Systematic discontinuation of long-term treatment with nucleos(t)ide analogues (NAs) is one strategy to increase functional cure rates in patients with chronic hepatitis B e antigen (HBeAg)-negative hepatitis B. Currently, available study results are heterogeneous; however, long-term hepatitis B surface antigen (HBsAg) loss rates of up to 20% have been reported in prospective trials. This review proposes criteria that can be used when considering NA discontinuation in patients with chronic hepatitis B virus (HBV). Discontinuing NA treatment frequently results in a virologic and biochemical relapse that runs through different phases: the lag phase, reactivation phase, and consolidation phase. The HBV-DNA flares observed during the reactivation phase are often transient and most likely represent a trigger for inducing a long-term immune control by specific CD8+ T cells, and therefore do not need immediate interventions but close follow-up evaluation. Low HBsAg levels at the time of treatment cessation predict a positive long-term response to NA discontinuation associated with a higher likelihood of HBsAg clearance. Other host and viral biomarkers are currently under evaluation that may prove to be helpful to further characterize the population that may benefit most from the finite NA treatment concept. Potential harmful biochemical flares during the reactivation phase need to be identified early and can be effectively terminated by reintroducing NA treatment. Hepatic decompensation represents a risk to patients with cirrhosis undergoing NA discontinuation. Therefore, the finite NA approach should only be considered after excluding advanced fibrosis and cirrhosis and if a close follow-up of the patient and supervision by an experienced physician can be guaranteed. Conclusion: For selected patients, NA discontinuation has become a powerful tool to achieve control over HBeAg-negative HBV infections. Its significant effect represents a challenge to novel treatment approaches, but it may also serve as their enhancer.

A prominent need in the youth psychotherapy literature includes the examination of mechanisms of change within the context of "real world" clinical settings, where the practice of psychotherapy differs significantly from that in controlled clinical trials. In examining mechanisms of change in youth psychotherapy, variables related to parent functioning may be among the most important factors to consider in predicting and promoting good child outcomes. The purpose of the present study was to evaluate three important aspects of parent functioning—psychological symptom distress, interpersonal relations, and social role performance—as potential predictors of successful treatment outcomes in a traditional community outpatient treatment setting for children and adolescents. Further, this study examined whether parents indirectly benefited from their children receiving services, expanding our view on the scope and benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and Social Role performance were measured using the domains of the Outcome Questionnaire 45 (OQ-45; Lambert et al., 2004), and youth treatment outcomes were measured using the parent and self-report versions of the Youth-Outcome Questionnaire (Y-OQ; Burlingame, Wells, Lambert, & Cox, 2004; Y-OQ-SR; Wells, Burlingame & Rose, 2003). Using Hierarchical Linear Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the relationship between these parent domains and youth progress in therapy. Results revealed that parent Symptom Distress and Social Role performance improved significantly over the course of youth treatment. Further, Social Role performance at intake significantly predicted the rate of change in parent-reported youth outcome; and Interpersonal Relations at intake significantly predicted rate of change in youth-reported outcome. Finally, changes in parent Social Role performance were associated with changes in youth symptoms over the course of treatment. Examining the associations between these variables is an important step toward identifying potential mechanisms of change in youth mental health treatment. The results of this study provide valuable information on the importance of attending to parent functioning in the assessment and treatment of youth mental health issues.

The first semester of practicum is a difficult time for counseling students as they learn to integrate knowledge and theory into clinical practice, often evoking high levels of anxiety (Barbee, Scherer, & Combs, 2003; Ronnestad & Skovholt, 1993) and limiting counselor selfefficacy (Bernard & Goodyear, 2009; Melchert et al., 1996). Practicum is the first opportunity counselors-in-training have to apply theoretical knowledge in a professional setting, use new clinical skills, and test how well they fit into the field of counseling (O‟Connell & Smith, 2005). Additionally, if counselor educators do not fully understand the process counselors in training develop counselor self-efficacy, they may be overlooking opportunities to educate a new generation of counselors or using their time, energy and resources in areas that may not be the most efficient in counselor development. The purpose of this study was to examine the effect of an embedded, rich-media distributed learning environment added to practicum had on the development of counselor self-efficacy, reduction of anxiety and effect on treatment outcomes for counselors in training in their first semester of practicum. This study found the use of distributed learning to extend education beyond the classroom significantly and positively affected the development of counselor selfefficacy, had mixed statistical results on the reduction of anxiety and did not have an affect on treatment outcome. Furthermore, the study used hierarchical linear modeling to see if the characteristics of individual practicums affected the three main constructs, the results did not find a significant effect from the groups. iv The results of the study produced several implications for counseling. First, if counselor educators help counselors in training become more aware of counselor self-efficacy, the students can better understand how the construct affects their anxiety, their comfort with expanding or improving their clinical skills and the approach they take to a client, session or treatment plan. A second implication is that using an embedded, rich-media learning environment may help the counselors in training to develop their clinical skills. The results of this study imply that utilizing technology and discussions beyond the classroom is beneficial for (a) increasing the students‟ counselor self-efficacy, (b) normalizing the emotions the students may experience and (c) improving the methods for development through vicarious learning. Also, as technology continues to evolve and as education continues to adapt by integrating technology into the classrooms, counselor educators should begin exploring how to best use technology to teach students during practicum. Traditionally, based on the nature of counseling, practicum has been an interpersonal experience, but the results of the current study imply the methods of extending learning beyond the traditional class time is beneficial. Finally, as counselor educators strive to increase students‟ counselor self-efficacy early in practicum, in an environment that contains anxiety and self-doubt (Bernard & Goodyear, 2009; Cashwell & Dooley, 2001) using vicarious learning through video and online discussions can assist in accomplishing the goal.

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Given the high rates of treatment drop-out and non-compliance within empirically-based treatments for OCD, it is important to increase our understanding of factors that impact the treatment process. Two studies were conducted to evaluate the clinical utility of the Obsessive Compulsive Consequences Scale-Revised (OCCS-R) and increase understanding of the relationships between the prognostic factors of motivation, insight, treatment compliance and treatment outcome. Study 1 used maximum likelihood Confirmatory Factor Analysis to show the OCCS-R's four factor solution was an adequate fit in a sub-clinical college population. Study 2 evaluated the clinical utility of the OCCS-R for predicting treatment outcome and its relationship to identified predictor variables. The OCCS-R predicted treatment drop-out but did not predict symptom improvement. Some support was found for predicted relationships between the OCCS-R and its factors, a general measure of motivation and treatment compliance. No variables predicted symptom improvement. Insight and initial symptom severity predicted treatment motivation which in turn predicted treatment compliance. / Ph. D.