Journal articles on the topic 'Therapist warmth'

Abstract Introduction CBT for insomnia (CBTI) is effective but a barrier to its widespread use is the lack of evidence-based delivery modalities other than face-to-face. The perception and acceptability of telemedicine for the delivery of CBTI is unknown. We conducted a randomized controlled non-inferiority trial comparing face-to-face (F2F) and telemedicine (via AASM SleepTM) delivery of CBTI. We compared measures of patient satisfaction with treatment and the perception of the therapist’s warmth and skills between F2F and SleepTM. Methods Adults with insomnia were recruited from insomnia clinics and the community and screened for sleep, medical, and mental health disorders. Eligible participants were randomized to receive CBTI either via AASM SleepTM or F2F in 6 weekly sessions of 45-60 minutes each. Participants completed the Client Satisfaction Questionnaire (CSQ-8) and The Therapy Evaluation Questionnaire (TEQ) after completing treatment. The CSQ-8 score ranges from 8-32 with high scores indicating greater satisfaction. We also analyzed the two items on the TEQ that assess participants’ perception of therapist’s warmth and skills. Item scores ranged from 1-7, with higher scores indicating greater warmth and skills. Results Sixty-five adults with chronic insomnia were recruited primarily from insomnia clinics. Sixty-two participants (41 women, mean age 48.9 ± 15.4 years) completed all 6 sessions of CBTI via F2F (n=32) or via AASM SleepTM (n=30). Independent samples t-tests revealed no significant differences between conditions on patient satisfaction (SleepTM, 28.5 +/-4.2 vs F2F 29.9 +/-2.4, t(-1.5), p=.14), therapist warmth (SleepTM, 6.0 ±1.1 vs F2F, 6.4±0.95, t(-1.4), p=.16), or therapist skills (Sleep TM 6.4 ±1.0 vs F2F, 6.7±0.59, t(-1.5), p=.15). Conclusion Our findings suggest no differences in patient satisfaction, perception of therapist’s warmth, or confidence in therapist’s skills between telemedicine (via the AASM SleepTM) and F2F delivery of CBTI. Telemedicine-delivered CBTI should be implemented more widely. Support Research supported by American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt)

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender–specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist—specifically warmth, empathy, encouragement, and guidance—can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

This study examined the effects of students' self-reported ratings on warmth and a female counselor's facilitative behavior on scores measuring the subjects' perception of the counseling relationship. 75 subjects were categorized as warm, neutral, or cool and then randomly assigned to either a facilitative or nonfacilitative counselor condition. Scores from the Barrett-Lennard Relationship Inventory indicate significant main effects for both subjects' warmth and the therapist's facilitative behaviors. In addition, significant interactions between these variables were obtained. The specific interpretations of these results are discussed and methodological issues are identified for further research.

Patients who engage in deliberate self-harm (DSH) form a heterogeneous population. There is a need for psychotherapeutic interventions that give therapists the flexibility to tailor the treatment plan to the needs of an individual patient. To detect essential ingredients for treatment, three different cognitive-behavioral theories of DSH will be reviewed: (1) the cognitive-behavioral theory of Linehan (1993a) , (2) the cognitive theory of Berk, Henriques, Warman, Brown, and Beck (2004) , and (3) the cognitive-behavioral theory of Rudd, Joiner, and Rajab (2001) . A review of these theories makes it possible to compare the different approaches to the essential aspects in the treatment of DSH: a trusting patient-therapist relationship, building emotion regulation skills, cognitive restructuring, and behavioral pattern breaking. An overview will be given of therapeutic techniques that can be used to address the cognitive, emotional, behavioral, and interpersonal problems associated with DSH.

Der Schock im Kindesalter ist ein gefährliches, oftmals tödlich verlaufendes Syndrom. Pathophysiologisch ist dieser Zustand durch ein ungenügendes Sauerstoffangebot im Verhältnis zum Verbrauch gekennzeichnet. Meistens ist dies bedingt durch eine ungenügende Funktion des Herz-Kreislauf-Systems. Ursachen können hypovolämische Zustände, distributive oder kardiogene Störungen sein, seltener sind Obstruktionen des kardialen Ausflusstraktes oder Störungen der Sauerstoffbindung an das Hämoglobin. Durch die resultierende Hypoxie kommt es zu einer Laktazidose. Die klinischen Leitsymptome sind gekennzeichnet durch Tachykardie, Tachypnoe und Unruhe. Es handelt sich um einen instabilen Zustand, den es frühzeitig zu erkennen und zu behandeln gilt. Es ist deshalb wichtig sich bewusst zu sein, dass es sich um ein fortschreitendes Geschehen handelt, in dessen Verlauf es vorerst durch Kompensationsmechanismen zu erhöhtem Herzminutenvolumen, warmer Peripherie und trockener Haut (warmer Schock), und erst später zur Dekompensation mit peripherer Vasokonstriktion, feucht-kalter Haut und Abnahme des Herzminutenvolumens kommt (kalter Schock). Schließlich erfolgt bei ausbleibender oder zu spät eingesetzter Therapie eine fortschreitende Zellschädigung mit Zelltod und damit Multiorganversagen (Multiple Organ Dysfunction Syndrome), das schließlich zum Tod des Patienten führt. Therapeutisch ist eine aggressive Volumentherapie mit natriumreichen Flüssigkeiten oder mit kolloidalen Plasmaersatzpräparaten indiziert, in ausgewählten Fällen sind auch Blutprodukte einzusetzen. Nach genügender Füllung des Kreislaufsystems soll eine Unterstützung desselben mittels inotropen Medikamenten angestrebt werden. Durch Kenntnisse von Grunderkrankungen und pathophysiologischen Zusammenhängen, durch Früherkennung und sofortiger Therapie kann die immer noch hohe Zahl der Todesfälle infolge von Schock im Kindesalter reduziert werden.

