Promoting the Internationalization of Evidence‐Based Practice: Benchmarking as a Strategy to Evaluate Culturally Transported Psychological Treatments

In addition to the growing evidence‐based practice movement in psychology, psychological treatments are undergoing increasing adaptation and transportation to other countries and cultures around the world, prompting the need to evaluate treatments in these diverse settings. This article proposes the “benchmarking” strategy as a valuable approach to evaluate the effectiveness of culturally adapted or transported treatments and to promote the internationalization of evidence‐based practice. We first describe the benchmarking concept in clinical research, followed by considerations for the cultural adaptation and transportation of psychological treatments. We then explain how the benchmarking strategy may be used to validate culturally transported and adapted psychological treatments. The article concludes with a discussion of considerations, limitations, and challenges for conducting cross‐cultural benchmarking research.     

Parent Management Training‐Oregon Model (PMTO™) in Mexico City: Integrating Cultural Adaptation Activities in an Implementation Model

This article describes the process of cultural adaptation at the start of the implementation of the Parent Management Training intervention‐Oregon model (PMTO) in Mexico City. The implementation process was guided by the model, and the cultural adaptation of PMTO was theoretically guided by the cultural adaptation process (CAP) model. During the process of the adaptation, we uncovered the potential for the CAP to be embedded in the implementation process, taking into account broader training and economic challenges and opportunities. We discuss how cultural adaptation and implementation processes are inextricably linked and iterative and how maintaining a collaborative relationship with the treatment developer has guided our work and has helped expand our research efforts, and how building human capital to implement PMTO in Mexico supported the implementation efforts of PMTO in other places in the United States.     

Errors in bone remodeling: Toward a unified theory of metabolic bone disease

Recent evidence suggests that skeletal adaptation is organized by a functional unit that includes cells of diverse origin working in coordination. Genetic and metabolic factors control and regulate the processes of modeling and remodeling, only rarely acting on the isolated individual functions of specific cell lines. Errors in the genetic or metabolic regulation of the functional unit affect the entire process of skeletal adaptation rather than specific elements of it. Viewed in this way, some metabolic bone diseases can be understood as relatively simple errors in factors that control the coordinated activities of the entire functional unit. This paper reviews the modeling and remodeling processes and demonstrates how abnormal morphological characteristics of bone tissue can be viewed as products of specific errors in the adaptive process.     

Psychometric properties and cultural adaptation of sleep disturbance measures in Arabic‐speaking populations: A systematic review

The aim of this review was to evaluate the psychometric properties and cross‐cultural adaptation of sleep disturbance scales that have been translated into Arabic or originally developed in Arabic, and to identify appropriate scales that can be used in research and clinical practice intended for Arabic‐speaking participants. The following databases were searched: CINAHL (2003–2019), MEDLINE (1946–2019), EMBASE (1980–2019), PsycINFO (1806–2019) and Cochrane Library (1806–2019). This review was conducted following PRISMA guidelines. Terwee et al. (J. Clin. Epidemiol., 60, 2007, 34) quality assessment was used to evaluate the psychometric properties of the studies, and cross‐cultural adaptation was assessed using criteria from Guillemin, Bombardier, and Beaton (J. Clin. Epidemiol., 46, 1993, 1417). Seven studies met the inclusion criteria, which included four scales: the Epworth Sleepiness Scale, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Arabic Scale of Insomnia. Cross‐cultural adaptations scored between good and poor; psychometric properties information was missing for most scales. The review suggested that Pittsburgh Sleep Quality Index may be a useful scale to measure sleep disturbance, as the scale showed good cultural adaptation and acceptable psychometric properties in an Arabic population. Furthermore, the scales measure seven different aspects of sleep quality. This review provides options to help researchers and clinicians select the most appropriate instrument for their practice. Further psychometric testing and cultural adaptation is required for sleep scales used in Arabic clinical populations to ensure validity and reliability in outcome measurement for research studies.     

Cultural relevance as program‐to‐community alignment

Calls for cultural sensitivity in the design and implementation of human services programs have become a standard response to the increasing diversity among the families and communities being served. In this article, we take a critical look at the construct, using data from a multi‐year evaluation of a statewide family support program. We examine how selected, locally implemented programs operationalize the state program's cultural sensitivity standard, using both etic and emic approaches; that is, we apply extant cultural competence definitions to assess program cultural sensitivity and document how the program staff articulated their approach to the cultural sensitivity. Findings suggest that programs focus more directly on the immediate cultural relevance of their services, rather than on developing more generalized competencies among their staff. Further, findings indicate that program‐to‐community alignment may well be a more useful representation of how programs address cultural issues. © 2009 Wiley Periodicals, Inc.     

