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The article focuses on the challenges and opportunities faced by therapists in developing portfolio careers in the counseling profession. It discusses the experiences of various practitioners who have diversified their careers by combining client sessions with other forms of work, such as management consultancy, writing, entrepreneurship, and digital media. It further highlights the reasons behind opting for portfolio careers.

Introduction A steadily rising opioid pandemic has left the US suffering significant social, economic, and health crises. Machine learning (ML) domains have been utilized to predict prolonged postoperative opioid (PPO) use. This systematic review aims to compile all up-to-date studies addressing such algorithms’ use in clinical practice.Methods We searched PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science using the keywords “machine learning,” “opioid,” and “prediction.” The results were limited to human studies with full-text availability in English. We included all peer-reviewed journal articles that addressed an ML model to predict PPO use by adult patients.Results Fifteen studies were included with a sample size ranging from 381 to 112898, primarily orthopedic-surgery-related. Most authors define a prolonged misuse of opioids if it extends beyond 90 days postoperatively. Input variables ranged from 9 to 23 and were primarily preoperative. Most studies developed and tested at least two algorithms and then enhanced the best-performing model for use retrospectively on electronic medical records. The best-performing models were decision-tree-based boosting algorithms in 5 studies with AUC ranging from .81 to .66 and Brier scores ranging from .073 to .13, followed second by logistic regression classifiers in 5 studies. The topmost contributing variable was preoperative opioid use, followed by depression and antidepressant use, age, and use of instrumentation.Conclusions ML algorithms have demonstrated promising potential as a decision-supportive tool in predicting prolonged opioid use in post-surgical patients. Further validation studies would allow for their confident incorporation into daily clinical practice.

Modern international travel can feel like a series of hurdles to negotiate, whether it's the late arrival of your airport taxi, unexpected traffic jams and flight delays, or just the [...]

YOU ONLY HAVE TO BROWSE AN AIRPORT BOOKSHOP to see that self-help is big business. But don't judge the whole sector by the latest bestseller claiming you can unleash 'unlimited [...]

When you took your wedding vows, chances are you didn't promise to 'love, honour and fly off to another country, leaving your partner to cope on their own, on a [...]

Fast-track your fitness 1 SEVEN-MINUTE WORKOUT The noughties was the decade we discovered less can be more when it comes to exercise. According to the American College of Sports Medicine's [...]

how many is too many? If you feel that drinking is affecting your productivity, Sally Brown suggests strategies for cutting down At times, travelling can feel like entering a parallel [...]

The article informs that self-doubt is a common challenge faced by therapists throughout careers. It is noted that a therapist job involves navigating ambiguity, uncertainty and the ever-changing external factors affecting clients. Additionally, the public's perception of profession can be dismissive or misinformed. Even experienced therapists may experience feelings of incompetence as self-expectations can increase with time. Self-doubt is not a static issue and can evolve over time.

The article discusses the need for a more flexible approach to the duration of the psychoanalytic sessions during psychotherapy to make therapy remain viable and to accommodate client preferences. It examines the efficacy of 50-minute hour session with a 10-minute break between clients and compares it with shorter or, conversely, longer sessions.

