Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment

BACKGROUND

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy.

METHODS

A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II.

RESULTS

Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation.

LIMITATION

Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II.

CONCLUSION

Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Choice Set Size Shapes Self-Expression

Across six studies (total N = 3,549), we find that participants who were randomly assigned to choose from larger assortments thought their choices were more self-expressive, an effect that emerged regardless of whether larger sets actually enabled participants to better satisfy their preferences. Studies examining the moderating role of choice domain and cultural context show that the effect of choice set size on perceived self-expression may be particular to contexts in which choices have some initial potential to express choosers' identities. We then test novel predictions from this theoretical perspective, finding that self-expression mediates the effect of choice set size on choice satisfaction, the likelihood of publicly sharing choices, and the perceived importance of choices. Together, these studies show that choice set size shapes perceived self-expression and illustrate how this meaning-based theoretical lens provides both novel explanations for existing effects and novel predictions for future research.

Balancing the Freedom-Security Trade-Off During Crises and Disasters

During crises and disasters, such as hurricanes, terrorist threats, or pandemics, policymakers must often increase security at the cost of freedom. Psychological science, however, has shown that the restriction of freedom may have strong negative consequences for behavior and health. We suggest that psychology can inform policy both by elucidating some negative consequences of lost freedom (e.g., depression or behavioral reactance) and by revealing strategies to address them. We propose four interlocking principles that can help policymakers restore the freedom-security balance. Careful consideration of the psychology of freedom can help policymakers develop policies that most effectively promote public health, safety, and well-being when crises and disasters strike.

Idea Technology and Ideology

Although we are accustomed to thinking about technology as involving things-objects and processes-derived from scientific discoveries, science also creates a technology of ideas, ways of thinking both about the world and about human beings. And unlike "thing technology," "idea technology" can have powerful effects even when the ideas are false. This paper discusses false idea technology, or ideology, and suggests mechanisms by which it can have effects on both individuals and societies. It discusses neuroscience as the "next frontier" of ideology that may change our conceptions of human nature.

The role of tacit knowledge in communication and decision-making during emerging public health incidents

Strong communication systems for knowledge exchange are required to prevent, respond to and mitigate the effects of emerging public health incidents (EPHIs). The objective of this paper is to examine how "tacit knowledge" - implicit knowledge used to guide everyday practice - is employed in professional relationships and communication processes between public health and acute care settings. A qualitative study design was used to explore the experiences of key informants from public health and acute care settings in Ontario, Canada, to examine how specific dimensions of tacit knowledge are employed in communications about EPHIs. Twenty-six in-depth interviews were conducted from 2014 to 2015. The results describe the way in which participants employ discretion and knowledge of local context, and rely on relationships built on trust and credibility, to facilitate decision-making and communication during EPHIs. Given the uncertainty characterizing most EPHIs, communicators rely a great deal on their informal knowledge and networks which allow them to remain flexible and respond quickly to changing situations. The results reveal that communication about public health guidance during emergencies is a complex and active process that draws from past experiences of the individuals involved, and is shaped by the requirements of local circumstances. The broader implications of these findings for building resilient and responsive health systems are considered. In particular, for rethinking the authority of standardized forms of evidence in public health decision-making, and the importance of knowledge which is grounded in the uniqueness of specific local contexts.

Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed

Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.

Comparing Practice Management Courses in Canadian Dental Schools

Practice management has become an increasingly important aspect of dental education over the years in order to better prepare students for the reality of practice. The aim of this study was to quantify and describe practice management courses taught at the ten Canadian dental schools in order to identify common approaches, compare hours, determine types of instructors, and assess the relationship between courses' learning objectives and the Association of Canadian Faculties of Dentistry (ACFD) competencies and Bloom's cognitive levels. The academic deans at these ten schools were surveyed in 2016; all ten schools responded for a 100% response rate. The authors also gathered syllabi and descriptions of the courses and analyzed them for themes. The results showed a total of 22 practice management courses in the ten Canadian dental schools. The courses provided 27 to 109 hours of teaching and were mostly taught in the third and fourth years and by dentists on three main topics: ethics, human resource management, and running a private practice. The courses were correlated to the ACFD competencies related to ethics, professionalism, application of basic principles of business practices, and effective interpersonal communication. Most of the courses' learning objectives addressed comprehension and knowledge in Bloom's cognitive levels of learning. These results can help to guide discussions on how practice management courses can be developed, improved, and refined to meet the challenges of preparing students for dental practice.

A Phase 1 study of ARQ 087, an oral pan-FGFR inhibitor in patients with advanced solid tumours

Background:

ARQ 087 is an orally administered pan-FGFR inhibitor with multi-kinase activity. This Phase 1 study evaluated safety, pharmacokinetics, and pharmacodynamics of ARQ 087 and defined the recommended Phase 2 dose (RP2D).