Potentially Perilous Pedagogies: Teaching Trauma Is Not the Same as Trauma-Informed Teaching

This article explores why and how trauma theory and research are currently used in higher education in nonclinical courses such as literature, women's studies, film, education, anthropology, cultural studies, composition, and creative writing. In these contexts, traumatic material is presented not only indirectly in the form of texts and films that depict traumatic events but also directly in the form of what is most commonly referred to in nonclinical disciplines as trauma studies, cultural trauma studies, and critical trauma studies. Within these areas of study, some instructors promote potentially risky pedagogical practices involving trauma exposure or disclosure despite indications that these may be having deleterious effects. After examining the published rationales for such methods, we argue that given the high rates of trauma histories (66%–85%), posttraumatic stress disorder (9%–12%), and other past event–related distress among college students, student risk of retraumatization and secondary traumatization should be decreased rather than increased. To this end, we propose that a trauma-informed approach to pedagogy—one that recognizes these risks and prioritizes student emotional safety in learning—is essential, particularly in classes in which trauma theories or traumatic experiences are taught or disclosed.     

A new approach for exploring functional development of fetal brain pathways

Study of functional development of central pathways in fetuses is challenging due to the lack of methods available. In this article, we present a novel approach to test if and when central functional pathways are established by a combination of mapping with c‐fos and chronically cannulated fetuses in utero. This approach is based on brain structures such as circumventricular organs (CVOs) that lack the blood–brain barrier (BBB), but are rich in sensors to peripheral signals and contain projections to other brain regions. If signaling molecules in the blood that are too large to cross the BBB induced c‐fos expression in both the CVOs and other nuclei inside the fetal brain, this can be evidence that projections from the CVOs to those nuclei are established and functional. This is a useful real‐time method to explore the status of functional maturation of pathways between the CVOs and other brain areas in developing fetuses. Notably, at the moment, this is the first and only in vivo method that can detect functional projections in the fetal brain in vitro. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 384–388, 2009.     

A Heuristic Framework for the Cultural Adaptation of Interventions

What conditions justify cultural adaptations to evidence‐based treatments, and how might those adaptations be developed? Lau's (2006 ) analysis brought considerable clarity to these questions. We place Lau's insights and those of others within an elaborated framework that proposes tests of three types of cultural equivalence to determine when evidence‐based treatments might merit adaptations: equivalence of (a) engagement, (b) action theory, and (c) conceptual theory. Extrapolating from Lau's examples and recommendations of others, we describe a sequence for developing adaptations that consists of the following phases: (a) information gathering, (b) preliminary adaptation design, (c) preliminary adaptation tests, and (d) adaptation refinement.     

The Mid-Fusiform Sulcus (sulcus sagittalis gyri fusiformis)

In the human brain, the mid-fusiform sulcus (MFS; sulcus sagittalis gyri fusiformis) divides the fusiform gyrus (FG) into lateral and medial partitions. Recent studies show that the MFS is identifiable in every hemisphere and is a landmark that identifies (a) cytoarchitectonic transitions among four areas of the FG, (b) functional transitions in many large-scale maps, and (c) the location of fine-scale functional regions. Thus, simply identifying the MFS in a person's brain provides researchers with knowledge regarding: (a) how cells are organized across layers within a particular cortical location, (b) how functional representations will be laid out in cortex, and (c) the precise location of functional regions from cortical folding alone. The predictive power of the MFS can guide future studies examining the anatomical-functional organization of the FG, as well as the development of translational applications for different patient populations. Nevertheless, progress has been slow in incorporating the MFS into the broader anatomical community and into neuroanatomical reference sources. For example, even though the MFS is a rare structural–functional landmark in human association cortex as just described, it is not recognized in the recently published Terminologia Neuroanatomica (TNA). In this review, I collate the anatomical and functional details of the MFS in one place for the first time. Together, this article serves as a comprehensive reference regarding the anatomical and functional details of the MFS, as well as provides a growing number of reasons to include the MFS as a recognized neuroanatomical structure in future revisions of the TNA. Anat Rec, 302:1491–1503, 2019. © 2018 American Association for Anatomy     