Many studies have highlighted how health professionals tend to categorise their patients in terms of moral evaluations, in particular perceiving patients as ‘good’ and ‘bad’. This article reports on a qualitative study which explored how occupational therapists experienced their patients/clients, investigating what social evaluations were made. Nine occupational therapists were interviewed using a relatively non-directive, phenomenological approach. Although the therapists were reluctant to stereotype their patients/clients, the use of moral and social evaluations was widespread. ‘Good’ patients were warmly responsive and made the therapists feel valued and effective. ‘Bad’ patients were manipulative, threatening and resisted change. An additional category of ‘difficult’ patients emerged which reflected the therapists' ambivalent responses to this patient/client group, who were experienced as positively challenging but hard work. The discussion emphasises how social evaluations are complex and involve multiple meanings which emerge in different contexts with different individuals.

Abstract Peripheral temperature can be monitored with various equipment ranging from digital or glass thermometers to mood rings. This article reports on an additional “yummy” temperature feedback approach, milk or dark chocolate, as an indicator of successful hand warming. The chocolate feedback was discovered initially by a trainee to reduce symptoms associated with syringomyelia. In addition, the article summarizes data demonstrating that hand warming is easily learned. Using a thermometer, 219 participants—students and physical therapists—rapidly warmed their hands an average of 10.1°F when guided with imagery. For the subset of 106 university students, their subjective stress levels decreased by 49% as their hands warmed. Regardless of the technique, hand warming provides a useful demonstration that voluntary self-control is possible.

Objective. Respiratory tract infections (RTIs) are the most commonly treated acute problems in general practice. Instead of treatment with antibiotics, therapies from the field of integrative medicine play an increasingly important role within the society. The aim of the study was to evaluate whether mustard footbaths improve the symptoms of patients with RTIs. Methods. The study was designed as a pilot study and was carried out as an interventional trial with two points of measurement. Between November and December 2017, six practices were invited to participate. Two of them participated in the study. Patients were included who presented with an RTI at one of the involved primary care practices during February and April 2018. Participants in the intervention group used self-administered mustard seed powder footbaths at home once a day, to be repeated for six consecutive days. The improvement of symptoms was measured using the “Herdecke Warmth Perception Questionnaire” (HeWEF). A variance analysis for repeated measurements was performed to analyse differences between the intervention and control groups. Results. In this pilot study, 103 patients were included in the intervention group and 36 patients were included in the control group. A comparison of the intervention and control group before the intervention started showed nearly no difference in their subjective perception of warmth measured by the HeWEF questionnaire. Participants of the intervention group who used mustard seed footbaths for six consecutive days showed an improvement in four of the five subscales of the HeWEF questionnaire. Conclusions. This study could provide a first insight into a possible strategy to improve symptoms regarding RTI by using mustard seed footbaths.

Physical sensations of tingling, warmth, dull pain, and heaviness are a common phenomenon in mind-body interventions, such as acupuncture, hypnotherapy, osteopathy, qigong, meditation, and progressive muscle relaxation. Even though there are striking parallels between sensations produced by many different interventions, no attempt has yet been made to understand them from a unifying perspective that combines information from different therapies and practices. Therefore, this narrative systematic review introduces the concept of therapeutic sensations and summarizes studies of their sensory quality, bodily topography, and the meaning that patients attach to them. Furthermore, it highlights the essential role of therapeutic sensations in the development of vital energy concepts, such as qi, prana, pneuma, and orgone, in various traditional medicine systems, body-oriented psychotherapy, and so-called energy medicine. Finally, the assessment of therapeutic sensations may help to gain a deeper understanding of such concepts, finding a common language between scientists, patients and practitioners, and bridging the wide gap between materialistic and vitalistic views.

Anumber of new drugs are moving through the osteoporosis therapy pipeline. Some show great promise for patients while one has fallen by the wayside at the last hurdle. New, effective therapies are warmly welcomed but there are still uncertainties around management of osteoporosis with currently available drugs that are contributing to what is commonly being referred to as the ‘treatment gap’; a differential between those patients who would benefit from treatment versus those who actually are receiving it. Furthermore, in parallel to the common public health disease of osteoporosis, there have been tangible developments in therapies available for some rare bone and calcium diseases.

A49-year-old, human immunodeficiency virus (HIV)- infected, Haitian-born woman presented with a left facial mass that she had noticed for the previous eight weeks. She was known to have been HIV-seropositive for the previous 11 years and had been on multiple antiretroviral therapies. Her past medical history was also significant for hypertension, disseminated varicella zoster virus and recurrent oral and buttock Herpes simplex episodes. She was taking the following medications at the time of her presentation with the facial mass: stavudine, lamivudine, didanosine, nelfinavir mesylate, famciclovir, hydrochlorothiazide and cotrimoxazole. She had no complaints of fever, chills, sweats, weight loss or anorexia. She denied any pain, redness or warmth at the site of the facial swelling. Her most recent CD4 lymphocyte count was 336 cells/µL, with an HIV viral load of log102.6 copies/mL. Physical examination revealed a 4 cm fluid-filled mass in the left parotid gland. There was no detectable induration, redness, warmth or tenderness, and no associated adenopathy. The rest of the examination was unremarkable. An aspirate of the mass was performed under sterile conditions and yielded 30 mL of turbid, yellow liquid. A Gram stain revealed no neutrophils, scant mononuclear cells and no visible organisms. An acid-fast stain was negative as well. Routine, mycobacterial and fungal cultures showed no growth. Cytological analysis showed scant reactive lymphocytes and no malignant cells. The patient was not given therapy and was observed for another two months. The fluid reaccumulated in the left parotid gland, and the patient?s only complaint concerned the unsightly appearance of the mass. The lesion was again aspirated for 30 mL of fluid and this time, the fluid had a turbid, brown appearance. All laboratory results were identical to the results from the first aspirate. What is your diagnosis, and how would you treat this patient?

