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Alliance ruptures of the withdrawal type are prevalent in adolescents with borderline personality disorder (BPD). Longer speech pauses are negatively perceived by these patients. Safran and Muran’s rupture model is promising but its application is very work intensive. This workload makes research costly and limits clinical usage. We hypothesised that pauses can be used to automatically detect one of the markers of the rupture model i.e. the minimal response marker. Additionally, the association of withdrawal ruptures with pauses was investigated. A total of 516 ruptures occurring in 242 psychotherapy sessions collected in 22 psychotherapies of adolescent patients with BPD and subthreshold BPD were investigated. Trained observers detected ruptures based on video and audio recordings. In contrast, pauses were automatically marked in the audio-recordings of the psychotherapy sessions and automatic speaker diarisation was used to determine the speaker-switching patterns in which the pauses occur. A random forest classifier detected time frames in which ruptures with the minimal response marker occurred based on the quantity of pauses. Performance was very good with an area under the ROC curve of 0.89. Pauses which were both preceded and followed by therapist speech were the most important predictors for minimal response ruptures. Research costs can be reduced by using machine learning techniques instead of manual rating for rupture detection. In combination with other video and audio derived features like movement analysis or automatic facial emotion detection, more complete rupture detection might be possible in the future. These innovative machine learning techniques help to narrow down the mechanisms of change of psychotherapy, here specifically of the therapeutic alliance. They might also be used to technologically augment psychotherapy training and supervision.

Purpose of Review This review provides an overview of the state of research on alliance ruptures and resolutions in the treatment of personality disorders (PDs). We discuss frequently used instruments to measure alliance ruptures and resolutions. We discuss the effectiveness of rupture resolution processes and highlight possible avenues for research to explore. Innovative assessments with the potential to reveal the link of ruptures and resolutions and mechanisms of psychotherapeutic change are discussed. Recent Findings The assessment of alliance rupture and resolutions is heterogeneous. Instruments vary largely with respect to a direct or indirect assessment, the time resolution of assessment (integral therapy, phase, session, event), session sampling strategy and perspectives (patient, therapist, observer). The heterogeneity in the instruments and study designs impedes comparability and interpretation of the findings. Results support the hypothesis that ruptures are more frequent in PD. Results also point towards beneficial effects of rupture resolution patterns, early alliance quality, and resolution complexity. Few studies control findings for pretreatment factors. Summary Evidence points to the direction that rupture resolution processes can be considered a general principle of change in the treatment of PD. The concept of alliance ruptures and resolutions provides a useful tool for the management of the therapeutic alliance and its moments of deteriorations throughout the treatment course. Dimensional pretreatment personality functioning is considered a key variable in future studies to highlight what works for whom.

The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We find that placebo vs. control treatments induce small, widespread reductions in pain-related activity, particularly in regions belonging to ventral attention (including mid-insula) and somatomotor networks (including posterior insula). Behavioral placebo analgesia correlates with reduced pain-related activity in these networks and the thalamus, habenula, mid-cingulate, and supplementary motor area. Placebo-associated activity increases occur mainly in frontoparietal regions, with high between-study heterogeneity. We conclude that placebo treatments affect pain-related activity in multiple brain areas, which may reflect changes in nociception and/or other affective and decision-making processes surrounding pain. Between-study heterogeneity suggests that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies. The neural mechanisms of placebo analgesia are not fully understood. Here the authors conducted a large scale meta-analysis of individual data from fMRI studies of pain and placebo conditions.

