Different Phases Of Treatment Research Articles

Family-oriented care and health-related quality of life for women with gynaecological cancer: A cross-sectional mixed-method study.

This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©). A cross-sectional mixed-method study. The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27). The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions. In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare. This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families. This study was prepared and reported according to the STROBE checklist. No patient or public contribution.

Hypnosis: a complementary tool for managing adolescents affected by anorexia nervosa

Anorexia Nervosa (AN) mainly affects adolescent girls and requires specialized, multidisciplinary care. In Geneva, the HUG's AliNEA unit and the pediatric hypnosis consultation have been collaborating since 2021 to integrate hypnosis into the management of AN. Hypnosis is seen as a complementary tool to the Maudsley therapeutic model, but not a miracle solution. It needs to be adapted to each patient's individual needs and to the different phases of treatment : re-association with the body, reinforcement of motivation, exploration of interpersonal relationships and consolidation of progress. Although scientific evidence is limited, patient testimonials underline its beneficial potential as a non-medicinal, individualized form of support.

High monocytic MDSC signature predicts multi-drug resistance and cancer relapse in non-Hodgkin lymphoma patients treated with R-CHOP.

Non-Hodgkin Lymphoma (NHL) is a heterogeneous lymphoproliferative malignancy with B cell origin. Combinatorial treatment of rituximab, cyclophsphamide, hydroxydaunorubicin, oncovin, prednisone (R-CHOP) is the standard treatment regimen for NHL, yielding a complete remission (CR) rate of 40-50%. Unfortunately, considerable patients undergo relapse after CR or initial treatment, resulting in poor clinical implications. Patient's response to chemotherapy varies widely from static disease to cancer recurrence and later is primarily associated with the development of multi-drug resistance (MDR). The immunosuppressive cells within the tumor microenvironment (TME) have become a crucial target for improving the therapy efficacy. However, a better understanding of their involvement is needed for distinctive response of NHL patients after receiving chemotherapy to design more effective front-line treatment algorithms based on reliable predictive biomarkers. Peripheral blood from 61 CD20+ NHL patients before and after chemotherapy was utilized for immunophenotyping by flow-cytometry at different phases of treatment. In-vivo and in-vitro doxorubicin (Dox) resistance models were developed with murine Dalton's lymphoma and Jurkat/Raji cell-lines respectively and impact of responsible immune cells on generation of drug resistance was studied by RT-PCR, flow-cytometry and colorimetric assays. Gene silencing, ChIP and western blot were performed to explore the involved signaling pathways. We observed a strong positive correlation between elevated level of CD33+CD11b+CD14+CD15- monocytic MDSCs (M-MDSC) and MDR in NHL relapse cohorts. We executed the role of M-MDSCs in fostering drug resistance phenomenon in doxorubicin-resistant cancer cells in both in-vitro, in-vivo models. Moreover, in-vitro supplementation of MDSCs in murine and human lymphoma culture augments early expression of MDR phenotypes than culture without MDSCs, correlated well with in-vitro drug efflux and tumor progression. We found that MDSC secreted cytokines IL-6, IL-10, IL-1β are the dominant factors elevating MDR expression in cancer cells, neutralization of MDSC secreted IL-6, IL-10, IL-1β reversed the MDR trait. Moreover, we identified MDSC secreted IL-6/IL-10/IL-1β induced STAT1/STAT3/NF-κβ signaling axis as a targeted cascade to promote early drug resistance in cancer cells. Our data suggests that screening patients for high titre of M-MDSCs might be considered as a new potential biomarker and treatment modality in overcoming chemo-resistance in NHL patients.

Blood Product Utilization Among Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia: A Single Center Ex