Methods:

Patients with advanced solid tumours received ARQ 087 administered initially at 25 mg every other day and dose-escalated from 25 to 425 mg daily (QD) continuous dosing. FGF19, 21, 23, and serum phosphate were assessed as potential biomarkers of target engagement.

Results:

80 patients were enrolled, 61 in dose-escalation/food-effect cohorts and 19 with pre-defined tumour types in the expansion cohort. The most common ARQ 087-related adverse events were fatigue (49%), nausea (46%), aspartate aminotransferase (AST) increase (30%), and diarrhoea (23%). Four patients (5%) experienced grade 1 treatment-related hyperphosphataemia. Dose-limiting toxicity was reversible grade 3 AST increase. The RP2D was 300 mg QD. Pharmacokinetics were linear and dose-proportional from 25 to 325 mg QD, and were unaffected by food. Statistically significant changes (P-value<0.05) suggest phosphate and FGF19 levels as markers of target engagement. In 18 evaluable patients with FGFR genetic alterations, 3 confirmed partial responses (two intrahepatic cholangiocarcinomas (iCCA) with FGFR2 fusions and one urothelial cancer with FGFR2 and FGF19 amplification) and two durable stable disease at ⩾16 weeks with tumour reduction (FGFR2 fusion-positive iCCA and adrenocortical carcinoma with FGFR1 amplification) were observed.

Conclusions:

ARQ 087 had manageable toxicity at the RP2D of 300 mg QD, showed pharmacodynamics effects, and achieved objective responses, notably in patients with FGFR2 genetic alterations.

“Leaky” Rationality: How Research on Behavioral Decision Making Challenges Normative Standards of Rationality

For more than 30 years, decision-making research has documented that people often violate various principles of rationality, some of which are so fundamental that theorists of rationality rarely bother to state them. We take these characteristics of decision making as a given but argue that it is problematic to conclude that they typically represent departures from rationality. The very psychological processes that lead to “irrational” decisions (e.g., framing, mental accounting) continue to exert their influence when one experiences the results of the decisions. That is, psychological processes that affect decisions may be said also to “leak” into one's experience. The implication is that formal principles of rationality do not provide a good enough normative standard against which to assess decision making. Instead, what is needed is a substantive theory of rationality—one that takes subjective experience seriously, considers both direct and indirect consequences of particular decisions, considers how particular decisions fit into life as a whole, and considers the effects of decisions on others. Formal principles may play a role as approximations of the substantive theory that can be used by theorists and decision makers in cases in which the formal principles can capture most of the relevant considerations and leakage into experience is negligible.

A new science of happiness: the paradox of pleasure

The pursuit of happiness is enshrined in the founding document of our nation as a fundamental and inalienable right. Yet nowhere is the method of this pursuit clearly defined. What, exactly, does it mean to be happy, and how can such happiness be sustained over the long term? Can happiness be accurately gauged or measured? How does the paradoxical relationship between happiness and pleasure shape our quest to lead the good life? And what does modern science have to tell us about this universal yet elusive pursuit? Steve Paulson, executive producer and host of To the Best of Our Knowledge, moderated a discussion that included attorney and author Kim Azzarelli, historian Darrin McMahon, and social psychologist Barry Schwartz, who joined forces to share their research and insight on happiness, pleasure, and the coveted good life.

Psychology, Idea Technology, and Ideology

Scientific development leads to a technology of ideas–idea technology–no less than it leads to a technology of objects But idea technology can have insidious effects that the technology of objects does not First, ideas can suffuse through a culture before people notice they are there And second, ideas can have profound effects even when they are false–when they are nothing more than ideology These effects can arise because sometimes when people act on the basis of ideology, they inadvertently arrange the very conditions that bring reality into correspondence with the ideology This potential effect of ideology is discussed in connection with the behavioral psychology of Skinner and the claim by Herrnstein and Murray that intelligence is, for all practical purposes, unmodifiable I suggest that, in general, psychologists must be on the lookout for positive feedback loops between theory and practice that contribute to theory confirmation and thus mislead psychologists into interpreting historically and culturally contingent truths as universal ones

Common Sense Beliefs about the Central Self, Moral Character, and the Brain

To assess lay beliefs about self and brain, we probed people's opinions about the central self, in relation to morality, willful control, and brain relevance. In study 1, 172 participants compared the central self to the peripheral self. The central self, construed at this abstract level, was seen as more brain-based than the peripheral self, less changeable through willful control, and yet more indicative of moral character. In study 2, 210 participants described 18 specific personality traits on 6 dimensions: centrality to self, moral relevance, willful control, brain dependence, temporal stability, and desirability. Consistent with Study 1, centrality to the self, construed at this more concrete level, was positively correlated to brain dependence. Centrality to the self was also correlated to desirability and temporal stability, but not to morality or willful control. We discuss differences and similarities between abstract (Study 1) and concrete (Study 2) levels of construal of the central self, and conclude that in contemporary American society people readily embrace the brain as the underlying substrate of who they truly are.

