Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.

Predicting Psychotherapy Dropouts: A Multilevel Approach

The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive–behavioural therapy without pre-determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. Copyright © 2014 John Wiley & Sons, Ltd.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

Solution of the relativistic Schrödinger equation for the δ ′ -Function potential in one dimension using cutoff regularization

We study the relativistic version of the Schrödinger equation for a point particle in one dimension with the potential of the first derivative of the delta function. The momentum cutoff regularization is used to study the bound state and scattering states. The initial calculations show that the reciprocal of the bare coupling constant is ultraviolet divergent, and the resultant expression cannot be renormalized in the usual sense, where the divergent terms can just be omitted. Therefore, a general procedure has been developed to derive different physical properties of the system. The procedure is used first in the nonrelativistic case for the purpose of clarification and comparisons. For the relativistic case, the results show that this system behaves exactly like the delta function potential, which means that this system also shares features with quantum filed theories, like being asymptotically free. In addition, in the massless limit, it undergoes dimensional transmutation, and it possesses an infrared conformal fixed point. The comparison of the solution with the relativistic delta function potential solution shows evidence of universality.

Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial

BACKGROUND Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. METHODS After clinical diagnosis and clarification of inclusion criteria (e.g., age 40-70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. DISCUSSION The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669.

La controvertida teoría de la historia de Karl Marx : Réplica a Julián Verardi

Este texto es una réplica al artículo de Julián Verardi "Forma y contenido en la concepción materialista de la historia". Contiene una respuesta a las críticas que Verardi formulara a Materialismo histórico: interpretaciones y controversias, y una clarificación de algunos conceptos centrales del materialismo histórico

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

La controvertida teoría de la historia de Karl Marx : Réplica a Julián Verardi

Este texto es una réplica al artículo de Julián Verardi "Forma y contenido en la concepción materialista de la historia". Contiene una respuesta a las críticas que Verardi formulara a Materialismo histórico: interpretaciones y controversias, y una clarificación de algunos conceptos centrales del materialismo histórico

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

La controvertida teoría de la historia de Karl Marx : Réplica a Julián Verardi

Este texto es una réplica al artículo de Julián Verardi "Forma y contenido en la concepción materialista de la historia". Contiene una respuesta a las críticas que Verardi formulara a Materialismo histórico: interpretaciones y controversias, y una clarificación de algunos conceptos centrales del materialismo histórico

La Educación en Ciencias como un llamado a la acción

Este artículo considera que tanto la educación en Ciencia, Tecnología, Sociedad y Ambiente (CTSA) como las formas convencionales de la enseñanza de problemas socio-científicos (PSC) son inadecuadas para satisfacer las necesidades e intereses de los y las estudiantes que se enfrentan con demandas, problemas y asuntos de la vida contemporánea. Se defiende un acercamiento educativo mucho más politizado, con un mayor énfasis en la crítica social, la clarificación de valores y la acción socio-política, a través de un enfoque basado en problemas que puede convivir con el currículo convencional basado en disciplinas. Para ello, es necesario que la confrontación de cuestiones, la consideración de los valores subyacentes y la acción sean totalmente integrados al currículum

Development of Border Economic Zones in Thailand: Expansion of Border Trade and Formation of Border Economic Zones

In the wake of economic globalization and development in Thailand, movement of people and commodities at the Thai borders is also becoming pronounced. Economic interdependence between Thailand and neighboring countries is growing through border customhouses. As a policy, Thailand is trying to stimulate trade and investment with neighboring countries following the ACMECS (Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy) scheme. In this report, first, movement of people and goods at the borders will be examined. Second, clarification of where and how development is proceeding will be presented. Last, this study will attempt to review the perspectives of policies on neighboring countries after Thaksin.

Agglomeration versus Fragmentation:A Comparison of East Asia and Europe

Inspired by the observed contrasting patterns of industrial distribution in East Asia and Europe, this paper conducts an empirical clarification of the difference in spatial relationships among countries within a region for the electric machinery industry by use of spatial econometric analysis. The results indicate that, while production in the electric machinery industry in a country is positively correlated with that of neighboring countries in East Asia, there is no significant spatial correlation in Europe. Such a difference in spatial interdependence has important implications for economic development in those regions.