ObjectiveThe hepatitis C virus (HCV) epidemic among gay, bisexual and other men who have sex with men (GBMSM) is associated with sexual and drug-related behaviours. To stem the tide of HCV infection in GBMSM, regular testing leading to early diagnosis and treatment as prevention is vital. This study aimed to evaluate the success of current HCV testing guidelines from the perspective of GBMSM in four Celtic nations.MethodsSubpopulation analysis of data from the 2020 cross-sectional online SMMASH3 (social media, men who have sex with men, sexual and holistic health) survey was undertaken to examine HCV testing experiences and sexual behaviours among sexually active GBMSM (n=1886) stratified across three groups: HIV-diagnosed GBMSM (n=124); HIV-negative GBMSM using pre-exposure prophylaxis (PrEP) (n=365); and HIV-negative/untested GBMSM notusing PrEP (n=1397).ResultsSexual behaviours associated with HCV acquisition were reported by the majority of HIV-diagnosed (76.6%, n=95) and PrEP-using (93.2%, n=340) GBMSM. Reassuringly, recent testing for HCV in these groups was common, with 79.8% (n=99) and 80.5% (n=294) self-reporting HCV screening within the preceding year, respectively, mostly within sexual health settings. While 54.5% (n=762) of HIV-negative/untested GBMSM not using PrEP reported sexual behaviours associated with HCV, 52.0% had not been screened for HCV in the last year, despite almost half (48.0%, n=190) of unscreened men being in contact with sexual health services in the same period.ConclusionsSexual behaviours associated with HCV acquisition among HIV-diagnosed and PrEP-using GBMSM are common but complemented by regular HCV testing within sexual health services. Current testing guidelines for these groups appear to be effective and generally well observed. However, behaviour-based HCV testing for HIV-negative/untested GBMSM notusing PrEP appears less effective and may undermine efforts to achieve HCV elimination. Accordingly, we need to increase HCV testing for these men in clinical settings and explore ways to screen those who are not in touch with sexual health services.

Tiredness comes with the territory when you travel for business, but new research points to long-term consequences for physical and psychological health and well-being when we regularly miss out on [...]

Have you become adept at smiling without opening your mouth? You're not the only one--according to an NHS survey, about one in seven people in the UK are so unhappy [...]

Over the past 20 years, the mobile phone has gone from being a luxury item to the centre of our existence. There is a downside, however. According to a recent [...]

An introduction is presented in which the editor discusses articles in the issue on topics including CPD (Continuing Professional Development) and career development, ethics and good practice and client presenting issues and case studies.

Having a therapist is so 20th century. Nowadays, the key to self-betterment is in personal coaching. Two decades ago, a coach was someone in charge of a sports team--now you [...]

Sally Brown reveals how yoga can make you stronger, smarter and healthier. And it's not just for girls If you had to invent a fitness technique for frequent travellers, your [...]

We may not be short of food, but what we're choosing to eat can be less than ideal for optimum health. Despite more than ten years of campaigning by the [...]

Consistency is the key to getting fit--finding a routine you like and doing it regularly. But that's easier said than done for the frequent traveller. Even if there is a [...]

Ever got on a plane feeling fine, and got off with a sore back? Although it may seem impossible to hurt yourself while sitting down, a long-haul flight can be [...]

If you've ever taken a long-haul flight east, chances are you have first-hand experience of how jet lag feels. There's no mistaking that distinctive combination of exhaustion and insomnia, spiced [...]

What's the most memorable souvenir you've picked up abroad? For a growing number of business travellers, it's a new nose or a wrinkle-free forehead. Coming back from a trip with [...]

Remember your last hangover at work, when you felt like your IQ had dropped 20 points overnight? Or the time you nearly nodded off in a meeting because you were [...]

The article focuses on client complains.

The article presents an interview through an online exhibition 'Feminist Connect' featuring Ghi Fremaux, Michael Hubbard, and Olga Alexander as artists. It provides insight into their artistic and conceptual processes and how their work informs each other. The artists spoke about their processes, their next projects, and how their work brings tribute to women in their unique way.

In the UK, coastal flooding and erosion are two of the primary climate-related hazards to communities, businesses, and infrastructure. To better address the ramifications of those hazards, now and into the future, the UK needs to transform its scattered, fragmented coastal data resources into a systematic, integrated portal for quality-assured, publicly accessible open data. Such a portal would support analyses of coastal risk and resilience by hosting, in addition to data layers for coastal flooding and erosion, a diverse array of spatial datasets for building footprints, infrastructure networks, land use, population, and various socio-economic measures and indicators derived from survey and census data. The portal would facilitate novel combinations of spatial data layers to yield scientifically, societally, and economically beneficial insights into UK coastal systems.

To mark the tenth anniversary of Nature Climate Change, we asked a selection of researchers across the broad range of climate change disciplines to share their thoughts on notable developments of the past decade, as well as their hopes and expectations for the coming years of discovery.