Abstract OBJECTIVE AND IMPORTANCE: We report the use of bilateral thalamic stimulation in a case of primary erythromelalgia with immediate and important pain relief for 3 years. CLINICAL PRESENTATION: A 12-year-old boy experiencing primary erythromelalgia had a 4-year history of recurrent attacks of severe burning pain in both feet, accompanied by local reddening, swelling, and heating of the skin. The attacks were triggered by warmth and exercise. The pain was relieved only by elevation and cooling of the lower limbs, which he achieved by immersing his legs in a bucket of ice water, resulting in severe ulceration of the skin. INTERVENTION: Because of the gradual aggravation of the signs and symptoms and resistance of the patient's condition to several medical therapies, the patient received spinal cord stimulation. The implants were removed twice because of recurrent infection. Finally, the patient was treated with bilateral electrical stimulation of the ventral posterolateral thalamic nucleus, which resulted in important pain control until 3 years later. The patient was able to avoid water immersions, and all ulcerations disappeared. CONCLUSION: We conclude that thalamic stimulation was successful in this case of primary erythromelalgia.

AbstractAcquired brain injury (ABI) commonly results in a range of interacting difficulties including regulating emotion, managing social interactions and cognitive changes. Emotional adjustment to ABI can be difficult and requires adaptation of standard psychological therapies. This article outlines a case where cognitive– behavioural therapy (CBT) was of limited effectiveness but was significantly enhanced with compassion focused therapy (CFT). This article describes Jenny, a 23-year-old woman who suffered a traumatic brain injury 3 years prior to attending rehabilitation. Jenny presented with low self-esteem and mental health difficulties. Neuropsychological assessment revealed executive functioning difficulties. Jenny entered a holistic neuropsychological rehabilitation program aimed at improving complex interacting difficulties, receiving CBT as part of this. As CBT was of limited effectiveness, reformulation of Jenny's difficulties was presented to her based on CFT. The CFT intervention employed aimed to help Jenny develop self-validation and acceptance through producing feelings of kindness and warmth. Shifting the affective textures to the self is a key process for CFT. Self-report measures of mental health and self-esteem showed positive changes and the usefulness of CFT for Jenny. Adaptations in the context of Jenny's ABI are discussed. In conclusion, CFT may be useful in conceptualising emotional responses and developing intervention in rehabilitation after ABI, especially because CFT is based on a neurophysiological model of affect regulation that pays particular attention to the importance of affiliative emotions in the regulation of threat-focused emotion and self-construction.

Objective: To explore whether children with various externalizing/prosocial behavior profiles benefit differently from face-to-face training than from an internet-based parent management training (PMT) programme. Methods: A total of 231 families with children (aged 10 to 13 years) with externalizing behavior problems (EBP) were randomized to receive either the Family Check-Up, delivered by therapists in the community, or the internet-based PMT program (iComet). Person-oriented analysis was used for subtyping the children according to combinations of prosocial behavior and EBP. Results: The person-oriented analysis resulted in five significantly different clusters. There were no significant differences between the five clusters in relation to the total difficulties score of the Strengths and Difficulties Questionnaire, family warmth or family conflict, but the within-group effect sizes for the main outcome (total difficulties score) from baseline to post-treatment varied from Cohen’s d of 0.52 to 2.56. There were no significant interaction effects between the clusters and type of intervention. However, for children high on symptoms of attention deficit hyperactivity disorder and moderate to high on oppositional defiant disorder, and low to relatively high on prosocial behaviors (Cluster 3 respectively 5), substantial residual EBP-symptomatology remained at post-treatment, although both interventions resulted in significant effects. The other three clusters were within the non-clinical EBP-range at post-intervention, irrespective of treatment condition. There were no significant differences between the clusters regarding treatment completion rate (ranging from 47.2% to 67.4%). This study illustrates the value of distinguishing between different profiles of children in the context of PMT for parents of children with EBP.

ZusammenfassungDie diabetisch neuropathische Osteoarthropathie (DNOAP, Charcot-Fuß) ist eine nichtinfektiöse Arthropathie, die sich in einem gut durchbluteten, insensitiven und biomechanisch alterierten Fuß entwickelt. Diabetes mellitus ist die häufigste Ursache der DNOAP, wobei die Veränderungen auch bei sensomotorischen Neuropathien anderer Genese auftreten. Die Pathogenese ist bisher nicht sicher aufgeklärt. Im Verlauf der Erkrankung tritt eine Knochen- und Gelenkdestruktion mit Fragmentation und anschließendem Remodelling der Gelenkstukturen auf. Charakteristischerweise präsentieren sich die Patienten mit einem warmen, geschwollenen und wenig schmerzhaften Fuß. Das Nativ-Röntgenbild ist diagnostisch wegweisend und wird in der differenzialdiagnostischen Abgrenzung gegenüber der Osteomyelitis durch die MR-Tomografie ergänzt. Die Therapie der DNOAP richtet sich nach dem Erkrankungsstadium. In der Frühphase der Erkrankung ist eine konsequente Druckentlastung von zentraler Bedeutung. Spätere Fußkomplikationen sind häufig, weshalb eine sorgfältige Verlaufskontrolle wichtig ist.