On Klatzky and Creswell (2014)

Klatzky and Creswell (2014) offer an interpretation of the unreliability of social priming effects by analogizing them to what is known about the complexity of cross-modal transfer effects in perception. The complexity of these transfer effects arises because they are both multiply determined and stochastic. In this commentary, I argue that Klatzky and Creswell’s thoughtful contribution raises the possibility that there might be deep and substantive limits to both the replicability and the generalizability of many of the phenomena that most interest psychologists, including social priming effects. Psychological phenomena largely governed by what Fodor (1983) called the “central system” may resist both replication and generalization by their very nature and not because of weak and underpowered experimental methods. With such phenomena, science might give us very good tools for explanation, but not for prediction (replication).

GeSn/Ge multiquantum well photodetectors on Si substrates

Vertical incidence GeSn/Ge multiquantum well (MQW) pin photodetectors on Si substrates were fabricated with a Sn concentration of 7%. The epitaxial structure was grown with a special low temperature molecular beam epitaxy process. The Ge barrier in the GeSn/Ge MQW was kept constant at 10 nm. The well width was varied between 6 and 12 nm. The GeSn/Ge MQW structures were grown pseudomorphically with the in-plane lattice constant of the Ge virtual substrate. The absorption edge shifts to longer wavelengths with thicker QWs in agreement with expectations from smaller quantization energies for the thicker QWs.

Evaluating the students' perspectives of a clinic mentoring programme

The purpose of this article is to describe and examine the effectiveness of a mentoring program for third and fourth year clinical dental students. This is an educational intervention for the pre-doctoral students at the Schulich School of Dentistry. We have recently instituted this program and have developed a questionnaire to assess the student perspectives using a SWOT analysis of the strengths, weaknesses, opportunities and threats of this intervention by analyzing the quantitative and qualitative responses of the students towards their clinical education and patient management. Our findings, both quantitative and qualitative, indicated that the mentoring program was well received by most students who would like to see the program expanded. The majority of students felt that the mentoring program aligned well with comprehensive care of their patients while enhancing their clinical experience. One of the strongest areas of agreement involved the ability to discuss cases in a non-threatening environment. The SWOT analysis identified key areas for future improvements. We offer steps to successfully implement a similar program based on our findings. It is our hope that our results might be instrumental for other schools wishing to adopt a similar model which supports patient-based comprehensive care.

A phase I dose escalation study of oral c-MET inhibitor tivantinib (ARQ 197) in combination with gemcitabine in patients with solid tumors

BACKGROUND

Tivantinib (ARQ 197) is an orally available, non-adenosine triphosphate competitive, selective c-MET inhibitor. The primary objective of this study was to evaluate the safety, tolerability and to establish the recommended phase II dose (RP2D) of tivantinib and gemcitabine combination.

PATIENTS AND METHODS

Patients with advanced or metastatic solid tumors were treated with escalating doses of tivantinib (120-360 mg capsules) in combination with gemcitabine (1000 mg/m(2) weekly for 3 of 4 weeks). Different schedules of administration were tested and modified based on emerging preclinical data. Tivantinib was given continuously, twice a day (b.i.d.) for 2, 3 or 4 weeks of a 28-day cycle or on a 5-day on, 2-day off schedule (the day before and day of gemcitabine administration).

RESULTS

Twenty-nine patients were treated with gemcitabine and escalating doses of tivantinib: 120 mg b.i.d. (n = 4), 240 mg b.i.d. (n = 6) and 360 mg b.i.d. (n = 19). No dose-limiting toxicities were observed in escalation. The RP2D was 360 mg b.i.d. daily, and 45 additional patients were enrolled in the expansion cohort. Grade ≥3 treatment-related toxicities were observed in 54 of 74 (73%) patients with the most common being neutropenia (43%), anemia (30%), thrombocytopenia (28%) and fatigue (15%). There was one treatment-related death due to neutropenia. Administration of gemcitabine did not affect tivantinib concentration. Fifty-six patients were assessable for response. Eleven (20%) patients achieved a partial response and 26 (46%) had stable disease (SD), including 15 (27%) who achieved SD for over 4 months. Ten of 37 patients with clinical benefit had prior exposure to gemcitabine.

CONCLUSION

The combination of tivantinib at its monotherapy dose and standard dose gemcitabine was safe and tolerable. Early signs of antitumor activity may warrant further development of this combination in nonsmall-cell lung cancer, ovarian, pancreatic and cholangiocarcinoma.

