A review of the adult psychotherapy outcome literature reveals decades of empirical studies that support the efficacy of group treatment for mental health concerns (Burlingame, Fuhriman, & Mosier, 2003; Horne & Rosenthal, 1997). Although research demonstrates positive results for the utilization of group therapy, between 33-50% of clients drop out before treatment is completed (Baekeland & Lundwall, 1975; Wierzbicki & Pekarik, 1993). Methods for improving psychotherapy retention have been addressed through the application of a client feedback model (i.e., monitoring treatment outcome routinely). Although using client feedback has been found to be beneficial for improving retention and even enhancing client outcome in both individual (Lambert et al., 2001a; Lambert et al., 2002; Miller, Duncan, Brown, Sorrell, & Chalk, 2006; Reese, Norsworthy, & Rowlands, 2009; Whipple et al., 2003) and couples psychotherapy (Anker, Duncan, & Sparks, 2009; Reese, Toland, Slone, & Norsworthy, 2010), evidence of client feedback efficacy in a group format is limited but worthy of investigation given the positive individual and couples therapy findings. In the current study, I evaluated the effects of client feedback in group psychotherapy using a randomized clinical trial design. Participants (N = 85) attended psychotherapy groups that were randomly assigned to a client feedback (Feedback) or treatment as usual (TAU) condition. Clients in the Feedback condition were predicted to experience a statistically significantly higher pre-post gain on the ORS compared to group clients in the TAU when controlling for their initial functioning. The effect size (ES) for Feedback between treatment conditions was found to be d = 0.35 on the Outcome Rating Scale when initial treatment functioning was controlled, which is a medium ES (Cohen, 1988). Additionally, statistically significantly more clients in the Feedback condition experienced reliable and clinically significant change, attended statistically significantly more sessions, and dropped out at a lower rate than clients in the TAU condition. Results of this study were similar to those generated by other studies that evaluated the efficacy of client feedback with individuals (Reese et al., 2009) and couples (Anker et al., 2009; Reese et al., 2010). Study limitations and implications for future work are provided.

Master of Science / Department of Biological & Agricultural Engineering / Stacy L. Hutchinson / The shortage of clean, usable water is a global problem (Millennium Ecosystem Assessment, 2005). As much as 80% of the world’s population has been reported to be in areas of high water security risk due to a convergence of factors, such as watershed disturbance, pollution, water resource development and biotic factors (Voeroesmarty et al., 2010). Water reuse technologies are a potential solution to this problem. However, implementation of treatment technologies for improved water reuse require rapid, effective monitoring techniques capable of insuring treatment quality. Fluorescence spectroscopy has shown potential for wastewater treatment monitoring due to its sensitivity, selectivity, and capacity to be employed in-situ. Online fluorescence data and full fluorescence excitation-emission matrices coupled with parallel factor analysis (PARAFAC) were employed to evaluate the treatment performance of a membrane bioreactor (MBR) at Fort Riley, KS. Specific research goals were to evaluate the effectiveness of fluorescence for monitoring wastewater treatment and to determine the contamination detection limit of fluorescence techniques in a non-potable reuse scenario. Study results revealed a two-stage startup period, the first 60 days indicated membrane cake layer formation and the first 90 days showed signs of oxic tank maturation. Fluorescence was found to be effective at monitoring carbon concentration trends throughout the MBR system, showed preferential removal of protein-like dissolved organic matter (DOM), and an increase in biodegradation of DOM as the oxic tank matured. A ratio of the humic-like fluorescent components to the protein-like fluorescent components correlated to TOC removal (R² = .845, p < .001). Also, fluorescence was able to detect contamination in the effluent at the 0.74-1.24 mg C/L level using two wavelength pairs, indicating that effective real-time monitoring for contamination can be accomplished with minimal instrumentation and post-processing of data.