IntroductionThe increase in aging population is a major advance in society, but also a great challenge, imposing the need for actions that promote successful aging, with higher subjective well-being and better health.Objectives(1) analyse the possible influence of socio-demographic variables in self-compassion, satisfaction with life, affection, physical and mental health (study variables); (2) understand how is that the study variables are associated with each other in old age; and (3) explore which variables best predict satisfaction with life and health in the elderly.MethodThe study sample consists of 155 individuals, aged between 65 and 94 years old, institutionalised and non-institutionalised.Results(1) significant correlations were found between some demographic and the study variables. (2) Significant associations were also found between self-compassion, subjective well-being and health. (3) linear regression analysis revealed that physical health is best predicted by greater life satisfaction and lower age; mental health is best predicted by increased satisfaction with life, self-compassion and decreased negative affect; and, finally, life satisfaction is predicted by a higher physical health and self-compassion.ConclusionsThese results suggest the importance of developing psychological skills such as warmth, tolerance and the acceptance of suffering bearing in mind that the elderly may experience difficulties resulting from the developmental characteristics of old age. Our findings suggest the possible beneficial effect of compassion, focused therapies designed for this specific population, particularly contributing to the promotion of life satisfaction and mental health of the Portuguese elderly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ZusammenfassungNach Extremitätentraumata, Läsionen peripherer Nerven oder des zentralen Nervensystems und selten spontan kann es zum Auftreten von charakteristischen Symptomkonstellationen eines komplex-regionalen Schmerzsyndroms (CRPS) kommen. Diese bestehen aus motorischen, sensiblen sowie autonomen Störungen. Nachdem dieser Symptomkomplex in der Vergangenheit mit wechselnden Bezeichnungen (z. B. M. Sudeck, Kausalgie, sympathische Reflexdystrophie) belegt wurde, lautet die von der International Association for the Study of Pain vorgeschlagene und aktuell verwendete Bezeichnung „komplexregionales Schmerzsyndrom“ (complex regional pain syndrome, CRPS). Aufgrund pathophysiologischer Gesichtspunkte erscheint eine Einteilung in Abhängigkeit der Hauttemperatur prinzipiell sinnvoller (primär warmes oder primär kaltes CRPS) als eine Einteilung in Typ I und II, der die Abwesenheit oder das Vorliegen einer einzelnen und eindeutigen peripheren Nervenläsion zugrunde liegt. Eine frühzeitige Diagnosestellung und Beginn einer auf die Symptomatik individuell abgestimmten Therapie unter Einbeziehung nicht medikamentöser und medikamentöser Therapieverfahren sind wichtig, um eine Chronifizierung zu vermeiden und die Funktion der betroffenen Extremität zu erhalten oder wieder herzustellen.

Abstract We retrospectively studied 232 patients with cold agglutinin disease (CAD) at 24 centers in 5 countries. In Norway and a northern region of Italy, the study was close to being population-based. For the first time, we demonstrate fourfold differences between cold and warmer climates regarding prevalence (20 vs 5 cases/million) and incidence (1.9 vs 0.48 cases/million per year). Mean baseline hemoglobin level was 9.3 g/dL, but 27% had hemoglobin <8 g/dL. Identification of typical features of CAD-associated lymphoproliferative disorder in the bone marrow was greatly increased by centralized biopsy assessment. CAD seems to be associated with a slightly increased risk of venous thrombosis. This work includes a follow-up study of therapies, focusing on the long-term outcomes of the rituximab plus bendamustine and rituximab plus fludarabine regimens. Rituximab plus bendamustine therapy resulted in responses in 35 (78%) of 45 patients; 24 (53%) achieved complete response. Interestingly, these rates were still higher than observed in the original (2017) prospective trial, and we also found a shift toward deeper responses with time. This is explained by the prolonged time to response seen in many patients, probably related to long-lived plasma cells. In patients responding to rituximab-bendamustine, median response duration was not reached after 88 months, and estimated 5-year sustained remission was 77%. The regimen appeared safe regarding late-occurring malignancies. Rituximab plus fludarabine therapy seems to carry a higher risk of long-term adverse effects.

The larynx is the first part of the respiratory and digestive tract and it performs vital functions. The air stream, passing through the throat and coming into contact with its mucous membrane, is moistened, warmed up and purified. Due to the anatomical structure of the mouth cavity and pharynx, it creates conditions for entry, presence and inactivation of microorganisms, viruses and fungi. Under normal conditions, due to effective protective mechanisms (mucociliary and immune), pathogens are trapped in the upper respiratory tract while the lower sections remain «clean». Acute pharyngitis is a widespread, polyetiological disease of the upper respiratory tract. There are quite a few preconditions for its development. A favorable background for local inflammation is the reduction of specific and non-specific protection factors, which may be observed in the existing chronic inflammation and worsened in diabetes mellitus and metabolic syndrome, with prolonged use of cytostatics and/or glucocorticosteroids and many other immunocompromised conditions. Due to the prevalence of pharyngitis, the development of effective screening and treatment methods is particularly relevant. Given the localized nature of inflammatory process in the pharynx and the possibility of side effects, general anti-inflammatory drugs are used less and less frequently, and local non-steroidal anti-inflammatory drugs are increasingly drawing the attention of physicians. The article discusses the possibilities and effectiveness of the medication based on benzidamine hydrochloride in treating pharyngitis of diverse etiology. The article presents the studies of foreign scientists, as well as dosages and peculiarities of the medication application. Treatment of acute tonsillipharyngitis with local non-steroidal anti-inflammatory drugs is commonly accepted and widely used in the practice of pediatricians, therapists and otorhinolaryngologists and allows to achieve rapid relief of the patient’s condition.

Context Cold-water immersion is the criterion standard for treatment of exertional heat illness. Cryotherapy and water immersion also have been explored as ergogenic or recovery aids. The kinetics of inflammatory markers, such as interleukin-6 (IL-6), during cold-water immersion have not been characterized. Objective To characterize serum IL-6 responses to water immersion at 2 temperatures and, therefore, to initiate further research into the multidimensional benefits of immersion and the evidence-based selection of specific, optimal immersion conditions by athletic trainers. Design Controlled laboratory study. Setting Human performance laboratory Patients or Other Participants Eight college-aged men (age = 22 ± 3 years, height = 1.76 ± 0.08 m, mass = 77.14 ± 9.77 kg, body fat = 10% ± 3%, and maximal oxygen consumption = 50.48 ± 4.75 mL·kg−1·min−1). Main Outcome Measures Participants were assigned randomly to receive either cold (11.70°C ± 2.02°C, n = 4) or warm (23.50°C ± 1.00°C, n = 4) water-bath conditions after exercise in the heat (temperature = 37°C, relative humidity = 52%) for 90 minutes or until volitional cessation. Results Whole-body cooling rates were greater in the cold water-bath condition for the first 6 minutes of water immersion, but during the 90-minute, postexercise recovery, participants in the warm and cold water-bath conditions experienced similar overall whole-body cooling. Heart rate responses were similar for both groups. Participants in the cold water-bath condition experienced an overall slight increase (30.54% ± 77.37%) in IL-6 concentration, and participants in the warm water-bath condition experienced an overall decrease (−69.76% ± 15.23%). Conclusions We have provided seed evidence that cold-water immersion is related to subtle IL-6 increases from postexercise values and that warmer water-bath temperatures might dampen this increase. Further research will elucidate any anti-inflammatory benefit associated with water-immersion treatment and possible multidimensional uses of cooling therapies.