CLINICALTRIALSGOV IDENTIFIER

NCT00874042.

A Phase-1b study of tivantinib (ARQ 197) in adult patients with hepatocellular carcinoma and cirrhosis

BACKGROUND

The mesenchymal-epithelial transition factor (MET) receptor is dysregulated in hepatocellular carcinoma (HCC), and tivantinib (ARQ 197) is an oral, selective, MET inhibitor.

METHODS

This Phase-1b study assessed tivantinib safety as primary objective in patients with previously treated HCC and Child-Pugh A or B liver cirrhosis. Patients received oral tivantinib 360 mg twice daily until disease progression or unacceptable toxicity.

RESULTS

Among 21 HCC patients, common drug-related adverse events (AEs) were neutropaenia, anaemia, asthenia, leucopaenia, anorexia, diarrhoea, and fatigue. No drug-related worsening of liver function or performance status occurred, but one Child-Pugh B patient experienced drug-related bilirubin increase. Four patients had drug-related serious AEs, including one neutropaenia-related death. Haematologic toxicities were more frequent than in previous tivantinib studies but were manageable with prompt therapy. Best response was stable disease (median, 5.3 months) in 9 of 16 evaluable patients (56%). Median time to progression was 3.3 months.

CONCLUSION

Tivantinib demonstrated a manageable safety profile and preliminary antitumour activity in patients with HCC and Child-Pugh A or B cirrhosis.

Mechanisms linking obesity, inflammation and altered metabolism to colon carcinogenesis

Due to its prevalence, obesity is now considered a global epidemic. It is linked to increased risk of colorectal cancer, the third most common cancer and the second leading cause of death among adults in Western countries. Obese adipose tissue differs from lean adipose tissue in its immunogenic profile, body fat distribution and metabolic profile. Obese adipose tissue releases free fatty acids, adipokines and many pro-inflammatory chemokines. These factors are known to play a key role in regulating malignant transformation and cancer progression. Obese adipose tissue is infiltrated by macrophages that participate in inflammatory pathways activated within the tissue. Adipose tissue macrophages consist of two different phenotypes. M1 macrophages reside in obese adipose tissue and produce pro-inflammatory cytokines, and M2 macrophages reside in lean adipose tissue and produce anti-inflammatory cytokines, such as interleukin-10 (IL-10). The metabolic networks that confer tumour cells with their oncogenic properties, such as increased proliferation and the ability to avoid apoptosis are still not well understood. We review the interactions between adipocytes and immune cells that may alter the metabolism towards promotion of colorectal cancer.

Emergency Medical Services: a resource for victims of domestic violence?

BACKGROUND

Domestic violence (DV), also known as intimate partner violence (IPV), is one of the leading causes of serious injury among women of childbearing age. As first responders on the scene during DV calls where personal injuries have occurred, Emergency Medical Services (EMS) could routinely identify, report and assist victims of violence. Yet, little is known of the prevalence of DV calls in EMS practice, Emergency Medical Technicians' (EMT) knowledge and comfort in responding to such calls, or how they care for victims.

METHOD

The objectives of this study were to assess EMTs' knowledge of and experience with providing care to victims of DV in the province of Ontario, Canada. Data were gathered through an online, short-answer survey. Survey data were analysed using basic frequency displays, and descriptive statistics are reported.

RESULTS

Almost 500 EMTs participated in this study, the vast majority of whom (90%) attended at least one DV call in the preceding year, with 65% attending between 10 and 20 DV calls. The majority of respondents (84.5%) wished for more education and training on the issue.

CONCLUSION

EMTs have frequent contact with victims of DV yet have received little education about the issue. The majority of those surveyed would like specific education and training on DV.

What a Piece of Work Is Man Beyond Pleasure and Pain How Motivation Works by E. Tory Higgins Oxford University Press, Oxford, 2012. 568 pp. S69.95, £45. ISBN 9780199765829

Arguing that there is much more to motivation than seeking pleasure and avoiding pain, Higgins points to the importance of desires for value, truth, and control.

Can patients help teach professionalism and empathy to dental students? Adding patient videos to a lecture course

A key aspect of predoctoral dental education involves ethics/professionalism and interpersonal communications. Empathy is an integral aspect of both. This study at the Schulich School of Medicine and Dentistry, University of Western Ontario, examined predoctoral students' perspectives to determine the impact of new educational methodologies designed to integrate patients' voices into a patient management lecture course. Videos of patients describing their dental experiences were added along with classroom discussion and students' reflective journals on the topics raised. Early results indicate that students perceived this innovation enhanced the teaching of professionalism, raised their awareness of the importance of empathy, and was a well-received addition to the course.