Presentation of floating mass transducer and Vibroplasty Couplers on CT and Cone Beam CT

Various titanium coupling elements, Vibroplasty Couplers, maintaining the attachment of the Floating Mass Transducer (FMT) of the active middle ear implant Vibrant Soundbridge (VSB) to the round window, the stapes suprastructure or the stapes footplate are in use to optimally transfer energy from the FMT to the inner ear fluids. In certain cases it is of interest to radiologically verify the correct position of the FMT coupler assembly. The imaging appearance of FMT connected to these couplers, however, is not well known. The aim of this study was to present the radiological appearance of correctly positioned Vibroplasty Couplers together with the FMT using two different imaging techniques. Vibroplasty Couplers were attached to the FMT of a Vibrant Soundbridge and implanted in formalin fixed human temporal bones. Five FMT coupler assemblies were implanted in different positions: conventionally to the incus, a Bell-Coupler, a CliP-Coupler, a Round Window-Coupler and an Oval Window-Coupler. High spatial resolution imaging with Multi-Detector CT (MDCT) and Cone Beam CT (CBCT) was performed in each specimen. Images were blind evaluated by two radiologists on a visual basis. Middle ear details, identification of FMT and coupler, position of FMT coupler assembly and artefacts were assessed. CBCT showed a better spatial resolution and a higher visual image quality than MDCT, but there was no significant advantage over MDCT in delineating the structures or the temporal bone of the FMT Coupler assemblies. The FMT with its coupler element could be clearly identified in the two imaging techniques. The correct positioning of the FMT and all types of couplers could be demonstrated. Both methods, MDCT and CBCT, are appropriate methods for postoperative localization of FMT in combination with Vibroplasty Couplers and for verifying their correct position. If CBCT is available, this method is recommended due to the better spatial resolution and less metal artifacts.     

Evolution of parental knowledge and efficacy across the pediatric neuropsychological evaluation process

Objective: The handful of studies examining parent satisfaction after pediatric neuropsychological evaluations have focused on post-evaluation appraisals. By examining parent experiences across the course of their child’s evaluation, this study aimed to provide important insights into how and when parents experience changes in knowledge, understanding of care options, and efficacy during evaluation process.

Method: Parents of youth receiving neuropsychological evaluation completed questionnaires at four time points (prior to evaluation [n?=?363], day of testing [n?=?300], prior to feedback [n?=?250], and post-report [n?=?99]). Parents rated aspects of their knowledge and efficacy regarding their child’s functioning. Parents also rated their perception of the neuropsychologist, medical provider, and school along the same domains. The resulting longitudinal data were analyzed using structural equation modeling and ANCOVA. Although primary analyses focused on the entire sample, differences between first-time evaluations and re-evaluations were also examined.

Results: Families receiving an initial evaluation showed lower ratings in knowledge, awareness of options, and efficacy at the beginning of the evaluation and a significant increase in ratings by the end of the evaluation. Families returning for re-evaluation showed higher initial ratings that changed comparatively little during the evaluation. Parents receiving initial evaluations also perceived increased knowledge of their child by medical providers and school.

Conclusion: The study supports the clinical assumption that parents gain knowledge about their child and treatment options during a neuropsychological evaluation. The difference between initial and re-evaluation warrants further study. Studying the process and experience of neuropsychological evaluation may provide more nuanced findings than post hoc satisfaction measures.     

The Supervisory Alliance in Group Supervision

In this paper the author explores the ways in which a supervision group can be a source of ruptures in the supervisory alliance. Furthermore, the group's involvement in repair of the supervisory alliance is examined. The author draws upon empirical material from supervision sessions with a supervision group consisting of one supervisor and four novice psychotherapists conducting psychodynamic psychotherapy at a university clinic. Based on the work of W.R. Bion, the paper argues that, in group supervision, the supervisory alliance cannot be separated from the group processes in which it is embedded. The author concludes that a supervision group can affect the supervisory alliance negatively through group dynamics, or the alliance can be ruptured by other alliance formations that constitute themselves in group supervision. However, a supervision group can contribute to the repair of the supervisory alliance by supporting the supervisee, compensating for the supervisor's imperfection and supporting the supervisor.     

Veal Calves Produce Less Antibodies against C. Perfringens Alpha Toxin Compared to Beef Calves

Enterotoxaemia is a disease with a high associated mortality rate, affecting beef and veal calves worldwide, caused by C. perfringens alpha toxin and perfringolysin. A longitudinal study was conducted to determine the dynamics of antibodies against these toxins in 528 calves on 4 beef and 15 veal farms. The second study aimed to determine the effect of solid feed intake on the production of antibodies against alpha toxin and perfringolysin. The control group only received milk replacer, whereas in the test group solid feed was provided. Maternal antibodies for alpha toxin were present in 45% of the veal calves and 66% of the beef calves. In beef calves a fluent transition from maternal to active immunity was observed for alpha toxin, whereas almost no veal calves developed active immunity. Perfringolysin antibodies significantly declined both in veal and beef calves. In the second study all calves were seropositive for alpha toxin throughout the experiment and solid feed intake did not alter the dynamics of alpha and perfringolysin antibodies. In conclusion, the present study showed that veal calves on a traditional milk replacer diet had significantly lower alpha toxin antibodies compared to beef calves in the risk period for enterotoxaemia, whereas no differences were noticed for perfringolysin.