Notes

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The analyst's embodied attunement and participation arises within an embodied analytic relationship. Understanding this "deep structure" of the interaction and attention to this level of interaction opens up new modes of engagement and therapeutic action. The importance of embodied attunement is supported by recent research and theories that the developing mind is shared and dialogical through bodily communication, by rhythms of cadence, tone, intensity, and movement. The analyst's embodied awareness of two bodies together and their interpersonal rhythm is the "tool" used to gauge the pulse, vitality of connection, and particular rhythmic qualities of a uniquely shared world. This provides a read on the most elemental way the dyad shares emotional experience (or fails to). The analyst's embodied participation is interpretation in another mode. Clinical examples illustrate how embodied attunement and intentional participation work in the session, and their therapeutic effect. Failures of attunement are also discussed in terms of how the analyst recognizes these failures and his internal process of reattunement.Psychoanalytic treatment is often indicated when trauma and its psyche/soma companion, dissociation, severely disrupt symbolic functioning and associative linking. After Freud's initial thinking on these matters, repression replaced rather than supplemented dissociation (which occasions segregating units of experience) as the primary defensive response to severe trauma. Because psychoanalysis had "repressed" the salience of dissociation as actively motivated (though passively experienced), an unnecessary schism has occurred between trauma theories and mainstream North American psychoanalysis, and within psychoanalysis itself. To fully restore dissociation's role in primitive mental states and provide a more integrated approach to technique, it is necessary to comprehend the triadic nature of trauma, which entails economic/drive, structural conflict and deficit, and object-relational factors. For a treatment model that addresses defensive dissociation in the here and now, primary and secondary dissociation must be distinguished, with each differentiated from splitting and repression. Technique requires addressing unconscious, repressed fantasies associated with the "trauma," object-relational patterns that interfere with linking, and psycho-economic issues that have disrupted ego functioning. A clinical example illustrates both the analyst's persistence in suffering the dead, eerie space of dissociated trauma and efforts to find language that helps structure the patient's somatic and enacted expressions (and accompanying dissociative and repressive processes) by which traumatic experiences are registered and conveyed.Although the importance of caregiver engagement in a child's psychological treatment is well established within outpatient treatment settings, the question remains whether these findings can be generalized to more intensive treatment settings where caregiver engagement may be more challenging to facilitate. A correlational, multi-informant design was used to collect data by caregiver self-report and therapist-report from a sample of 64 caregivers of youth referred for partial hospitalization. Results show that caregivers' attitudinal self-assessment of engagement was not significantly related to their self-report of behavioral engagement (e.g. number of family sessions attended) or therapists' report of caregiver engagement. After controlling for caregiver expectations and therapist ratings of caregiver engagement, only caregiver ratings of attendance at family sessions marginally predicted treatment outcomes, but in the negative direction. Implications for adapting measures of caregiver engagement to intensive treatment settings and its impact on treatment outcomes are discussed.
Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm.

Compare our experience with valve and coil BLVR devices.

Retrospective.

Single tertiary care centre.

Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded.

Change in PFTs and completion of the 6MWT.

60 Turkish men with a diagnosis of chronic pulmonary lung disease.

Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (
=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (
=.500). E3 ligase Ligand chemical There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients;
=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups.

Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema.

Relatively small sample, retrospective design, single-centre retrospective study.

None.
None.
Diabetes mellitus increases stroke risk 1.5 to 3 fold, particularly ischemic stroke. There is limited literature on the impact of diabetes on stroke patients in Saudi Arabia.

Determine the association of diabetes on the presentation, subtypes, in-hospital complications and outcomes of ischemic stroke and transient ischemic attacks (TIA).

IRB approved, retrospective chart review.

Tertiary care center.

All adult patients with ischemic stroke or TIA aged 18 years or older admitted from January 2016 to December 2017 were included.

Stroke severity at presentation, stroke-related complications, discharge disposition and discharge modified Rankin Scale (mRS) in relation to diabetes.

802 patients.

Among 802 cases, 584 (72.8%) had diabetes; the majority (63.1%) were males. The mean age was younger in the non-diabetic stroke group (54.6 [15.5] years vs. 63.3 [9.9],
<.001). Hypertension (83.6% vs 49.1%,
<.001), dyslipidemia (38.9% vs. 28.9%,
=.009), prior stroke (27.7% vs. 19.3%
=.014), and ischemic heart disease (20.
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