Sexual dysfunctions are serious mental health issues that impact an estimated one in three Americans. Due to the complex, relational nature of most sexual dysfunctions, mental health professionals trained to work with couples and their relationship interactions are likely to have better outcomes when treating clients with sexual dysfunction. Data from CIGNA Health Solutions was analyzed to explore differences in therapy outcome for various types of mental health professions when treating clients with sexual dysfunctions. The current research is a retrospective analysis of administrative data that explores whether or not type of profession (i.e. psychologists, Masters of social work, marriage and family therapist, or professional counselor) influences the outcome of mental health treatment. This study also explores whether therapy modality (i.e. individual, conjoint, or mixed mode, a combination of individual and conjoint therapy) influences therapy outcome. Treatment outcome was measured by recidivism rates, client drop out from therapy, the total number of sessions, and cost of treatment. Participants included 230 males and 189 females ages 18 to 101 (M =38.9, SD = 11.4) who received treatment for sexual disorders from 2001 to 2006. Participants were from all regions of the United States. Results indicate that overall, psychotherapeutic treatment for sexual dysfunctions is relatively brief, averaging about seven sessions across all professions. Results suggest that marriage and family therapists treat sexual dysfunctions using a conjoint and mixed mode approach more frequently than therapists with other licenses. Results also suggest that mixed mode therapy has drastically lower dropout rates and longer retention than individual or conjoint therapy. These results suggest that utilizing a combination of relational and individual sessions is beneficial to the treatment of sexual dysfunctions.

Background: Neuropilin (NRP) is a transmembrane protein, which has been shown to be a pro-angiogenic mediator and implicated as a potential driver of cancer progression. NRP-1 up-regulation in ovarian cancer tissue predicts poor prognosis. However, the clinical relevance of the soluble form of NRP-1 (sNRP-1) as a circulating biomarker in ovarian cancer patients is unknown. - Methods/patients cohort: sNRP-1 levels were quantified in a cohort of 88 clinically documented ovarian cancer patients by a commercially available sNRP-1 enzyme-linked immunosorbent assay (ELISA) kit (Biomedica, Vienna, Austria). Patients (81.8% with FIGOIII/IV) received primary cytoreductive surgery with the aim of macroscopic complete resection (achieved in 55.7% of patients) and the recommendation of adjuvant chemotherapy in line with national guidelines. - Results: Higher levels of sNRP-1 reflected more advanced disease (FIGO III/IV) and indicated a trend towards suboptimal surgical outcome, i.e. any residual tumor. sNRP-1 was neither related to the patients’ age nor the BRCA1/2 mutational status. Patients with higher sNRP-1 levels at primary diagnosis had a significantly reduced progression-free survival (PFS) (HR = 0.541, 95%CI: 0.304 - 0.963; p = 0.037) and overall survival (OS) (HR = 0.459, 95%CI: 0.225 - 0.936; p = 0.032). Principal component analysis showed that sNRP-1 levels were unrelated to the circulating hepatocyte growth factor (HGF) and the soluble ectodomain of its receptor the tyrosine kinase mesenchymal–epithelial transition (c-MET), suggesting that there is no proportional serological concentration gradient of soluble components of the NRP-1/HGF/c-MET signaling axis. - Conclusions: In line with the previously shown tissue-based prognostic role, we demonstrated for the first time that sNRP-1 can also act as a readily accessible, prognostic biomarker in the circulation of patients with ovarian cancer at primary diagnosis. Given its known role in angiogenesis and conferring resistance to the poly ADP-ribose polymerase (PARP) inhibitor olaparib in vitro, our results encourage more detailed investigation into sNRP-1 as a potential predictive biomarker for bevacizumab and/or PARP-inhibitor treatment.

The goal of presented gradual thesis is to propose financing of development strategy of the town. Thesis is divided into chapters and subsequently into subchapters for better orientation. It consists of two main parts, Review of Literature and Solution and Results chapters. The Review of Literature Chapter includes the list of literature of various authors, on which is based the practical part of thesis. Terms as municipality, sorts of municipalities and their effectiveness, as well as development strategy, strategic management, investment strategy, budget, town budget process and especially classification of income and expenditure are defined in this part. Possible resources of financing of development strategies were specified there too. Following practical part Solution and Results applies rules and knowledge described in Review of Literature Chapter to chosen municipality, in this case local government Bor. The town Bor is introduced by most important statistics, location etc. This chapter presents the Strategic Development Town Plan (SDTP), build-up process, processing and describes coherence to land use plan. SDTP includes investment actions intended to be implemented. Of course it depends on town budget and its development. In order to better visualize town money management, Bor was compared to 39 other towns of similar size by method of financial and property analysis or retrospective analysis. The appreciation of relative index was defined to every index. At the end proposal of financing was sorted. Thesis describes the process of approval of investment by local government and which factors are more or less important for final decision. The most important factor is source of financing, own or outsourcing, and its effect to financial health of municipality. Financial sources were compared in terms of advantages and disadvantages and difficulties of processing them. Selected resources were evaluated using a prospective analysis, which shows us the future form of the budget including financing of investment project. As optimal on the grounds of financing proposals resulted a combination of subsidies and self-financing.