Abstract Background Within a sufficiently large bacterial population, some members will naturally adopt an alternate, metabolically-active state that favors small molecule synthesis over cell division. In Staphylococcus aureus this process can be sharply accelerated by multiple factors present during infection including nutrient limitation, host cationic peptide exposure and polymorphonuclear neutrophil internalization. These isogenic “tolerant” subpopulations have variable responses during antibiotic exposure and can remain viable in the presence of typically bactericidal concentrations. Survivors of antibiotic exposure can restart cell division upon cessation of antibiotics and cause relapse or recurrent infection. In this study we determine the ability of typical and atypical antistaphylococcal therapies to reduce the viability of tolerant Staphylococcus aureus bacteria. Methods S. aureus strain ATCC29213 as well as four clinical isolates (two MSSA, two MRSA) were selected for analysis. Overnight cultures were diluted in pre-warmed broth (MHB50) to 1×106 cfu/mL. Tolerance was induced by exposure to mupirocin (low [0.032 µg/mL] or high [3.2 µg/mL]) for 30 min. Tolerant cultures were exposed to vancomycin (35 µg/mL), cefazolin (25 µg/mL), daptomycin (7 µg/mL), telavancin (10 µg/mL), dalbavancin (6 µg/mL) or oritavancin (14 µg/mL) and viability was assessed by dilution plating at pre-defined time points (0, 2, 6, 24, 48 h). The minimum duration for 3-log viability reduction from baseline (MDK99.9) and culture viability at 48h were calculated independently for each of three biological replicates. Results The rate of bacterial killing (MDK99.9) was reduced for all study antibiotics by the addition of mupirocin in a dose-dependent manner. In contrast to all other regimens, including lipoglycopeptide comparators, oritavancin was the only antimicrobial agent that maintained a similar extent of bacterial killing against tolerant staphylococci. Conclusion Antimicrobial tolerant staphylococci exhibit a decreased rate of killing by antistaphylococcal agents. However, oritavancin remained effective at maintaining a similar extent of killing. Further studies to investigate the role of otritavancin against recurrent or relapse staphylococcal infection is warranted. Disclosures All Authors: No reported disclosures

Abstract Background: Paroxysmal cold hemaglobinuria (PCH) is caused by an IgG autoantibody which behaves as a biphasic hemolysin, attaching to RBCs at cold temperatures and activating complement at warmer temperatures, leading to hemolysis. This antibody, known as the Donath-Landsteiner antibody (DL-A), frequently shows specificity for the P-antigen. PCH was historically associated with syphilis infection. More recently, the DL-A has been found primarily in children with acquired autoimmune hemolytic anemia (AIHA) following a viral illness. In adults, PCH is rare and may occur as an idiopathic disease or in association with a lymphoproliferative disorder. Cases in children usually resolve spontaneously, whereas the adult form can be chronic and pose a therapeutic challenge, since treatment with steroids and splenectomy may be ineffective. Recently rituximab has been demonstrated to be a useful agent in treating AIHA that is resistant to conventional therapies. Case Report: A 64-year-old woman presented to another hospital with three months of progressive weakness. She was found to be severely anemic. Gastrointestinal blood loss was ruled out. Extensive work up was obtained with CT imaging and bone marrow biopsy, which showed no evidence of malignancy. A hemolytic process was identified and she was placed on oral prednisone 60mg daily. The patient then presented to Cedars-Sinai Medical Center three months later with recurrent fatigue and a hemoglobin concentration (Hb) of 6.6 g/dL. Lab values revealed an elevated reticulocyte count (7.9%), WBC 27.6, total bilirubin 3.5 mg/dL, indirect fraction 3.4 mg/dL, elevated LDH 445 U/L, absent haptoglobin, and microspherocytes on peripheral blood smear. The Direct Antiglobulin (Coombs) Test (DAT) was positive with an anti-complement reagent and negative with an anti-IgG reagent, leading to the suspicion of a DL-A or cold agglutinin. Cold agglutinin titer was normal. A Donath-Landsteiner test was positive, confirming the diagnosis of PCH. Steroids were rapidly tapered and she was given rituximab 375 mg/m2. Her Hb increased and evidence of hemolysis ceased. The patient received 3 additional doses of rituximab weekly. Her Hb recovered to normal. The patient did well for 9 months until she presented again with acute hemolysis (Hb 8.8 g/dL.) The DAT was again positive with an anti-complement reagent and negative with an anti-IgG reagent. She was given a single dose of rituximab with cessation of hemolysis. She received another 3 doses, which resulted in stabilization of her Hb. She remains well at 6 months follow-up. Discussion: The most frequent form of AIHA is due to a warm, IgG antibody and is commonly responsive to steroids or splenectomy, whereas in cold agglutinin disease, caused by an IgM antibody these therapies are usually ineffective. The use of rituximab has been reported as a useful treatment for both warm and cold AIHA refractory to conventional therapy. This is the first case report to our knowledge of a patient with adult PCH refractory to steroids successfully treated with rituximab. This patient responded dramatically to rituximab on two separate occasions, and has remained in remission since the second cycle after treatment with this single agent. Rituximab may represent an effective therapy for adult patients with chronic PCH.