Real-time biofeedback integrated into neuromuscular training reduces high-risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation

Prospective evidence indicates that functional biomechanics and brain connectivity may predispose an athlete to an anterior cruciate ligament injury, revealing novel neural linkages for targeted neuromuscular training interventions. The purpose of this study was to determine the efficacy of a real-time biofeedback system for altering knee biomechanics and brain functional connectivity. Seventeen healthy, young, physically active female athletes completed 6 weeks of augmented neuromuscular training (aNMT) utilizing real-time, interactive visual biofeedback and 13 served as untrained controls. A drop vertical jump and resting state functional magnetic resonance imaging were separately completed at pre- and posttest time points to assess sensorimotor adaptation. The aNMT group had a significant reduction in peak knee abduction moment (pKAM) compared to controls (p = .03, d = 0.71). The aNMT group also exhibited a significant increase in functional connectivity between the right supplementary motor area and the left thalamus (p = .0473 after false discovery rate correction). Greater percent change in pKAM was also related to increased connectivity between the right cerebellum and right thalamus for the aNMT group (p = .0292 after false discovery rate correction, r² = .62). No significant changes were observed for the controls (ps > .05). Our data provide preliminary evidence of potential neural mechanisms for aNMT-induced motor adaptations that reduce injury risk. Future research is warranted to understand the role of neuromuscular training alone and how each component of aNMT influences biomechanics and functional connectivity.     

The contribution of proprioceptive feedback to sensorimotor adaptation

It is known that proprioceptive signals from muscles, joints, and skin are involved in the execution of aimed arm movements, but their role in the acquisition of new motor behaviour is largely unknown. Previous research using deafferented patients yielded inconsistent findings: sensorimotor adaptation was found to be less, equal, or even better than in controls. The present study uses a different approach: we degraded proprioceptive signals in healthy subjects by wrist vibration, while leaving them intact in a control group. In order to induce sensorimotor adaptation, both groups executed pointing movements under a visual (Exp. A) or a mechanical perturbation (Exp. B). We found that adaptation to the visual distortion was little affected by vibration, while adaptation to the mechanical distortion was substantially impaired. We conclude that proprioceptive signals which overtly disagree with visual ones (Exp. A) are not used for adaptation, while those which largely agree with visual ones (Exp. B) are used to enhance adaptive recalibration. These results indicate that intact proprioception is needed for mechanical but not for visual adaptation, which implies that the underlying mechanisms are at least partly distinct.     

The different facets of “culture” in genetic counseling: A situated analysis of genetic counseling in Hong Kong

In this article, we problematize the concept of “culture” in genetic counseling. With globalization and increased mobility of both genetic professionals and clients, there is an increased acknowledgement of the impact of “culture” on a counseling process. There is, however, little agreement on what “culture” is. The essentialist understanding that has long been dominant in the medical literature views culture as a set of shared beliefs, attitudes and practices among a group of people. Such an approach does not account for the individual differences and the dynamic nature of genetic counseling encounters. Following Zayts and Schnurr (2017), we use the distinction between two orders of culture: culture₁ that refers to the static, generalized understanding of culture that is external to the specific context, and culture₂, an analytic concept that denotes dynamic enactments of culture, emerging in the interaction. We use empirical data from genetic counseling sessions to illustrate these different facets of culture and to consider how and why speakers draw on them. The clinical implications of the study include highlighting the importance of cultural awareness among counselors, including cultural self‐awareness, and demonstrating how authentic interactional data could be used to enhance cultural training in genetic counseling.     

First validation of the model of sustainable mental health: Structural model validity and the indirect role of adaptation

Objectives

There is a growing interest in mental well-being as a vital outcome in clinical practice in addition to mental illness. The model of sustainable mental health (SMH) was recently introduced to delineate how interventions can improve mental health by targeting barriers and resources of adaptation to life stressors, improving the ability to adapt and thereby reducing mental illness and improving mental well-being. The aim of the current study is to empirically validate the conceptual model of SMH as well as the assumed indirect role of ability to adapt.

