In a world of technological breakthroughs, it is not surprising that psychotherapists have, along with the general population, taken to the multiple possibilities offered by devices or systems that affect communication. E-mail, now an ever-present phenomenon of near "real time" interaction, provides a myriad of possibilities for enhanced dialogue in psychotherapy relationships. This paper will describe the growing phenomenon of e-mail as an adjunctive tool in psychotherapy practice by initially reviewing the most current of the recent literature. The authors will present a model for the adjunctive use of e-mail between patient and therapist. Case material will illustrate this model as applied to ongoing treatment, crisis intervention, and follow-up.

The morphology of early interactions between neural tube and myotome in the amphibian embryo and tail regenerate was examined using the electron microscope. Two types of contacts were observed. At the most primitive level where the myotome was yet unsegmented, multiple adhesive-type contacts linked neural tube and myotome. In newly segmented areas early ventral roots were recognizable as small bundles of one to five axons extending the short distance to the myotome. There was only one bundle per segment and in addition to axons, each bundle always contained one or more primitive glial cell processes which accompanied axons as they left the cord. At points of root exit primitive glial processes appeared to funnel axons into the root. The cytoarchitecture of the cord and the new roots suggested that the primitive glia may play a role in pathfinding for motor axons as they leave the cord and extend toward their targets.

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Micronutrient deficiencies remain unacceptably high in the diets of many impoverished communities in both developed and developing countries. However, despite declining consumption patterns, pulse crops such as lentils (Lens culinaris Medik.) can serve as important crops to fill the micronutrient gap. In the present study, three lentil cultivars grown over a 2‐yr study period at two locations (Bison and Wall, SD) in the Northern Great Plains were evaluated to assess the crop's ability to meet the daily nutritional requirements of critical micronutrients: Fe, Mg, K, Se, and Zn. Results were found to vary significantly by location and by cultivar. The greatest differences were found for Se. Between cultivars, concentrations ranged from 115 to 210% of daily requirements per 100 g lentils at Bison and 295 to 381% at Wall. On the basis of average yields per hectare and nutrient concentrations, lentils were found on average to meet the yearly recommended intake requirements of 13 and 20 adult females for Fe, 9 and 13 adults for Mg, 7 and 11 adults for K, 49 and 125 adults for Se, and 14 and 26 adults for Zn between the two study sites, respectively.

Introduction The strength of the evidence base for the comparative effectiveness of three common surgical modalities for paediatric nephrolithiasis (ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy) and its relevance to patients and caregivers are insufficient. We describe the methods and rationale for the Pediatric KIDney Stone (PKIDS) Care Improvement Network Trial with the aim to compare effectiveness of surgical modalities in paediatric nephrolithiasis based on stone clearance and lived patient experiences. This protocol serves as a patient-centred alternative to randomised controlled trials for interventions where clinical equipoise is lacking. Methods and analysis The PKIDS is a collaborative learning organisation composed of 26 hospitals that is conducting a prospective pragmatic clinical trial comparing the effectiveness of ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy for youth aged 8–21 years with kidney and/or ureteral stones. Embedded within clinical care, the PKIDS trial will collect granular patient-level, surgeon-level and institution-level data, with a goal enrolment of 1290 participants over a 21-month period. The primary study outcome is stone clearance, defined as absence of a residual calculus of >4 mm on postoperative ultrasound. Secondary outcomes include patient-reported physical, emotional and social health outcomes (primarily using the Patient-Reported Outcome Measurement Information System), analgesic use and healthcare resource use. Timing and content of secondary outcomes assessments were set based on feedback from patient partners. Heterogeneity of treatment effect for stone clearance and patient-reported outcomes by participant and stone characteristics will be assessed. Ethics and dissemination This study is approved by the central institutional review board with reliance across participating sites. Participating stakeholders will review results and contribute to development dissemination at regional, national and international meetings. Trial registration number NCT04285658; Pre-results.