Introduction: There is an unmet need for safe and effective anticoagulant reversal agents, with rapid onset of effects, for use in cases such as serious or life-threating bleeding, prior to urgent or emergency surgery, after major trauma, or in cases of anticoagulant overdose. Ciraparantag, an anticoagulant reversal agent with broad activity, binds directly to anticoagulant molecules including direct oral anticoagulants (DOACs), enoxaparin, and unfractionated heparin, without binding to endogenous coagulation factors or other plasma proteins. Two Phase 2 studies evaluated the safety and efficacy of ciraparantag for reversal of anticoagulation induced by apixaban or rivaroxaban in healthy adults. Methods: Two randomized, placebo-controlled, dose-ranging studies were conducted in healthy subjects 50-75 years of age. Subjects received apixaban or rivaroxaban until steady state. Study 1 subjects received apixaban 10 mg orally twice daily for 3.5 days. Study 2 subjects received rivaroxaban 20 mg orally once daily for 3 days. At steady-state anticoagulation subjects were randomized 3:1 to a single intravenous (IV) dose of ciraparantag (Study 1: 30, 60, or 120 mg; Study 2: 30, 60, 120 or 180 mg) or placebo. Efficacy was based on manual whole blood clotting time (WBCT) at multiple timepoints over 24 hours beginning at 15 minutes after dosing. Subjects and technicians performing the WBCT testing were blinded to treatment. WBCT measures were performed in triplicate (simultaneous testing by 3 different evaluators) at 3 separate timepoints to analyze inter-observer variability using an analysis of variance (ANOVA) model with effects for observer and subject. Results: In Study 1 (apixaban), 49 subjects were randomized to receive study drug (36 ciraparantag, 13 placebo) and completed the study as planned. In Study 2 (rivaroxaban), 64 subjects were randomized to receive study drug (48 ciraparantag, 16 placebo) and all but one subject completed the study as planned. Ciraparantag demonstrated a rapid and dose-dependent reversal of apixaban and rivaroxaban anticoagulation as measured by the proportion of subjects whose WBCT decreased to within 10% above baseline at 15 minutes after study drug infusion. A lower dose of ciraparantag was required to achieve reversal of apixaban in a large fraction of subjects compared to the dose required for reversal of rivaroxaban (Figure). Reversal of anticoagulation was sustained in these subjects throughout the 24-hour measurement period. In both studies, there was good agreement among the triplicate manual WBCT measurements; all inter-observer coefficient of variance values were <5%. Ciraparantag was well tolerated; the most frequent adverse events were mild, transient sensations of warmth during or soon after infusion. Conclusions: In healthy subjects at steady-state levels of anticoagulation, ciraparantag single IV doses were well tolerated and produced rapid reversal of anticoagulation in high proportions of subjects within 15 minutes of administration (the first timepoint assessed) at doses ≥60 mg for apixaban and at a dose of 180 mg for rivaroxaban which were maintained throughout the 24-hour measurement period. Figure. Proportion of subjects with WBCT reversed to within 10% above baseline at 15 minutes and 30 minutes after dosing Disclosures Ansell: Amag Pharmaceuticals, Inc.: Consultancy. Bakhru:Pherosphere Technologies, Inc.: Current Employment. Luo:Amag Pharmaceuticals, Inc.: Current Employment. Villano:Amag Pharmaceuticals, Inc.: Consultancy. OffLabel Disclosure: Ciraparantag is an investigational drug being evaluated for the reversal of anticoagulation induced by direct oral anticoagulant (DOAC) therapies.

Among all the pharmacological therapies, the thermotherapy is believed to be a quite advantageous and mostly employed therapy. Typically, Ice is used for acute injuries and warmth is used for sprains and strains. It seems appropriate to use hot and cold packs in osteoarthritis according to targeted problem to be addressed.

Background: Guidelines of neonatal resuscitation are revised regularly. Gaps in knowledge transfer commonly occur when the guidelines are communicated to the clinical practitioners. Maintaining body temperature and supporting oxygenation are main goals that clinical practitioners aim to achieve in assisting newborns during the feto-neonatal transition at birth. Objectives: In this study, we aim to examine the compliance to guidelines in neonatal resuscitation regarding the temperature maintenance and oxygen use in newborns at birth. Methods: From October to November 2013, a prospective questionnaire surveillance was conducted in all attended deliveries at all four hospitals in Edmonton, Alberta, Canada. All clinical practitioners (registered nurses, physicians and respiratory therapists) were requested to complete the questionnaires immediately after the attended delivery regarding temperature maintenance and oxygenation monitoring. Descriptive statistics were used with mean±SD (range) and % presented. Results: During the 14-days study period, data was obtained in 518 of 712 (73%) attended deliveries of newborns with gestational age 38.6±2.0 (23-42) weeks and birth weight 3324±589 (348-6168) g. Of these deliveries, 58% were normal vaginal deliveries and 29% were cesarean sections. There were 8.8% and 8.4% newborns who required positive pressure ventilation and continuous positive pressure, respectively. Radiant warmer heat was used in 81% (419/518) with 63% (266/419) turned to full power. Room temperature was 21.6±1.6 (17-31)°C. Body temperature at 30-60 min after birth was 36.8±0.5 (32.4-38.1)°C with hypothermia (<36.5°C) in 17%. Percutaneous oxygen saturation was measured in 15% newborns and 96% had sensors placed at the right wrist. At the initiation of resuscitation, 21% oxygen was used in 76% and the oxygen concentration was adjusted according to an oxygen saturation chart in 17%. In 70% of the cases, clinical practitioners commented that this chart was not helpful. Conclusions: Gaps in knowledge transfer contribute to non-compliance in the guidelines of neonatal resuscitation for temperature maintenance and oxygen use. Caution is needed to avoid hypothermia and hyperoxia in at-risk populations such as prematurity.