Infection with ( ) may cause dyspepsia and/or unexplained functional nonspecific, gastrointestinal complaints of the irritable bowel syndrome (IBS) spectrum. Hitherto, in infected patients with symptoms of the IBS spectrum the occurrence of additional food intolerance/malabsorption is not evaluated. We used a retrospective analysis of charts from 548 patients who presented with gastrointestinal complaints of the irritable bowel syndrome spectrum. An enzyme-linked IgA immunosorbent assay or histologic evaluation of gastric mucosa were used to detect infection. A hydrogen breath (H ) test was performed to evaluate fructose malabsorption (FM) and lactose intolerance (LIT). Serum diamine oxidase value of <10 U/ml and a response to a histamine-reduced diet was used to identify histamine intolerance (HIT). We found 293 patients infected with , within these were 58 patients with LIT, 23 LIT patients with FM and 46 LIT patients with HIT. Additionally, 13 lactose- and histamine intolerance patients also had FM. The Kruskal Wallis test and pairwise comparison were used to analyze differences of the area under the curve of expiratory hydrogen. In lactose H breath tests compared with LIT-only patients, LIT with , LIT and with HIT, LIT and with FM showed significantly higher exhaled H levels (p=0.022). Pairwise comparison demonstrated infected patients with LIT exhaled more H compared to LIT-only (p=0.029). with lactose- and histamine intolerance, and with lactose-, histamine intolerance and FM compared to -only patients indicated a significantly higher occurrence of stomach pain during lactose H breath tests (p=0.012 and p=0.005, respectively). We demonstrate that LIT patients with high expiratory H levels in lactose breath tests may have infection and possibly additional food intolerance/malabsorption. Subsequently, besides eradication, a dietician is necessary for an individually tailored reduction- or exclusion diet of symptom triggering food components.

Alloy solidification was investigated in situ and real time by using a unique experimental setup developed at the European Synchrotron Radiation Facility (ESRF) combining both synchrotron X-ray radiography and topography. Although synchrotron X-ray radiography enables the investigation of the solid-liquid interface of metallic alloys, white-beam synchrotron X-ray topography enables the investigation of the formation of strains and defects formation in the growing solid microstructure. In this article, we present results obtained during directional solidification experiments performed with Al-3.5 wt pct Ni samples. First, the initial state after thermal stabilization is characterized. Next, the interface morphological instability and the transition to the columnar growth regime are thoroughly investigated. Topography observation shows that several parts of each dendrite become disoriented while the microstructure is developing. Disorientations are quantified and the aluminum yield stress at the melting point is estimated from the bending of secondary arms. Last, coupled growth of eutectic and dendrites settles with the formation of the eutectic phase. The eutectic grains grow strained and the dendrites concomitantly undergo additional stress.

In this article, we present a review of observations during Al-3.5 wt pct Ni alloy solidification experiments performed at the European Synchrotron Radiation Facility (ESRF) in Grenoble. These experiments provide direct access to dynamical phenomena during columnar growth (initial transient and breakdown of a planar solid-liquid interface), and for the first time to the transition from columnar-to-equiaxed microstructure (nucleation ahead of a columnar front and blocking of a columnar front by an equiaxed microstructure) and fully equiaxed growth (propagation of an effective front). Based on these experimental observations, critical parameters such as columnar growth velocity variation during the transition or equiaxed-grain diameter are measured and discussed. [PUBLICATION ABSTRACT]

The mechanical properties of a cast product, and therefore its application, depend strongly on its inner microstructure. During the solidification step a change from columnar to equiaxed grain structure can occur. It is thus critical to understand the physical mechanisms of this transition in order to accurately predict and control its occurrence and the final grain structure morphology. This article reports on observations of the CET (Columnar to Equiaxed Transition) induced by a sudden increase of the pulling velocity during the directional solidification on a refined Al-3.5wt%Ni alloy by using synchrotron X-ray radiography. The influence of the pulling velocity on the blocking of the columnar structure is described. Next, the distribution of surface area and longitudinal asymmetry of the grains after CET are quantitatively characterized and discussed.

The phenomena involved during equiaxed growth are dynamic, so that in situ and real-time investigation by X-ray imaging is compulsory to fully analyse the microstructure formation. The experiments on Al - 10 wt% Cu alloy of this paper are carried out at the European Synchrotron Radiation Facility (ESRF) in Grenoble (France). Equiaxed growth was achieved in nearly isothermal conditions and continuously monitored from the very early stages of solidification to an asymptotic state. First, measurements of dendrite arms velocity for a same grain showed slight differences in the early stages of the growth. This effect is attributed to a gravity-related \"self - poisoning\" of the grain. Then, the propagation of primary dendrite arms was analysed and two successive growth regimes were observed. First, due to the relative distance with neighbour grains, each grain could be considered as isolated (i.e. growing freely) and tip growth rate gradually increased. In a subsequent phase, tip growth rate slowly decreased towards zero, due to the proximity of neighbouring grains. Using an image analysis technique, we were able to measure the solute profiles in the liquid phase between interacting arms. These measurements confirmed that solutal impingement is responsible for stopping the grain growth.