Climate-induced sea-level rise and vertical land movements, including natural and human-induced subsidence in sedimentary coastal lowlands, combine to change relative sea levels around the world’s coasts. Although this affects local rates of sea-level rise, assessments of the coastal impacts of subsidence are lacking on a global scale. Here, we quantify global-mean relative sea-level rise to be 2.5 mm yr−1over the past two decades. However, as coastal inhabitants are preferentially located in subsiding locations, they experience an average relative sea-level rise up to four times faster at 7.8 to 9.9 mm yr−1. These results indicate that the impacts and adaptation needs are much higher than reported global sea-level rise measurements suggest. In particular, human-induced subsidence in and surrounding coastal cities can be rapidly reduced with appropriate policy for groundwater utilization and drainage. Such policy would offer substantial and rapid benefits to reduce growth of coastal flood exposure due to relative sea-level rise.

Composing is an essential part of literacy development in early childhood classrooms, and writing experiences are continually changing through advances in technology. Writing in a new language can be particularly challenging for emergent bilinguals as they navigate learning how to spell in English as part of the writing process. New pedagogical tools must be used to support these students as meaning makers and composers. In this study, we investigated how a group of first‐grade emergent bilinguals used word prediction software as they created digital compositions over the course of a year. The results suggest several positive ways, such as basic spelling support, extended written responses, and additional opportunities to practice reading, that this digital tool enhanced the meaning‐making process of emergent bilingual writers. Recommendations for educators to implement word prediction software in classrooms are included.

Dear Editor In terms of current National Parks regulations in Zimbabwe, bow-hunting requires a specific permit from the Director-General. To avoid confusion please note that the Director-General will only grant [...]

The article explores as any therapist working in private practice, or any service provider, will tell you, the admin involved in running a practice can be time consuming. At its most basic level, it includes scheduling and booking appointments, tracking payments and recording and safely storing client notes and other personal data. I'm assuming I'm not the only practitioner who uses a mixed bag of digital and manual/ paper- based approaches.

A study was conducted to test the suitability of a range of organic and inorganic residuals mixed with municipal biosolids to create a soil amendment effective for a broad range of end uses. Biosolids suitable for unrestricted use were sourced from San Francisco, CA. Residuals including urban wood and yard waste, nut shells, biochar, and sawdust were sourced from nearby producers. Existing biosolids based soil products, peat, and a yard–food compost were used as controls. Experimental mixtures were tested for a range of soil properties, appearance, odor, germination, and growth response. Several mixtures performed as well as or better than the yard–food compost, and several performed comparably to the biosolids soil controls. Yard waste fines blended with biosolids in a 50:50 ratio by volume or yard waste fines blended with biosolids and 20% sand at 40:40:20 were highly effective across all measured indices. Mixed yard and recycled lumber fines blended with biosolids at these same ratios performed similarly well. Blends with a high percentage of char performed poorly in germination and growth response, likely as a result of elevated electrical conductivity. Certain blends such as gypsum and redwood shavings failed to mix well with biosolids to create a uniform looking material and were less visually appealing. In general, blends that met established quality control parameters for compost performed well on the measured indices. These results suggest that blending Class A biosolids with organic and inorganic feedstocks to meet quality criteria developed for compost will create marketable soil products.

Synthetic fertilizers make up a significant fraction of the energy required to grow switchgrass (Panicum virgatumL.) for ethanol production. A field study compared biosolids and synthetic fertilizers on biomass yield, ethanol production, and nitrous oxide (N2O) emissions of switchgrass to determine if using an alternative source of nutrient would lower the energy density of the fuel. Minimal N2O emissions were observed the first year of the study (0.99 ± 1.5 g N2O ha−1d−1for biosolids), with no difference between treatments. Biosolids were added in excess of agronomic rates, and gas samples were collected immediately after irrigation for the subsequent years to examine maximum N2O emissions. Mean Year 2 emissions increased for fertilizers to 1.8 ± 8 g N2O ha−1d−1(n= 131) and to 3.73 ± 10.2 g N2O ha−1d−1(n= 130) for biosolids‐amended soils. Emissions in Year 3 were similar to Year 2. Yield was similar and ranged from 3.7 ± 5 to 11 ± 1.1 and from 5.0 ± 0.2 to 13.4 ± 1.7 Mg ha−1for biosolids and fertilizer, respectively. The potential ethanol yield was 365 ± 28 L Mg−1and 374 ± 34 L Mg−1for the biosolids‐ and fertilizer‐grown grass, respectively. Greenhouse gas emissions associated with fertilizer production were considered for N, P, and K and totaled 1,653 kg carbon dioxide equivalent (CO2e) ha−1. The equivalent credits for substitution of biosolids (18 Mg ha−1) were −2,492 kg CO2e ha−1. Nitrous oxide emissions were calculated based on 1% of total N applied for agronomic applications and were 8,600 and 3,500 g N2O ha−1for the biosolids and fertilizer treatments, respectively. Total carbon costs associated with fertilization were 2,700 kg CO2e ha−1for fertilizer and 60 kg CO2e ha−1for biosolids. Using measured N2O data would have resulted in lower emissions for both treatments.