Isolated mammalian hearts have been used to study cardiac physiology, pharmacology, and biomedical devices in order to separate myocardial characteristics from the milieu of the intact animal and to allow for increased control over experimental conditions. Considering these benefits and that MRI is the “gold” standard for measuring myocardial function, it was considered desirable to have a system which would allow simultaneous MR imaging of an isolated beating heart. Here we describe a unique portable system, which enables physiologic perfusion of an isolated heart during simultaneous MR imaging. A two unit system was designed to physiologically support a large mammalian isolated heart during MR imaging were a modified Krebs-Henseleit perfusate was used as a blood substitute. The first unit, which resides in an adjacent support room next to the scanner, contains all electronically powered equipment and components (with ferromagnetic materials) which cannot operate safely near the magnet, including (1) a thermal module and custom tube in tube heat exchanger warming the perfusate to 38°C; (2) a carbogen tank (95% O2 5% CO2) and hollow fiber oxygenator; and (3) two centrifugal blood pumps which circulates and pressurizes the left and right atrial filling chambers. The second unit, which resides next to the magnet and is free of ferromagnetic materials, receives warmed, oxygenated perfusate from the first unit via PVC tubing. The isolated hearts were connected to the second unit via four cannulae sutured to the great vessels. A support system placed inside the scanner on the patient bed secured the hearts and cannulae in the correct anatomical position. To date, this system was tested in a 1.5 T Siemens scanner using swine hearts (n=2). The hearts were arrested with St. Thomas cardioplegia and removed via a medial sternotomy. After cannulation of the great vessels, reperfusion, and defibrillation, four-chamber and tagged short-axis cine loops were acquired using standard ECG gating. Tagged short-axis images obtained at the base, mid-ventricle, and apex were used to measure the following functional parameters for one heart: LV end-diastolic volume=38.84 ml, LV end-systolic volume=23.23 ml, LV stroke volume=15.6 ml, LV ejection fraction=40.18%, and peak LV circumferential strain=16%. The feasibility of MR imaging an isolated, four-chamber working large mammalian heart was demonstrated using a custom designed and built portable MRI compatible perfusion system. This system will be useful in studying in vitro cardiac function (including human hearts) and developing MRI safe biomedical devices and MRI guided therapies in a controlled setting.