Background: Adolescent and young adult (AYA, 15-39 years old) patients with acute lymphoblastic leukemia (ALL) often experience pancytopenia and severe immunosuppression. Particularly during intensive phases of chemotherapy, allogeneic blood transfusion support is essential in their care. The utilization of both red blood cell (RBC) and platelet transfusions, as well as the thresholds used to determine when transfusions are needed, are poorly described in this population. The objective of this study is to describe blood product utilization in AYA patients with ALL treated at our institution.
 Methods: A cohort of 20 AYA patients with ALL treated at Riley Hospital for Children from October 2020 to July 2023 were identified for data collection. Pre- and post-transfusion laboratory values, transfusion totals, comorbid events or complications, transfusion reactions, and minimal residual disease (MRD) values were collected and analyzed. All values reported are mean ± standard deviation for continuous variables and n (%) for categorical variables. Values were calculated individually for each patient for each phase of therapy and averaged across all patients.
 Results: Patients studied had varying needs for transfusions throughout their therapy (50.75 ± 48.06), with an average of 22.95 ± 15.65 RBC transfusions and 25.60 ± 29.65 platelet transfusions. Patients being treated with standard chemotherapy protocols required moretransfusions during induction (14.13 ± 21.56) and delayed intensification (14.07 ± 24.29) phases compared to other phases. Patients with MRD positive status required more transfusions (69.14 ± 58.14) than patients with MRD negative status (40.92 ± 40.84).
 Conclusions and Potential Impacts: This study helped to elucidate the need for transfusions among the AYA ALL patient population, throughout the different phases of treatment. These findings hold implications for establishing guidelines that could clarify when transfusions should be given in this population, helping physicians provide the best care to future patients.

Peripheral T lymphocyte and immunocyte subset dynamics: markers of neoadjuvant therapy outcomes in esophageal squamous cell carcinoma.

In patients with resectable esophageal squamous cell carcinoma (ESCC), neoadjuvant therapy increased the curative resection rate, disease-free survival, and overall survival for patients with resectable ESCC. However, the efficacy of neoadjuvant therapy varies among different patients. We aim to compare the differences in the characteristics of peripheral blood T lymphocyte subsets before and after neoadjuvant therapy in patients with different curative efficacy. This study enrolled 266 ESCC patients who received neoadjuvant therapy and esophagectomy from August 2018 to August 2022. The postoperative pathological results divided patients into the major pathological response (MPR) and non-MPR groups. Compare the differences in peripheral blood T lymphocyte subsets and analyze the trend of changes in T lymphocyte subsets at different phases of treatment. Propensity score matching was used to reduce the influence of potential confounding factors. Prior to the neoadjuvant therapy, particularly before the second cycle, the MPR group exhibited significantly higher ratios of CD4/CD8 (P=0.009) and helper T cells (TH ratio, P=0.030) compared to the non-MPR group. In contrast, the suppressor T cell ratio (TS ratio) was lower (P=0.016) in the MPR group. The difference in peripheral blood lymphocyte subsets between the two groups of patients who underwent neoadjuvant chemoradiotherapy is significant. In peripheral blood, T lymphocyte subsets varied significantly based on the effectiveness of neoadjuvant treatment. Prior to the second cycle of neoadjuvant therapy, a higher CD4/CD8 and TH ratio, coupled with a decreased TS ratio, might suggest enhanced treatment outcomes.

Orthodontic treatment in stage IV periodontitis patients: Timing, management and long-term prognosis

Patients affected by severe periodontitis can develop a secondary malocclusion due to pathologic tooth migration that, if untreated, can hinder the maintenance of the entire dentition. In these cases, the combination of the appropriate stepwise periodontal therapy together with orthodontic treatment may become essential to re-establish health, aesthetics and function, leading to patient satisfaction and long-term stability. However, to successfully perform orthodontic tooth movement in stage IV periodontitis patients is paramount to carefully plan the treatment with a interdisciplinary approach, respecting the correct timing of the different phases of treatment, adapting biomechanics and appliance design individually, considering loss of periodontal support suffered from each patient. At the end of orthodontic treatment, after eventual prosthetic procedures, life-long retention and supportive periodontal care are needed to ensure good long-term prognosis. The present review describes the diagnostic, prognostic and therapeutic challenges associated with the combined ortho-perio treatment of stage IV periodontitis patients, providing both a literature and expert-based support for a biologically-orientated approach.

Clinical characteristics and treatment approaches in patients with Susac syndrome: a scoping review of cases.