Methods

This study used an existing dataset of the general population with self-reported reduced well-being due to the corona crisis (n = 849, mean age 53 years, SD = 15). Measurements of mental illness (depression and anxiety), mental well-being, ability to adapt, a specific barrier for adaptation (i.e., repetitive negative thinking), and a specific resource for adaptation (i.e., positive reframing) were included. Structural equation modeling was used to assess both the structural validity of the model and the indirect effect of ability to adapt.

Results

An acceptable to good fit was found for the model of SMH and all paths between the proposed elements of the model were significant and in the hypothesized direction. Ability to adapt served as an indirect pathway trough which repetitive negative thinking (B = 0.149, 95% confidence interval [CI] = 0.016–0.028) and positive reframing (B = 0.163, 95% CI = 0.065–0.123) were linked with mental illness and mental well-being.

Conclusion

The current study provides the first empirical support of the internal validity of the model of SMH in a sample of the general population with reduced well-being, suggesting that barriers and resources to adaptation have an effect on mental illness and mental well-being through the ability to adapt. The model of SMH may therefore be a good model to use in research and clinical practice for developing, implementing, and evaluating a balanced treatment approach targeting both barriers and resources for adaptation.     

Can Verona Coding Definitions of Emotional Sequences (VR-CoDES) be applied to standardized Chinese medical consultations? – A reliability and validity investigation

ObjectiveTo investigate the reliability and validity of the Chinese version of VR-CoDES.MethodsThe VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns.ResultsICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences.ConclusionThe Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation.Practice implicationMore consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation.     

If bone is the answer,then what is the question?

In the 19th century, several scientists attempted to relate bone trabecular morphology to its mechanical, load‐bearing function. It was suggested that bone architecture was an answer to requirements of optimal stress transfer, pairing maximal strength to minimal weight, according to particular mathematical design rules. Using contemporary methods of analysis, stress transfer in bones was studied and compared with anatomical specimens, from which it was hypothesised that trabecular architecture is associated with stress trajectories. Others focused on the biological processes by which trabecular architectures are formed and on the question of how bone could maintain the relationship between external load and architecture in a variable functional environment. Wilhelm Roux introduced the principle of functional adaptation as a self‐organising process based in the tissues. Julius Wolff, anatomist and orthopaedic surgeon, entwined these 3 issues in his book The Law of Bone Remodeling (translation), which set the stage for biomechanical research goals in our day. ‘Wolff's Law’ is a question rather than a law, asking for the requirements of structural optimisation. In this article, based on finite element analysis (FEA) results of stress transfer in bones, it is argued that it was the wrong question, putting us on the wrong foot. The maximal strength/minimal weight principle does not provide a rationale for architectural formation or adaptation; the similarity between trabecular orientation and stress trajectories is circumstantial, not causal. Based on computer simulations of bone remodelling as a regulatory process, governed by mechanical usage and orchestrated by osteocyte mechanosensitivity, it is shown that Roux's paradigm, conversely, is a realistic proposition. Put in a quantitative regulatory context, it can predict both trabecular formation and adaptation. Hence, trabecular architecture is not an answer to Wolff's question, in the sense of this article's title. There are no mathematical optimisation rules for bone architecture; there is just a biological regulatory process, producing a structure adapted to mechanical demands by the nature of its characteristics, adequate for evolutionary endurance. It is predicted that computer simulation of this process can help us to unravel its secrets.     

Culture as an explanation in population health

In the last two decades, culture has emerged in population health as a common explanation for health outcomes and disparities. This paper systematically reviews such cultural accounts, focusing on a historical sample of articles from prominent population health journals (1930–2008, n=100) and a contemporary sample of articles in the American Journal of Public Health (2008, n=95). The review reveals that references to culture rarely (1) specify the precise pathways by which culture influences health or (2) assess the plausibility of these pathways. Despite these weaknesses, a few studies have begun to clarify, measure, and assess how culture can influence health outcomes, and these articles reflect promising new avenues for understanding how cultural factors influence variation in health and well-being.     