Sensitization profiles and cross-reactivity among plant allergens. Molecular mechanisms of food allergy development and the role of enhancers

La prevalencia de las alergias está aumentando desde mediados del siglo XX, y se estima que actualmente afectan a alrededor del 2-8 % de la población, pero las causas de este aumento aún no están claras. Encontrar el origen del mecanismo por el cual una proteína inofensiva se convierte en capaz de inducir una respuesta alérgica es de vital importancia para prevenir y tratar estas enfermedades. Aunque la caracterización de alérgenos relevantes ha ayudado a mejorar el manejo clínico y a aclarar los mecanismos básicos de las reacciones alérgicas, todavía queda un largo camino para establecer el origen de la alergenicidad y reactividad cruzada. El objetivo de esta tesis ha sido caracterizar las bases moleculares de la alergenicidad tomando como modelo dos familias de panalergenos (proteínas de transferencia de lípidos –LTPs- y taumatinas –TLPs-) y estudiando los mecanismos que median la sensibilización y la reactividad cruzada para mejorar tanto el diagnóstico como el tratamiento de la alergia. Para ello, se llevaron a cabo dos estrategias: estudiar la reactividad cruzada de miembros de familias de panalérgenos; y estudiar moléculas-co-adyuvantes que pudieran favorecer la capacidad alergénica de dichas proteínas. Para estudiar la reactividad cruzada entre miembros de la misma familia de proteínas, se seleccionaron LTPs y TLPs, descritas como alergenos, tomando como modelo la alergia a frutas. Por otra parte, se estudiaron los perfiles de sensibilización a alérgenos de trigo relacionados con el asma del panadero, la enfermedad ocupacional más relevante de origen alérgico. Estos estudios se llevaron a cabo estandarizando ensayos tipo microarrays con alérgenos y analizando los resultados por la teoría de grafos. En relación al estudiar moléculas-co-adyuvantes que pudieran favorecer la capacidad alergénica de dichas proteínas, se llevaron a cabo estudios sobre la interacción de los alérgenos alimentarios con células del sistema inmune humano y murino y el epitelio de las mucosas, analizando la importancia de moléculas co-transportadas con los alérgenos en el desarrollo de una respuesta Th2. Para ello, Pru p 3(LTP y alérgeno principal del melocotón) se selección como modelo para llevarlo a cabo. Por otra parte, se analizó el papel de moléculas activadoras del sistema inmune producidas por patógenos en la inducción de alergias alimentarias seleccionando el modelo kiwi-alternaria, y el papel de Alt a 1, alérgeno mayor de dicho hongo, en la sensibilización a Act d 2, alérgeno mayor de kiwi. En resumen, el presente trabajo presenta una investigación innovadora aportando resultados de gran utilidad tanto para la mejora del diagnóstico como para nuevas investigaciones sobre la alergia y el esclarecimiento final de los mecanismos que caracterizan esta enfermedad. ABSTRACT Allergies are increasing their prevalence from mid twentieth century, and they are currently estimated to affect around 2-8% of the population but the underlying causes of this increase remain still elusive. The understanding of the mechanism by which a harmless protein becomes capable of inducing an allergic response provides us the basis to prevent and treat these diseases. Although the characterization of relevant allergens has led to improved clinical management and has helped to clarify the basic mechanisms of allergic reactions, it seems justified in aspiring to molecularly dissecting these allergens to establish the structural basis of their allergenicity and cross-reactivity. The aim of this thesis was to characterize the molecular basis of the allergenicity of model proteins belonging to different families (Lipid Transfer Proteins –LTPs-, and Thaumatin-like Proteins –TLPs-) in order to identify mechanisms that mediate sensitization and cross reactivity for developing new strategies in the management of allergy, both diagnosis and treatment, in the near future. With this purpose, two strategies have been conducted: studies of cross-reactivity among panallergen families and molecular studies of the contribution of cofactors in the induction of the allergic response by these panallergens. Following the first strategy, we studied the cross-reactivity among members of two plant panallergens (LTPs , Lipid Transfer Proteins , and TLPs , Thaumatin-like Proteins) using the peach allergy as a model. Similarly, we characterized the sensitization profiles to wheat allergens in baker's asthma development, the most relevant occupational disease. These studies were performed using allergen microarrays and the graph theory for analyzing the results. Regarding the second approach, we analyzed the interaction of plant allergens with immune and epithelial cells. To perform these studies , we examined the importance of ligands and co-transported molecules of plant allergens in the development of Th2 responses. To this end, Pru p 3, nsLTP (non-specific Lipid Transfer Protein) and peach major allergen, was selected as a model to investigate its interaction with cells of the human and murine immune systems as well as with the intestinal epithelium and the contribution of its ligand in inducing an allergic response was studied. Moreover, we analyzed the role of pathogen associated molecules in the induction of food allergy. For that, we selected the kiwi- alternaria system as a model and the role of Alt a 1 , major allergen of the fungus, in the development of Act d 2-sensitization was studied. In summary, this work presents an innovative research providing useful results for improving diagnosis and leading to further research on allergy and the final clarification of the mechanisms that characterize this disease.