Susac syndrome (SuS) is a rare disease characterized by encephalopathy, hearing impairment and visual disturbances. Immunosuppressive treatments are used based on the hypothesis that an autoimmune endotheliopathy drives the disease. However, a solid evidence-based treatment approach is lacking. The aim of this review is to provide an overview of patient characteristics, disease course and treatment patterns related to successful outcome that have been reported in literature since 2013. Three reviewers conducted a systematic literature search in February 2022. The primary outcome was treatment used, derived from cases classified as probable or definite SuS, describing successful treatment outcome (i.e. no signs of disease activity for ≥ 1month). Secondary outcomes were time-to-relapse and follow-up time. Published case reports and case series were included. Various clinical characteristics and treatment(s) were extracted and categorized into different phases of treatment. A total of 810 records was identified. 120 articles met inclusion criteria and 161 cases were extracted. Of these, 151 cases were classified as probable or definite SuS and included in the final analysis. Number of combinations of treatments used per treatment phase were: 6 empirically, 35 after confirmed diagnosis, 43 for maintenance treatment, 22 after relapse, 18 during maintenance post-relapse. Median follow-up time was 12.3months (0.5; 120) and median time to relapse was 4months (1; 120). This scoping review summarizes treatment approaches in patients with SuS, highlighting variability. International efforts to collect clinical, imaging and treatment data from patients with SuS in registries are needed, in order to provide less biased and long-term follow-up information on treatment response, predictors of relapse and patient outcomes. This may lead to more evidence-based therapeutic approaches.

Optimization of WWTP of Dairy Industry

Moroccan industry, like most industries around the world, today faces a water scarcity. Water is one of the basic utilities for all kinds of production, especially in the agro-food sector. Morocco, a country of bioclimatic and ecological transition with fragile resources, is threatened with rapid degradation in the event of overexploitation of underground water reserves. Indeed, the evolution of the water supply over the last decade already testifies to the irregularity of the outlook and confirms climate failure. “From 1990 to 2000, the resources in m3 per inhabitant per year fell from 1200 to 950. In 2020 the water resources are only around 600m3 / inhabitant / year, at a time when the demand for water total has reached the ceiling of 20 to 21km3 of water that can be mobilized. The country will drop to the shortage threshold for 500m3 / inhabitant / year around the year 2030".In fact, Morocco has launched programs to save water and review some resource allocations in order to meet growing needs. One of these programs is the launch of 10-95 law. It about the regulation of water discharges by establishing a financing instrument based on “the polluter pays” principle. This law has forced several industries, to install wastewater treatment plants (WWTP) for their water discharges to the extent that they meet the standards defined by Law 10-95. On this work, we will present an analysis of the operation of a wastewater treatment plant in a Moroccan dairy, the issues that have arisen and the solutions that have been provided. The analysis of the influential of the WWTP during the different phases of treatment gave results, which allowed us to optimize the performance of each phase and reduce the cost of running the WWTP.

LUNG-IST-127: A pilot phase II study of maintenance cabozantinib plus pembrolizumab for patients with metastatic squamous non-small cell lung cancer (sqNSCLC) with disease control following induction therapy.

TPS9151 Background: First-line combination chemotherapy with pembrolizumab followed by maintenance pembrolizumab is the standard of care treatment for patients with metastatic sqNSCLC. This was established by the phase III KEYNOTE-407 trial, which demonstrated a median progression-free survival (PFS) of 6.4 months in the experimental arm. Despite these advances, there remains a need to continue to improve upon survival outcomes for these patients. Cabozantinib is a small-molecule inhibitor of multiple tyrosine kinsases including MET, VEGFRs, AXL, RET, and ROS, which are receptors involved in tumor cell-proliferation, angiogenesis, and immune cell regulation. Preclinical studies have demonstrated the ability of cabozantinib to modulate both adaptive and innate immune cells and to exhibit synergistic activity when used in combination with immune checkpoint inhibitors. We hypothesize that cabozantinib in combination with pembrolizumab in the maintenance phase of first-line treatment of metastatic sqNSCLC will prolong median PFS with a tolerable toxicity profile. Methods: LUNG-IST 127 is a pilot phase II, single-arm clinical trial of maintenance cabozantinib in combination with pembrolizumab for patients with metastatic sqNSCLC who achieved disease control following standard 1L induction therapy with chemotherapy and pembrolizumab. Thirty-six patients will be enrolled at 2 US sites to receive first-line induction therapy with carboplatin, nab-paclitaxel or paclitaxel, and pembrolizumab for four cycles. After induction therapy, those who have achieved disease control based on re-staging imaging will continue onto maintenance therapy with cabozantinib 40mg PO daily in combination with pembrolizumab 200mg IV every 3 weeks. The primary endpoint is PFS estimated by Kaplan-Meier methods with associated 95% confidence intervals. Based on an exploratory power analysis using an elevated one-sided alpha level of 0.40, we hypothesize that the proposed therapy will prolong median PFS from 6.4 to 9 months. Key secondary endpoints include overall survival (OS), overall response rate (ORR), and characterizing the safety and tolerability of cabozantinib in combination with pembrolizumab. Quality of life will also be measured with the EORTC QLQ-C30. Correlative endpoints include characterizing cfDNA from biofluids and assessing the change in circulating immune cells in different phases of treatment in association with PFS and OS. This trial would be the first to address whether there is clinical benefit in utilizing combination cabozantinib and pembrolizumab in the maintenance phase of treatment in metastatic sqNSCLC. Clinical trial information: NCT05613413 .