Lung tissue rheology and 1/f noise

The mechanical properties of lung tissue are important contributors to both the elastic and dissipative properties of the entire organ at normal breathing frequencies. A number of detailed studies have shown that the stress adaptation in the tissue of the lung following a step change in volume is very accurately described by the functiont ^−k for some small positive constantk. We applied step increases in length to lung parenchymal strips and found the ensuing stress recovery to be extremely accurately described byt ^−k over almost 3 decades of time, despite the quasi-static stress-length characteristics of the strips being highly nonlinear. The corresponding complex impedance of lung tissue was found to have a magnitude that varied inversely with frequency. We note that this is highly reminiscent of a phenomenon known as 1/f noise, which has been shown to occur ubiquitously throughout the natural world. 1/f noise has been postulated to be a reflection of the complexity of the system that produces it, something like a central limit theorem for dynamic systems. We have therefore developed the hypothesis that thet ^−k nature of lung tissue stress adaptation follows from the fact that lung tissue itself is composed of innumerable components that interact in an extremely rich and varied manner. Thus, although the constantk is no doubt determined by the particular constituents of the tissue, we postulate that the actual functional form of the stress adaptation is not.     

Effects of short-term adaptation of saccadic gaze amplitude on hand-pointing movements

 We investigated whether and how adaptive changes in saccadic amplitudes (short-term saccadic adaptation) modify hand movements when subjects are involved in a pointing task to visual targets without vision of the hand. An experiment consisted of the pre-adaptation test of hand pointing (placing the finger tip on a LED position), a period of adaptation, and a post-adaptation test of hand pointing. In a basic task (transfer paradigm A), the pre- and post-adaptation trials were performed without accompanying eye and head movements: in the double-step gaze adaptation task, subjects had to fixate a single, suddenly displaced visual target by moving eyes and head in a natural way. Two experimental sessions were run with the visual target jumping during the saccades, either backwards (from 30 to 20°, gaze saccade shortening) or onwards (30 to 40°, gaze saccade lengthening). Following gaze-shortening adaptation (level of adaptation 79±10%, mean and s.d.), we found a statistically significant shift (t-test, error level P<0.05) in the final hand-movement points, possibly due to adaptation transfer, representing 15.2% of the respective gaze adaptation. After gaze-lengthening adaptation (level of adaptation 92±17%), a non-significant shift occurred in the opposite direction to that expected from adaptation transfer. The applied computations were also performed on some data of an earlier transfer paradigm (B, three target displacements at a time) with gain shortening. They revealed a significant transfer relative to the amount of adaptation of 18.5±17.5% (P<0.05). In the coupling paradigm (C), we studied the influence of gaze saccade adaptation of hand-pointing movements with concomitant orienting gaze shifts. The adaptation levels achieved were 59±20% (shortening) and 61±27% (lengthening). Shifts in the final fingertip positions were congruent with internal coupling between gaze and hand, representing 53% of the respective gaze-amplitude changes in the shortening session and 6% in the lengthening session. With an adaptation transfer of less than 20% (paradigm A and B), we concluded that saccadic adaptation does not ”automatically” produce a functionally meaningful change in the skeleto-motor system controlling hand-pointing movements. In tasks with concomitant gaze saccades (coupling paradigm C), the modification of hand pointing by the adapted gaze comes out more clearly, but only in the shortening session. Received: 9 February 1998 / Accepted: 18 August 1998     

Conflict adaptation in schizophrenia: reviewing past and previewing future efforts

Introduction: Cognitive control impairments have been suggested to be a critical component in the overall cognitive deficits observed in patients diagnosed with schizophrenia. Here, we zoom in on a specific function of cognitive control, conflict adaptation. Abnormal neural activity patterns have been observed for patients diagnosed with schizophrenia in core conflict adaptation areas such as anterior cingulate cortex and prefrontal cortex. On the one hand, this strongly indicates that conflict adaptation is affected. On the other hand, however, outcomes at the behavioural level are needed to create a window into a precise interpretation of this abnormal neural activity.Methods. We present a narrative review of behavioural work within the context of conflict adaptation in schizophrenia, focusing on various major conflict adaptation markers: congruency sequence effects, proportion congruency effects, and post-error and post-conflict slowing. The review emphasises both methodological and theoretical aspects that are relevant to the understanding of conflict adaptation in schizophrenia.Results. Based on the currently available set of behavioural studies on conflict adaptation, no clear-cut answer can be provided as to the precise conflict adaptation processes that are impaired (and to what extent) in schizophrenia populations.Conclusions. Future work is needed in state-of-the-art designs in order to reach better insight into the specifics of conflict adaptation impairments associated with schizophrenia.