Objectifs : Pour les parents, vivre le deuil d'un enfant atteint d'un cancer est un cheminement complexe et douloureux dont il est difficile de comprendre tous les enjeux, en particulier ce qui influence la santé psychologique et la qualité de vie à long terme. Les objectifs étaient 1/ de décrire la qualité de vie, la détresse psychologique et les symptômes de deuil de parents endeuillés, 2/ d'explorer l’influence du sexe et du temps écoulé depuis le décès sur les résultats aux tests de santé psychologique, et 3/ d’identifier des prédicteurs de la santé psychologique actuelle des parents. Méthode : Une analyse quantitative rétrospective a été effectuée auprès de 32 mères et 14 pères d'enfants décédés du cancer au CHU Sainte-Justine. Ceux-ci ont rempli un questionnaire en ligne comportant le Medical Outcomes Study Short Form (SF-12), le Brief Symptom Inventory (BSI-18) et l’Inventory of Complicated Grief (ICG-19). Résultats : Les symptômes de deuil des parents demeurent très présents, jusqu'à 18 ans après le décès. La majorité (58 %) des parents rapportent un deuil compliqué rétrospectivement. La plupart des mères rapportent des symptômes de deuil importants, ainsi qu’un changement significatif entre la première année après le décès et maintenant comparativement aux pères. Enfin, les prédicteurs de la qualité de vie et de la détresse psychologique nous renseignent sur des modèles de vulnérabilité de la santé psychologique des parents, tel qu’être père, avoir des symptômes élevés de deuil et peu de temps écoulé entre le décès et la complétion du questionnaire. Conclusion : Cette étude permet de nous informer sur les effets du deuil. Les résultats suggèrent qu'un suivi des parents endeuillés est nécessaire, même longtemps après le décès de leur enfant. / Objectives: For parents, grieving the loss of a child from cancer is a complex and painful journey for which we do not understand all the issues, in particular, what influences psychological health and long-term quality of life and more specifically the situation of fathers. This study was conducted with parents two to twenty years after the death of their child. The objectives are 1/ to describe the quality of life, psychological distress, and bereavement symptoms of bereaved parents, 2/ to explore the influence of gender and time since death on psychological health test results, and 3/ to identify predictors of parents' current psychological health. Methods: A retrospective quantitative analysis carried out was conducted with 32 mothers and 14 fathers of children who died of cancer at Sainte-Justine UHC between 2000 and 2016 were recruited and completed a self-reported online questionnaire using Medical Outcomes Study Short Form (SF-12), Brief Symptom Inventory (BSI-18) and Inventory of Complicated Grief (ICG-19). Results: Parents’ symptoms of grief continue to be very present, even up to 18 years after death (58%). Mostly mothers recall very significant symptoms of grief. They report a significant change between the first year after death and now which is less true for fathers. Finally, the predictors of Quality of Life and distress provide us with information on vulnerability patterns: being a father, having high symptoms of grief, and short time elapsed since death. Conclusion: Understanding the differences between fathers’ and mothers’ grief is important for health professionals to better support both bereaved parents efficiently. The results suggest that a follow-up of bereaved parents is needed, even long after the death of their child.

As many as one in five children and adolescents may suffer from a mental health disorder, yet there are barriers that often prevent children from receiving optimal treatment. The current study explores the influence of practitioner license type, therapy modality, diagnosis, age, and gender on mental health therapy for children and adolescents. Data was provided by Cigna, a leading health care insurance provider in the United States. Participants include 106,374 boys (53.2%) and 93,753 girls (46.8%) ages 3 to 18 (M = 12.1, SD = 3.9) who were treated in outpatient facilities throughout the United States of America. Results indicate that there are differences in dropout, recidivism, cost, and treatment length by provider license, therapy modality, diagnosis, age, and gender. Specifically, results suggest that marriage and family therapists have the lowest percent recidivism and are among the lowest in terms of dropout and cost effectiveness. The results also suggest that family therapy is more cost effective than individual or mixed therapy and that mixed therapy has a much lower percent dropout than individual or family therapy. Analysis by diagnosis suggests a potential severity scale based on dropout, recidivism, and number of sessions. There are also significant differences in dropout and recidivism by age suggesting that younger children are more likely to dropout of treatment. These results provide valuable information about mental health treatment of children and adolescents. Specifically, utilizing a family based approach may help reduce the total length of treatment while utilizing a mixed mode approach to therapy may help reduce the risk of dropout from treatment. Also, some diagnoses appear to be more difficult to treat, with higher percentages of dropout and requiring more time and money for successful treatment. Limitations and future directions are discussed.