Estudio microestructural y de los procesos de hidratación de cementos con adiciones

En los últimos años, las sociedades industrializadas han tomado una mayor conciencia sobre el problema que suponen las emisiones indiscriminadas de gases de efecto invernadero a la atmósfera. El hormigón, cuyo principal componente es el cemento, es probablemente el material más utilizado en construcción. En la actualidad, las emisiones globales de CO2 debidas a la combustión del CaCO3 del cemento Pórtland representan entre el 5% y el 10% respecto del total. Estos valores son de gran interés si se considera que el compromiso aceptado al firmar el Protocolo de Kioto es de una reducción del 5% antes del año 2020, sobre el total de gases producidos. El principal objetivo del presente trabajo es el estudio microestructural y de los procesos de hidratación de los cementos con adiciones. Para ello se propone contribuir a la investigación sobre nuevos productos cementicios basados en micropartículas esféricas vítreas que pueden adicionarse al cemento antes del proceso de amasado. Los resultados obtenidos se han contrastado con las adiciones convencionales de más uso en la actualidad. El nuevo material basa su composición en la química del aluminio y el silicio. Al disminuir la cantidad de CaCO3, se contribuye al desarrollo sostenible y a la reducción de emisiones de CO2. La patente creada por el Grupo Cementos Pórtland Valderrivas (GCPV), describe el proceso de producción de las cemesferas (WO 2009/007470, 2010). Los productos que forman la materia prima para la elaboración de las cemesferas son arcillas, calizas, margas o productos o subproductos industriales, que tras su molienda, son fundidos mediante un fluido gaseoso a elevada temperatura (entre 1250ºC y 1600ºC). Este proceso permite obtener un producto final en forma esférica maciza o microesfera, que tras estabilizarse mediante un enfriamiento rápido, consigue una alta vitrificación idónea para su reactividad química, con una mínima superficie específica en relación a su masa. El producto final obtenido presenta prácticamente la finura requerida y no precisa ser molido, lo que reduce las emisiones de CO2 por el ahorro de combustible durante el proceso de molienda. El proceso descrito permite obtener un amplio abanico de materiales cementantes que, no solo pueden dar respuesta a los problemas generados por las emisiones de CO2, sino también a la disponibilidad de materiales en países donde hasta el momento no se puede fabricar cemento debido a la falta de calizas. Complementariamente se ha optimizado el método de cálculo del grado de hidratación a partir de los resultados del ensayo de ATD-TG en base a los modelos de cálculo de Bhatty y Pane. El método propuesto permite interpretar el comportamiento futuro del material a partir de la interpolación numérica de la cantidad de agua químicamente enlazada. La evolución del grado de hidratación tiene una relación directa con el desarrollo de la resistencia mecánica del material. Con el fin de caracterizar los materiales de base cemento, se ha llevado a cabo una amplia campaña experimental en pasta de cemento, mortero y hormigón. La investigación abarca tres niveles: caracterización microestructural, macroestructural y caracterización del comportamiento a largo plazo, fundamentalmente durabilidad. En total se han evaluado ocho adiciones diferentes: cuatro adiciones convencionales y cuatro tipos de cemesferas con diferente composición química. Los ensayos a escala microscópica comprenden la caracterización química, granulométrica y de la superficie específica BET de los materiales anhidros, análisis térmico diferencial y termogravimétrico en pasta de cemento y mortero, resonancia magnética de silicio en pasta de cemento, difracción de rayos X de los materiales anhidros y de las probetas de pasta, microscopía electrónica de barrido con analizador de energía dispersiva por rayos X en pasta y mortero, y porosimetría por intrusión de mercurio en mortero. La caracterización macroscópica del material comprende ensayos de determinación del agua de consistencia normal y de los tiempos de inicio y fin de fraguado en pasta de cemento, ensayos de resistencia mecánica a flexión y compresión en probetas prismáticas de mortero, y ensayos de resistencia a compresión en probetas de hormigón. Para caracterizar la durabilidad se han desarrollado ensayos de determinación del coeficiente de migración de cloruros y ensayos de resistividad eléctrica en probetas de mortero. Todos los ensayos enumerados permiten clarificar el comportamiento de las cemesferas y compararlo con las distintas adiciones de uso