened iron binding by the R121D mutant is explained by occlusion of the anion‐binding site by the Asp side chain. The opening of the two domains in the apoR121D structure (a rotation of 54°) closely matches that of the N‐lobe in full‐length lactoferrin, showing that the extent of the conformational change depends on properties inherent to the N‐lobe. Differences in the C‐terminal portion of the N‐lobe (residues 321–332) for apoR121D relative to the closed wild‐type iron‐bound structure point to the importance of this region in stabilizing the open form.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract 217
HCT is used with curative intent in children with cancer at risk for relapse. Improvements in transplantation strategies have contributed to increments in survival approximating 10% per ...decade. Adult HCT survivors are at increased risk for chronic health conditions (Sun, Blood 2010). The magnitude of risk of these conditions in childhood HCT survivors compared with the general population is not defined. Furthermore, while children treated with conventional therapy carry a substantial burden of morbidity (Oeffinger, N Engl J Med 2006), little data exists regarding the added impact of HCT-related conditioning and GvHD on the prevalence of chronic health conditions and functional status.
Participants were drawn from two studies: BMTSS and CCSS. BMTSS examined long-term outcomes in individuals undergoing HCT between 1976 and 1998 at City of Hope or University of Minnesota. Participants were ≤21 years of age at diagnosis of AML, ALL, HL, and NHL, had survived at least 5 yrs from primary diagnosis and 2 yrs from myeloablative HCT. CCSS is a multi-institutional cohort of five-year survivors of childhood cancer diagnosed between 1970 and 1986, and their siblings. For the current study, participation was limited to those treated conventionally with the same diagnoses as BMTSS. Participants for both studies had completed a questionnaire covering the following areas: presence of physical health conditions (endocrinopathies; central nervous system compromise; cardiopulmonary dysfunction; gastrointestinal sequelae; musculoskeletal abnormalities; and subsequent malignancies); chronic GvHD (BMTSS); and sociodemographics. Responses obtained from BMTSS were compared to conventionally treated childhood cancer survivors and sibling controls enrolled in CCSS. Chronic physical health conditions were graded using CTCAE v 3.0 (grade 1–4, ranging from mild to life-threatening/ disabling). Relative risk regression was used to identify risk of health conditions (RR) and 95% confidence interval (CI).
The current study included 145 BMTSS participants, 4,020 siblings, and 7,207 CCSS cancer survivors. Median age at participation – BMTSS: 24 yrs; childhood cancer survivors: 24.6 yrs; siblings: 26.6; time from diagnosis – BMTSS: 11.9 yrs; CCSS: 15.6 yrs. 79.3% of BMTSS participants reported at least one condition (grades 1–4); 59.3% multiple (≥2); and 25.5% severe or life-threatening conditions (grade 3–4). Prevalence and severity of these conditions was significantly greater for BMTSS when compared with cancer survivors or siblings (Figure). BMTSS vs. Siblings: After adjustment for age at questionnaire, gender, and ethnicity, BMTSS participants were significantly more likely than sibling controls to report chronic health conditions: grades 1–4: RR=2.7 (95% CI, 2.4–3.0, p<0.01); grades 3–4: RR=6.4 (4.6-8.8, p<0.01); multiple conditions: RR=5.9 (5.0-7.0, p<0.01). In addition, BMTSS participants were significantly more likely to report compromised functional status: adverse general health: RR=3.4 (2.1-5.3, p<0.01); activity limitations: RR=6.8 (5.0-9.3, p<0.01); and functional impairment: RR=7.8 (5.1-12.0, p<0.01). BMTSS vs. CCSS cancer survivors: After adjustment for age, follow-up, gender, ethnicity/race, diagnosis, pre-HCT therapeutic exposures (dose-specific chemotherapy, radiation), and treatment era, BMTSS participants were 1.5 (1.3-1.7, p<0.01) times as likely as conventionally treated patients to report a chronic condition; 2.3 (1.5-3.5, p<0.01) times as likely to report severe/ life-threatening conditions; and 2.2 (1.7-2.8, p<0.01) times as likely to report multiple conditions. Allogeneic HCT recipients with a history of chronic GvHD were at a modestly higher risk of reporting multiple chronic health conditions (Table).
Display omitted
RR (95% CI) Grades 1-4RR (95% CI) Grade 3 or 4RR (95% CI) Multiple (≥2) ConditionsConventionally treated (CCSS)1.01.01.0Autologous HCT (BMTSS)1.3 (1.0–1.7)1.7 (0.7–3.9)1.5 (0.9–2.2)Allogeneic HCT, no GvHD (BMTSS)1.5 (1.2–1.7)2.5 (1.6–3.9)2.2 (1.7–2.8)Allogeneic HCT, GvHD (BMTSS)1.7 (1.4–2.0)2.7 (1.3–5.3)2.9 (2.1–3.9)
Childhood HCT survivors carry a significantly higher burden of morbidity when compared with the general population, as well as children treated with conventional therapy, providing evidence for a critical need for close monitoring of this high-risk population.
No relevant conflicts of interest to declare.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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