Healthcare Utilization Among Patients with Advanced Systemic Light Chain Amyloidosis

Introduction Information on health service use in advanced systemic light chain (AL) amyloidosis, a rare hematologic disease, is outdated and non-specific, in part because there was no ICD-10 code for AL amyloidosis when prior studies were conducted. While there is now an ICD-10 code for AL amyloidosis, healthcare claims datasets do not include lab results and therefore lack Mayo stage (disease severity). Given the limitations of prior real-world studies, we used a validated consensus method to estimate healthcare utilization in patients with advanced AL amyloidosis during different phases of treatment. Methods We used a RAND/UCLA modified Delphi panel method to estimate healthcare utilization in patients with AL amyloidosis including those with advanced stage disease. We defined advanced patients in two ways: Mayo stage 3 or 4 during first-line therapy or those with signs of cardiac involvement (i.e., elevated troponin and/or NT-proBNP) after completing first-line therapy. We conducted the following steps: 1) expert panelists (9 hematologists, 2 cardiologists, 1 patient advocate) with a median 15 years' experience treating and/or managing AL amyloidosis were provided a systematic literature review on utilization in AL amyloidosis; 2) panelists independently estimated utilization (inpatient, outpatient, testing, chemotherapy, procedures) during two treatment phases (the 1-year period after starting first-line therapy and the 1-year period after completing first-line therapy) among advanced patients with varied hematologic treatment response (complete or very good partial response [CR/VGPR], partial or no response); 3) we discussed areas of disagreement during a moderated meeting; 4) panelists completed ratings independently a second time following this discussion. Results During the 1-year period after starting first-line therapy, 1-5% of patients with advanced AL amyloidosis were expected to be treated with a hematopoietic stem cell transplantation (HSCT). Half (45-55%) were expected to have ≥1 hospital admission and 28-38% were expected to have ≥2 hospital admissions, depending on the presence of non-cardiac symptomatic organ involvement. Patients were also expected to have high rates of other utilization in the year after starting first-line therapy: ~25% would receive a bone marrow biopsy, 12-15% would receive a cardiac pacemaker placed, and up to 7% would begin chronic dialysis. In the year after completing first-line therapy, 10% with a CR/VGPR and 15-20% with partial or no response were expected to have ≥2 hospital admissions. High rates of other utilization were expected to continue, especially for advanced patients with partial or no response (50% would receive a bone marrow biopsy and up to 10% would receive a cardiac pacemaker or begin chronic dialysis). Conclusions A diverse panel of experts, guided by a review of the literature and clinical experience, used the modified Delphi panel method to estimate healthcare utilization in patients with advanced AL amyloidosis at different points in the disease course. During the year after starting first-line therapy, advanced patients were expected to have high rates of hospitalization (traditionally the most expensive type of healthcare utilization), were not considered to be good candidates for HSCTs and had high rates of other utilization. Utilization remained high in advanced patients after completing first-line therapy especially for those with partial or no response. The development of new treatment options that can induce CR/VGPR and facilitate organ recovery or improve function may lead to decreased utilization.

Food Insecurity Among People With Cancer: Nutritional Needs as an Essential Component of Care.

A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.