Objectives: Dental Monitoring® (“DM,” Dental Monitoring, Paris, France), is a cloud-based software that allows orthodontists to track patients’ treatment remotely. The purpose of this study was to investigate the accuracy of the software in making linear measurements. Methods: Patients took intraoral photographs using the DM application, immediately followed by impressions for plaster models. Intercanine and intermolar width and arch depth measurements were made by DM and compared to measurements made on the plaster models. Data was analyzed using two one-sided t-tests for equivalence with equivalence bounds of +/-0.5mm. Significance level was set at 0.05. Results: Thirty sets of measurements were compared. The intercanine and intermolar measurement differences were on average 0.17mm and -0.02mm, respectively, and were deemed equivalent. The arch depth measurements had an average difference of -0.54mm and were deemed not equivalent. Conclusion: The monitoring software seems to provide an accurate assessment of linear tooth movements.

No description available.

The early identification of non-responding psychotherapy clients and reducing their treatment failure rates are the principal functions of Clinical Support Tools (CST). Nearly two decades of patient-focused research have produced several "evidence-based treatment monitoring" (EBTM) practices, that measure individual patients' responses to theory-guided treatments and alert therapists of clients who are at risk of eventual treatment failure. Clinical Support Tools are a quality management program that bundle several EBTM practices, and have been shown to improve outcomes in failing clients (Shimokawa, Lambert & Smart, 2010). Appropriately, EBTM has generated significant interest as it expands notions of what constitutes evidence-based practice with non-responding patients (APA, 2006). There is a practical need to disseminate Clinical Support Tools to a wider audience of clinicians and practice environments. The current study was designed to advance understanding of CST mechanisms by providing detailed, qualitative data that demonstrate how CST procedures are utilized in routine practice. Eleven doctoral-level psychologists experienced in using Clinical Support Tools at a university counseling center were interviewed about their use of Clinical Support Tools with a recent non-responding client and about their general experiences with past non-responding clients. Clinicians' responses were categorized as Actions, Decisions, or Attitudes, and were subjected to inductive, thematic content analysis. Results were interpreted to indicate which CST functions were active or inactive in the therapists' routine care. Findings indicated that therapists utilized CST resources to monitor patient status, to identify problems that may have explained therapy non-response, and to initiate corrective interventions. Although it was clear that therapists used the CST signal-alarm system to initiate a problem assessment and corrective intervention, it was less clear whether therapists used CST's to determine significance of client change or to determine the client's prognosis. This observation needs to be confirmed through further investigation. Future research that quantifies CST utilization and investigates implementation-outcome relationships is recommended. Finally, practical avenues for increasing the influence and prevalence of EBTM practices in behavioral healthcare are discussed.

Background The monoclonal antibody natalizumab (NAT) inhibits the migration of lymphocytes throughout the blood–brain barrier by blocking very late antigen (VLA)-4 interactions, thereby reducing inflammatory central nervous system (CNS) activity in patients with multiple sclerosis (MS). We evaluated the effects of different NAT treatment regimens. Methods We developed and optimised a NAT assay to measure free NAT, cell-bound NAT and VLA-4 expression levels in blood and cerebrospinal fluid (CSF) of patients using standard and prolonged treatment intervals and after the cessation of therapy. Results In paired CSF and blood samples of NAT-treated MS patients, NAT concentrations in CSF were approximately 100-fold lower than those in serum. Cell-bound NAT and mean VLA-4 expression levels in CSF were comparable with those in blood. After the cessation of therapy, the kinetics of free NAT, cell-bound NAT and VLA-4 expression levels differed. Prolonged intervals greater than 4 weeks between infusions caused a gradual reduction of free and cell-bound NAT concentrations. Sera from patients with and without NAT-neutralising antibodies could be identified in a blinded assessment. The NAT-neutralising antibodies removed NAT from the cell surface in vivo and in vitro. Intercellular NAT exchange was detected in vitro. Conclusions Incorporating assays to measure free and cell-bound NAT into clinical practice can help to determine the optimal individual NAT dosing regimen for patients with MS.

