Pin tract infections are virtually universal complications with the use of external fixation. While most are superficial and respond to oral antibiotics and local care, septic loosening may occur at the bone-pin interface, which may lead to instability of the fixator, catastrophic failure, fracture, and long-term osteomyelitis. Classification systems and prevention protocols have been developed to address this ubiquitous complication. Treatment of severe pin tract infections often requires debridement, parenteral antibiotics, and removal of the offending pin or the entire external fixator. In cases of osteomyelitic pin tracks, a sizable cavity is often present. We describe a simple technique for treatment of deep bone pin tract infection through the use of debridement, irrigation, and an antibiotic \"sparkler,\" which is a specially prepared percutaneous implant of antibiotic laden bone cement.Levels of Evidence: Level 5.

Objective: This study investigated the relationship between therapeutic techniques and session impact, by examining the replicability of findings observed in a university-based training clinic (Boswell et al., 2010) in another practice-oriented setting: private practice.
Method: N = 8 therapists completed session-level assessments of their technique use for N = 38 clients. The same client sample completed session-level assessments of session outcome. Technique-outcome associations were examined with multilevel models.
Results: As in Boswell et al., common factors were associated with positive session impact. For clients who received higher average common factor techniques (relative to their own therapist\'s caseload), session impact was the poorest in sessions with higher behavioral change techniques use (relative to the client\'s own average). Moreover, clients with the lowest average common factor techniques (relative to their therapist\'s caseload) reported better session impact in sessions that involved a higher degree of session-level behavioral change techniques (relative to their own average).
Conclusion: In line with Boswell et al., therapists should be mindful of the consistency of their routine technique use between- and within-clients, and this can be aided through collection of their own practice-oriented data.

One of the leading causes for failing at expatriate assignments is the accompanying expatriate partners\' (AEPs) unhappiness with life abroad or inability to adjust to the challenges of the host country. Strength-based therapeutic interventions have the potential to increase individuals\' mental health and well-being. The current study formed part of a multimethod study consisting of three related but independent sub-studies. The first sub-study identified the strengths of Gratitude, Curiosity and Hope to be positively associated with AEPs\' resilience and well-being. These results were used to construct a quantitative model that illustrates the interplay between these constructs. In the second sub-study, the proposed model was qualitatively reviewed by a smaller group of AEPs to inform and enrich our understanding of AEPs\' personal experiences of these constructs. In the current study, a panel of practicing psychologists who provide counselling services for South African expatriates and AEPs were asked to qualitatively review a proposed quantitative model. A cross-sectional, interpretive descriptive research design, applying purposive sampling was used to identify and recruit participants. The objective for the current study was firstly to ascertain why participants thought strengths of Gratitude, Curiosity and Hope featured so prominently in the model. Secondly, the study aimed to determine how these participants would, from their experience in working with AEPs, enhance these strengths and AEPs\' resilience in therapy, and ultimately facilitate greater well-being and successful adjustment abroad. Participants completed an online questionnaire consisting of two semi-structured, open-ended questions. The data were analyzed using primary and secondary cycle coding to ultimately develop themes. Results indicated that strengths of Curiosity, Gratitude and Hope featured prominently because these strengths include elements that form part of the process of expatriation. Participants were able to suggest practical strength-based therapeutic techniques which would assist in enhancement of strengths, resilience and ultimately well-being. It is proposed that the therapeutic techniques and approaches suggested in this study could contribute to the success rate of expatriate assignments.

In the past, open osteotomy was always performed through a dorsal approach in the surgical treatment of brachymetatarsia, which created scar formation on the dorsal skin, subsequently resulting in dissatisfaction with cosmetic results. In this study, we provided a plantar approach to avoid forming scars on the dorsal side. A retrospective review was conducted in nine patients (13 feet) with brachymetatarsia treated with an open osteotomy and gradual bone lengthening through a plantar approach. Visual analogue scale (VAS) was used to evaluate the satisfaction of foot appearance, and we designed a questionnaire called appearance index (AI) to assess the influence of foot appearance on quality of life after surgery. The complications were also recorded during the follow-up. The patients were followed up for 34.8 ± 23.7 months. All cases were healed with a time of 64.4 ± 7.1 days and a healing index of 44.1 ± 7.8 d/cm. Satisfaction VAS for foot appearance improved from a preoperative score of 1.7 ± 1.3 points to a postoperative score of 9.3 ± 0.5 points. The AI improved from a preoperative score of 9.2 ± 0.8 points to a postoperative score of 0.6 ± 0.7 points. Complications were observed in three feet (23.1%), but none was related to the plantar approach. In conclusion, the plantar approach for metatarsal osteotomy and pins fixation was a safe and efficient technique with a satisfactory cosmetic result for the patients. No complications related to the novel approach, such as neurovascular injury, were reported.

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.

This study examined clinicians\' views of the roles of two elements of cognitive behavioral therapy (CBT) in explaining treatment outcomes-CBT techniques and the therapeutic alliance.
Ninety-eight clinicians who reported delivering CBT for eating disorders completed measures addressing their beliefs about what is effective in CBT, their use of specific techniques, and their own anxiety levels.
Clinicians substantially overestimated the role of both therapeutic techniques and the alliance in explaining treatment outcomes in CBT. Weak but significant correlations were found between therapist anxiety levels and their beliefs about the value of therapeutic techniques or the alliance. However, these associations were in different directions, with higher levels of clinician anxiety associated with more belief in the effects of the alliance but with less belief in the role of CBT techniques. Belief in the role of the therapeutic alliance was associated with a lower likelihood of encouraging the patient to change their eating pattern, while belief in the role of techniques was linked to greater use of case formulation, cognitive restructuring, behavioral experiments and body image work.
Clinicians overestimate the value of both the alliance and therapy techniques in explaining treatment outcomes in CBT for eating disorders. Their beliefs about the strength of these factors are related to their own anxiety, and to their choice of techniques. Clinicians and supervisors should attend to the evidence regarding the impact of a range of elements of therapy, and work with all of those factors to enhance outcomes.

What exactly is the relationship between conscious awareness and the unconscious mind? How, for example, does the brain classify and sort its different functions into conscious or unconscious processes? How has the history of human conceptualizations about the unconscious influenced current theories? Steve Paulson, executive producer of To the Best of Our Knowledge, moderated a discussion among neuroscientist Heather Berlin, psychologist Efrat Ginot, and psychiatrist George Makari to shed light on the history of the mind and the latest insights into the still emerging science of the unconscious.