Of Motivational Art “Live to be outstanding.” What is new media in the age of the ‘rock ‘n’ roll life coach’ Anthony Robbins? There is no need to be ‘spectacular’ anymore. The Situationist critique of the ‘spectacle’ has worn out. That would be my assessment of the Robbins Age we now live in. Audiences are no longer looking for empty entertainment; they need help. Art has to motivate, not question but assist. Today’s aesthetic experience ought to awaken the spiritual side of life. Aesthetics are not there for contemplation only. Art has to become (inter)active and take on the role of ‘coaching.’ In terms of the ‘self mastery’ discourse, the 21st Century artist helps to ‘unleash the power from within.’ No doubt this is going to be achieved with ‘positive energy.’ What is needed is “perverse optimism” (Tibor Kalman). Art has to create, not destroy. A visit to the museum or gallery has to fit into one’s personal development program. Art should consult, not criticize. In order to be a true Experience, the artwork has to initiate through a bodily experience, comparable to the fire walk. It has to be passionate, and should shed its disdain for the viewer, along with its postmodern strategies of irony, reversal and indifference. In short: artists have to take responsibility and stop their silly plays. The performance artist’s perfect day-job: the corporate seminar, ‘trust-building’ and distilling the firm’s ‘core values’ from its ‘human resources’. Self-management ideology builds on the 80s wave of political correctness, liberated from a critical negativism that only questioned existing power structures without giving guidance. As Tony says: “Live with passion!” Emotions have to flow. People want to be fired up and ‘move out of their comfort zone.’ Complex references to intellectual currents within art history are a waste of time. The art experience has to fit in and add to the ‘personal growth’ agenda. Art has to ‘leverage fears’ and promise ‘guaranteed success.’ Part therapist, part consultant, art no longer compensates for a colourless life. Instead it makes the most of valuable resources and is aware of the ‘attention economy’ it operates in. In order to reach such higher plains of awareness it seems unavoidable to admit and celebrate one’s own perverse Existenz. Everyone is a pile of shit and has got dirty hands. Or as Tibor Kalman said: “No one gets to work under ethically pure conditions.” (see Rick Poynor’s <http://www.undesign.org/tiborocity/>). It is at that Zizekian point that art as a counseling practice comes into being. Mapping the Limits of New Media To what extent has the ‘tech wreck’ and following scandals affected our understanding of new media? No doubt there will also be cultural fall-out. Critical new media practices have been slow to respond to both the rise and the fall of dotcommania. The world of IT firms and their volatile valuations on the world’s stock markets seemed light years away from the new media arts galaxy. The speculative hey-day of new media culture was the early-mid 90s, before the rise of the World Wide Web. Theorists and artists jumped eagerly at not-yet-existing and inaccessible technologies such as virtual reality. Cyberspace generated a rich collection of mythologies. Issues of embodiment and identity were fiercely debated. Only five years later, with Internet stocks going through the roof, not much was left of the initial excitement in intellectual and artistic circles. Experimental technoculture missed out on the funny money. Over the last few years there has been a steady stagnation of new media culture, its concepts and its funding. With hundreds of millions of new users flocking onto the Net, the arts could no longer keep up and withdrew to their own little world of festivals, mailing lists and workshops. Whereas new media arts institutions, begging for goodwill, still portray artists as working at the forefront of technological developments, collaborating with state of the art scientists, the reality is a different one. Multi-disciplinary goodwill is at an all time low. At best, the artist’s new media products are ‘demo design’ as described by Peter Lunenfeld in Snap to Grid. Often it does not even reach that level. New media art, as defined by its few institutions, rarely reaches audiences outside of its own subculture. What in positive terms could be described as the heroic fight for the establishment of a self-referential ‘new media arts system’ through a frantic differentiation of works, concepts and traditions, may as well be classified as a dead-end street. The acceptance of new media by leading museums and collectors will simply not happen. Why wait a few decades anyway? The majority of the new media art works on display at ZKM in Karlsruhe, the Linz Ars Electronica Center, ICC in Tokyo or the newly opened Australian Centre for the Moving Image are hopeless in their innocence, being neither critical nor radically utopian in approach. It is for that reason that the new media arts sector, despite its steady growth, is getting increasingly isolated, incapable of addressing the issues of today’s globalized world. It is therefore understandable that the contemporary (visual) arts world is continuing the decades old silent boycott of interactive new media works in galleries, biennales and shows such as Documenta. A critical reassessment of the role of arts and culture within today’s network society seems necessary. Let’s go beyond the ‘tactical’ intentions of the players involved. This is not a blame game. The artist-engineer, tinkering away on alternative human-machine interfaces, social software, or digital aesthetics has effectively been operating in a self-imposed vacuum. Over the last few decades both science and business have successfully ignored the creative community. Even worse, artists have actively been sidelined in the name of ‘usability’. The backlash movement against web design, led by usability guru Jakob Nielsen, is a good example of this trend. Other contributing factors may have been fear of corporate dominance by companies such as AOL/Time Warner and Microsoft. Lawrence Lessig argues that innovation of the Internet itself is in danger. In the meanwhile the younger generation is turning its back from new media arts questions and operates as anti-corporate activists, if at all engaged. Since the crash the Internet has rapidly lost its imaginative attraction. File swapping and cell phones can only temporarily fill the vacuum. It would be foolish to ignore this. New media have lost their magic spell; the once so glamorous gadgets are becoming part of everyday life. This long-term tendency, now in a phase of acceleration, seriously undermines the future claim of new media altogether. Another ‘taboo’ issue in new media is generationalism. With video and expensive interactive installations being the domain of the ‘68 baby boomers, the generation of ‘89 has embraced the free Internet. But the Net turned out to be a trap for them. Whereas real assets, positions and power remains in the hands of the ageing baby boomers, the gamble of its predecessors on the rise of new media did not materialize. After venture capital has melted away, there is still no sustainable revenue system in place for the Internet. The slow working education bureaucracies have not yet grasped the new media malaise. Universities are still in the process of establishing new media departments. But that will come to a halt at some point. The fifty-something tenured chairs and vice-chancellors must feel good about their persistent sabotage. ‘What’s so new about new media anyway? Technology was hype after all, promoted by the criminals of Enron and WorldCom. It’s enough for students to do a bit of email and web surfing, safeguarded within a filtered and controlled intranet…’ It is to counter this cynical reasoning that we urgently need to analyze the ideology of the greedy 90s and its techno-libertarianism. If we don’t disassociate new media quickly from that decade, if we continue with the same rhetoric, the isolation of the new media sector will sooner or later result in its death. Let’s transform the new media buzz into something more interesting altogether – before others do it for us.The Will to Subordinate to Science The dominant wing of Western ‘new media arts’ lacks a sense of superiority, sovereignty, determination and direction. One can witness a tendency towards ‘digital inferiority’ at virtually every cyber-event. Artists, critics and curators have made themselves subservient to technology – and ‘life science’ in particular. This ideological stand has grown out of an ignorance that cannot be explained easily. We’re talking here about a subtle mentality, almost a taboo. The cult practice between ‘domina’ science and its slaves the new media artists is taking place in backrooms of universities and art institutions, warmly supported by genuinely interested corporate bourgeois elements – board members, professors, science writers and journalists – that set the technocultural agenda. Here we’re not talking about some form of ‘techno celebration.’ New media art is not merely a servant to corporate interests. If only it was that simple. The reproach of new media arts ‘celebrating’ technology is a banality, only stated by outsiders; and the interest in life sciences can easily be sold as a (hidden) longing to take part in science’s supra-human ‘triumph of logos,’ but I won’t do that here. Scientists, for their part, are disdainfully looking down at the vaudeville interfaces and well-meant weirdness of biotech art. Not that they will say anything. But the weak smiles on their faces bespeak a cultural gap light years wide. An exquisite non-communication is at hand here. Performance artist Coco Fusco recently wrote a critique of biotech art on the Nettime mailinglist (January 26, 2003). “Biotech artists have claimed that they are redefining art practice and therefore the old rules don't apply to them.” For Fusco bioart’s “heroic stance and imperviousness to criticism sounds a bit hollow and self-serving after a while, especially when the demand for inclusion in mainstream art institutions, art departments in universities, art curricula, art world money and art press is so strong.” From this marginal position, its post-human dreams of transcending the body could better be read as desires to transcend its own marginality, being neither recognized as ‘visual arts’ nor as ‘science.’ Coco Fusco: “I find the attempts by many biotech art endorsers to celebrate their endeavor as if it were just about a scientific or aesthetic pursuit to be disingenuous. Its very rhetoric of transcendence of the human is itself a violent act of erasure, a master discourse that entails the creation of ‘slaves’ as others that must be dominated.” OK, but what if all this remains but a dream, prototypes of human-machine interfaces that, like demo-design, are going nowhere? The isolated social position of the new media arts in this type of criticism is not taken into consideration. Biotech art has to be almighty in order for the Fusco rhetoric to function. Coco Fusco rightly points at artists that “attend meetings with ‘real’ scientists, but in that context they become advisors on how to popularize science, which is hardly what I would call a critical intervention in scientific institutions.” Artists are not ‘better scientists’ and the scientific process is not a better way of making art than any other, Fusco writes. She concludes: “Losing respect for human life is certainly the underbelly of any militaristic adventure, and lies at the root of the racist and classist ideas that have justified the violent use of science for centuries. I don't think there is any reason to believe that suddenly, that kind of science will disappear because some artists find beauty in biotech.” It remains an open question where radical criticism of (life) science has gone and why the new media (arts) canon is still in such a primitive, regressive stage. Links http://www.undesign.org/tiborocity/ Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Lovink, Geert. "Fragments on New Media Arts and Science" M/C: A Journal of Media and Culture< http://www.media-culture.org.au/0308/10-fragments.php>. APA Style Lovink, G. (2003, Aug 26). Fragments on New Media Arts and Science. M/C: A Journal of Media and Culture, 6,< http://www.media-culture.org.au/0308/10-fragments.php>