The article explores the impact of Covid-19 on the therapy profession and how practitioners are adapting to support their clients – and themselves. Topic include counselling services, issues about keeping up rental payments on property while seeing a drop in income; and views of Integrative counsellor Rachel Shattock Dawson notes that working online effectively turns therapy into a level geographically.

The article offers information on the Association for Counselling and Therapy Online (ACTO). Topic include online work can impact from in-person work and, with the addition of being isolated and any personal anxieties about the current situation, therapists may be at a risk of burnout without proper training.

The author discusses the impact of social media on mental health of girls and mentions growing incidence of sexual harassment which is impacting girls mental health. Topics discussed include exploration of relationship between teen aspiration, influence of social media and mental health, availability of smartphones which has created chances for cyber-flashing and sexual harassment and importance of talking about internet safety.

AbstractDeveloping biosolids-based composts or soil blends suitable for use in urban areas is increasingly common. End uses for compost vary and can include use as a soil conditioner for existing turf, to establish new turf, for tree planting, in urban agriculture, and for use along highway right-of-ways. The carbon benefits/costs of biosolids compost were modeled for King County, Washington. Soil carbon sequestration was highest for use on disturbed soils such as new housing developments, neglected urban soils, or highway right-of-ways (–1.1 Mg CO2eqper Mg compost) and lowest for use in well-tended yards or other highly maintained landscapes (–0.036 Mg CO2eqper Mg compost). Compost use for tree growth, calculated over a 30-year period, added above-ground sequestration benefits ranging from –1.53 Mg CO2eqper Mg compost for a mature tree grown on a healthy soil to –4.58 Mg CO2eqper Mg compost for a newly planted tree grown on a disturbed site. Assuming a 20 km haul distance, transport costs ranged from 0.005 Mg CO2eqper Mg compost for delivery in a 5 Mg truck to 0.09 Mg CO2eqper Mg compost for pick up in a personal vehicle. Ecosystem services associated with different end uses for compost in urban areas also vary. This model suggests that while uses for biosolids compost will likely be varied, for a program as a whole, significant carbon benefits can be expected.

The article discusses the ways of minimizing the stress levels. Topics include stages of burnout which is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment, according to Professor Christina Maslach, the psychologist; starting with a reduction in factors supporting the ability to cope, such as eating a balanced diet, getting quality sleep and regular exercise; and signs of emotional exhaustion like sleep disruption, tiredness, and lack of motivation.

An introduction to articles in the issue is presented on topics including a professional journey of a therapist where she wondered if she was withholding some of herself from clients by never self-disclosing, how embarking on a new training changed one's career after 20 years, and the pros and cons of integrating a new modality or completely transitioning to a new way of working.

The article offers information on how can we make a blended approach work for us and our clients. Topics include the hybrid or blended working is here to stay for many professions, including ours, the hybrid way of working mean in practice, and what do we need to consider to ensure we work ethically and effectively, and the hybrid working means conducting some of our work with clients remotely and some in person.

The article discusses on several reasons which cause depression in older people and mentions the challenges for counselor for working with older people. Topics discussed include information on study related to ageing which cause increasing incidences of mental illness in population; challenges for counsellor in working with clients with dementia; and need to use fundamental skills while working with older people like narrative therapy, acceptance therapy, and life review models.