Background The monoclonal antibody natalizumab (NAT) inhibits the migration of lymphocytes throughout the blood–brain barrier by blocking very late antigen (VLA)-4 interactions, thereby reducing inflammatory central nervous system (CNS) activity in patients with multiple sclerosis (MS). We evaluated the effects of different NAT treatment regimens. Methods We developed and optimised a NAT assay to measure free NAT, cell-bound NAT and VLA-4 expression levels in blood and cerebrospinal fluid (CSF) of patients using standard and prolonged treatment intervals and after the cessation of therapy. Results In paired CSF and blood samples of NAT-treated MS patients, NAT concentrations in CSF were approximately 100-fold lower than those in serum. Cell-bound NAT and mean VLA-4 expression levels in CSF were comparable with those in blood. After the cessation of therapy, the kinetics of free NAT, cell-bound NAT and VLA-4 expression levels differed. Prolonged intervals greater than 4 weeks between infusions caused a gradual reduction of free and cell-bound NAT concentrations. Sera from patients with and without NAT-neutralising antibodies could be identified in a blinded assessment. The NAT-neutralising antibodies removed NAT from the cell surface in vivo and in vitro. Intercellular NAT exchange was detected in vitro. Conclusions Incorporating assays to measure free and cell-bound NAT into clinical practice can help to determine the optimal individual NAT dosing regimen for patients with MS.

L'hadronthérapie est une méthode de traitement du cancer qui emploie des ions (carbone ou proton) au lieu des rayons X. Les interactions entre le faisceau et le patient produisent des radiations secondaires. Il existe une corrélation entre la position d'émission de certaines de ces particules et la position du pic de Bragg. Parmi ces particules, des gamma-prompt sont produits par les fragments nucléaires excités et des travaux actuels ont pour but de concevoir des systèmes de tomographie par émission mono-photonique capable d'imager la position d'émission ces radiations en temps réel, avec une précision millimétrique, malgré le faible nombre de données acquises. Bien que ce ne soit pas actuellement possible, le but in fine est de surveiller le dépôt de dose. La caméra Compton est un des système TEMP qui a été proposé pour imager ce type de particules, car elle offre une meilleure résolution énergétique et la possibilité d'avoir une image 3D. Cependant, en pratique l'acquisition est affectée par le bruit provenant d'autres particules secondaires, et les algorithmes de reconstruction des images Compton sont plus compliqués et encore peu aboutis, mais sur une bonne voie de développement. Dans le cadre de cette thèse, nous avons développé une chaîne complète allant de la simulation de l'irradiation d'un fantôme par un faisceau de protons allant jusqu'à la reconstruction tomographique des images obtenues à partir de données acquises par la caméra Compton. Nous avons étudié différentes méthodes de reconstruction analytiques et itératives, et nous avons développé une méthode de reconstruction itérative capable de prendre en compte les incertitudes de mesure sur l'énergie. Enfin nous avons développé des méthodes pour la détection de la fin du parcours des distributions gamma-prompt reconstruites. / Hadrontherapy is a cancer treatment method which uses ions (proton or carbon) instead of X-rays. Interactions between the beam and the patient produce secondary radiation. It has been shown that there is a correlation between the emission position of some of these particles and the Bragg peak position. Among these particles, prompt-gamma are produced by excited nuclear fragments and current work aims to design SPECT systems able to image the emission position the radiation in real time, with a millimetric precision, despite the low data statistic. Although it is not currently possible, the goal is to monitor the deposited dose. The Compton camera is a SPECT system that proposed for imaging such particles, because it offers a good energy resolution and the possibility of a 3D imaging. However, in practice the acquisition is affected by noise from other secondary particles and the reconstruction algorithms are more complex and not totally completed, but the developments are well advanced. In this thesis, we developed a complete process from the simulation of irradiation of a phantom by a proton beam up to the tomographic reconstruction of images obtained from data acquired by the Compton camera. We studied different reconstruction methods (analytical and iterative), and we have developed an iterative method able to consider the measurement uncertainties on energy. Finally we developed methods to detect the end-of-range of the reconstructed prompt-gamma distributions.