Hubungan Kadar C-Reactive Protein dengan Jumlah Leukosit Penderita Tuberkulosis Paru pada Fase Pengobatan 0 dan 2 Bulan di BKPM Purwokerto

Pulmonary tuberculosis is still a health problem to control in the world. This disease is caused by the bacterium Mycobacterium tuberculosis, which can cause inflammation that can trigger increased levels of C-Reactive Protein and leukocytes in the body. This study was conducted to determine the correlation between C-Reactive Protein levels and the number of leukocytes with treatment phases 0 and 2 months in BKPM Purwokerto. The design of this study was an analytical observation with a cross-sectional research design. Results from 30 pulmonary tuberculosis patients treated for 0 and 2 months showed a correlation between CRP levels and white blood cell counts (p = 0.002, r = 0.445). There is a moderate relationship between CRP levels and leukocyte counts. High levels of CRP correlate with increasing the number of leukocytes. More research is needed on the relationship between CRP levels and leukocyte counts with different phases of treatment.

Lifetime direct healthcare costs of treating colorectal cancer: a systematic review.

Colorectal cancer is a global public health issue and imposes a significant economic burden on populations and healthcare systems. This paper systematically reviews the literature to estimate the direct costs of colorectal cancer incurred during different phases of treatment (initial, continuing and end of life). MEDLINE, EMBASE, Web of science, Evidence-based medicine reviews: National health service economic evaluation database guide, econlit and grey literature from the 1st of January 2000 to the 1st of February 2020. The methodological quality of the included studies was assessed using the Evers' Consensus on health economic criteria checklist. In total, 39,489 records were retrieved, and 17 studies were included. Costs by phase of treatment varied due to heterogeneity. However, studies that examined average costs for each phase of treatment showed a V-shaped distribution where the initial and end of life phases contribute the most and the continuing phase the least. The initial phase ranged from $7,893 to $60,289; the continuing annual phase ranged from $2,323 to $15,744; and the end of life phase ranged from $15,916 to $99,687. Studies that provided the total cost of each phase conversely showed that the continuing phase was the highest contributor to the cost of treating CRC. This study estimates the cost of the contemporary management of colorectal cancer despite the methodological heterogeneity. These costs place a heavy burden on healthcare providers, patients and their families. Identifying these costs can impact health care budgets and guide policymakers in making informed decisions for the future.

Using ROM in family therapy.

Routine outcome monitoring (ROM) is in this article defined as a tool for feedback-informed therapy where clients' therapy relevant information is applied in real-time therapy. Because family therapy represents a comprehensive clinical setting, ROM is experienced as particularly useful. In a vignette from family therapy practice, the use of ROM is demonstrated on individual, couple, and family levels with reference to integrative systemic therapy. ROM information is shown to play a central role in the different phases of treatment. It is demonstrated how ROM facilitates patient-centered assessment that strengthens the therapeutic collaboration such as the working alliance, identifying treatment targets, and possible constraints. In particular, ROM revealing alliance rupture followed by alliance repair is emphasized as a crucial therapeutic event in this treatment.

Long-term trajectory of postoperative health-related quality of life in young breast cancer patients: a 15-year follow-up study.

Breast cancer (BC) patients often experience various long-term sequelae due to aggressive treatment. We analyzed and illustrated long-term trajectory during different phases of treatment and survivorship. Data were obtained from a cohort of 298 BC patients diagnosed between 2004 and 2006 and were followed up until 2020. We measured HRQoL using EORTC QLQ-C30, QLQ-BR23, and EuroQoL-5D questionnaires and conducted eight assessments right after initial diagnosis, during treatment, post-treatment, and during survivorship phases. Linear mixed model was used to assess changes in HRQoL. Overall HRQoL measured by EQ-5D index of long-term BC survivors were further compared with that of the age-matched general population. Of 298 participants, 246 women survived and 124 participated in the long-term follow-up survey (LTFU). Overall, HRQoL functions deteriorated during treatment but gradually improved between 1- and 3-year post-diagnosis and stabilized over LTFU measure. Significant recovery was observed in physical, role, emotional, social functions, and future perspectives (p < 0.05). Treatment-related acute symptoms were reported in the first year but diminished afterward, and treatment-related financial difficulties lessened. At LTFU, BC survivors reported a high level of insomnia, fatigue, and pain and appeared to have poorer overall HRQoL than the general population (mean difference, EQ-5D index: 0.073, p < 0.001). Through 15-year survivorship, BC survivors showed improvement in many aspects of HRQoL. However, some inferior aspects remain relevant for long-term survivors. Ongoing supportive programs concentrating on pain management, persistent cancer-related fatigue, and sleeping problems might aid enhance their HRQoL.