convencional. Los resultados reflejan un buen comportamiento resistente y durable de los materiales con adición de cemesferas. La caracterización microscópica refleja su relación con las propiedades mesoscópicas y permite comprender mejor la evolución en los procesos de hidratación de las cemesferas. In recent years industrialised societies have become increasingly aware of the problem posed by indiscriminate emission of greenhouse gases into the atmosphere. Concrete, with a main component being cement, is arguably the most widely used construction material. At present, global emissions of CO2 due to the combustion of CaCO3 from Portland cement represent between 5% and 10% of the total. If the requirement of the Kyoto Protocol of a reduction of 5% of the total gas produced before 2020 is considered, then such values are of significant interest. The main objective of this work is the assessment of the microstructure and the hydration processes of cements with additions. Such an examination proposes research into new cementitious products based on vitreous spherical microparticles that may be added to the cement before the mixing process. The results are compared with the most commonly used conventional additions. The new material bases its composition on the chemistry of aluminium and silicates. By decreasing the amount of CaCO3, it is possible both to contribute to sustainable development and reduce CO2 emissions. The patent created by Grupo Cementos Portland Valderrivas (GCPV) describes the production process of microspheres (WO 2009/007470, 2010). The products that form the raw material for manufacture are clays, lime-stone, marl and industrial products or by-products that melt after being ground and fed into a gaseous fluid at high temperatures (1250°C and 1600°C). This process allows the obtaining of a product with a solid-spherical or micro-spherical shape and which, after being stabilised in a solid state by rapid cooling, obtains a high vitrification suitable for chemical reactivity, having a minimal surface in relation to its mass. Given that the final product has the fineness required, it prevents grinding that reduces CO2 emissions by saving fuel during this process. The process, which allows a wide range of cementitious materials to be obtained, not only addresses the problems caused by CO2 emissions but also enhances the availability of materials in countries that until the time of writing have not produced cement due to a lack of limestone. In addition, the calculation of the degree of hydration from the test results of DTA-TG is optimised and based on Bhatty and Pane calculation models. The proposed method allows prediction of the performance of the material from numerical interpolation of the amount of chemically bound water. The degree of hydration has a direct relationship with the development of material mechanical strength. In order to characterise the cement-based materials, an extensive experimental campaign in cement paste, concrete and mortar is conducted. The research comprises three levels: micro-structural characterisation, macro-structural and long-term behaviour (mainly durability). In total, eight additions are assessed: four conventional additions and four types of microspheres with different chemical compositions. The micro-scale tests include characterisation of chemical composition, particle size distribution and the BET specific surface area of anhydrous material, differential thermal and thermogravimetric analysis in cement paste and mortar, silicon-29 nuclear magnetic resonance in cement paste, X-ray diffraction of the anhydrous materials and paste specimens, scanning of electron microscopy with energy dispersive X-ray analyser in cement paste and mortar, and mercury intrusion porosimetry in mortar. The macroscopic material characterisation entails determination of water demand for normal consistency, and initial and final setting times of cement paste, flexural and compressive mechanical strength tests in prismatic mortar specimens, and compressive strength tests in concrete specimens. Tests for determining the chloride migration coefficient are performed to characterise durability, together with electrical resistivity tests in mortar specimens. All the tests listed allow clarification of the behaviour of the microspheres and comparison with the various additions of conventional use. The results show good resistance and durable behaviour of materials with a microsphere addition. Microscopic characterisation reflects their relationship with mesoscopic properties and provides insights into the hydration processes of the microspheres.