Risk factors for potential drug-drug interactions of statins in patients with acute coronary syndrome

The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study.

BackgroundDepression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care.ObjectiveThe aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression.MethodsThis retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures.ResultsOn average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model.ConclusionsUsing a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.

Direct and indirect effects of SARS-CoV-2 on wastewater treatment

The novel SARS-CoV-2 is expanding internationally. While the current focus is on limiting its transmission from direct contact with infected patients and surfaces during the pandemic, the secondary transmission potential via sewage should not be underestimated, especially in low-income and developing countries with weak wastewater treatment technologies. Recent studies have indicated SARS-CoV-2 positivity also be detected in the feces of patients. Therefore, the risk of transmission and infection can be increased into sewage by the fecal-oral way, mainly in some parts of the globe with a high amount of open defecation. This review collected scattered data and recent studies about the direct and indirect effects of coronavirus in the water cycle. The direct impacts of COVID-19 on wastewater are related to the presence of the coronavirus and suitable viral removal methods in different phases of treatment in wastewater treatment plants. The indirect effects of COVID-19 on wastewater are related to the overuse of cleaning and disinfecting products to protect against viral infection and the overuse of certain drugs to protect against virus or novel mental problems and panic to COVID-19 and consequently their presence in wastewater. This unexpected situation leads to changes in the quality of wastewater and brings adverse and harmful effects for the human, aquatic organisms, and the environment. Therefore, applying effective wastewater treatment technologies with low toxic by-products in wastewater treatment plants will be helpful to prevent the increasing occurrence of these extra contaminants in the environment.

Comparative Evaluation of Changes in Microflora in Delayed and Immediate Implant Placement: An In vivo Study.

Aim:This study is aimed to compare and evaluate the changes in the microflora in immediate and delayed placed implants.Materials and Methods:In this study, the implant site sample was taken and assessed during different phases of treatment for delayed and immediate implants. They were looked for Streptococcus, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, and Fusobacterium nucleatum.Results:The results showed that Streptococci were found in a higher number in all the phases of the treatment. The presence of pathogenic organisms such as P. gingivalis and Fusobacterium, in considerable amounts, was seen in both the groups.Conclusion:Thus, we conclude that implant mode of placement, delayed or immediate placement does not alter the flora of the oral cavity. Organisms present remains the same in all the phase of the treatment. To prevent the disease, one must continuously monitor the implant, with the increasing age changes, the microflora is continually changing in the oral cavity. The periodontal health should be assessed before the placement of the implant, followed by follow-ups after a set period for a better prognosis.

Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy.

This study is the first to investigate the effect of psychodynamic technique (PT), therapeutic alliance, and their interactions with outcome in psychodynamic child psychotherapy. The sample comprised 79 Turkish children (mean age = 6.86 years, 38% girls) with discrete internalizing (22%), discrete externalizing (11%) and comorbid internalizing and externalizing (67%) problems. Independent raters coded 359 sessions from different phases of treatment using the Child Psychotherapy Process Q-Sort for PT and Therapy Process Observational Coding System-Alliance Scale. Problem-assessment measures were collected at intake and every 10th session in treatment using the Children's Behavior Checklist and Brief Problem Monitor. Multilevel modeling analyses indicated that the PT and therapeutic alliance interacted such that more use of the PT in the context of high therapeutic alliance predicted less problem behaviors, whereas in the context of low therapeutic alliance PT predicted more problem behaviors. This relationship was moderated by problem comorbidity such that for children with comorbid problems, though a strong therapeutic alliance was indicated, an increase in PT use did not have a significant effect. Findings suggest that the use of psychodynamic interventions is indicated in the context of a strong therapeutic alliance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic alliance is not established. For children with comorbid problems, keeping the relationship strong is important. (PsycInfo Database Record (c) 2021 APA, all rights reserved).