Intervention Fidelity: An Essential Component for Understanding ASD Parent Training Research and Practice

Previous research has explored the efficacy and effectiveness of autism spectrum disorder (ASD) parent training interventions. Recent trials of such programs have not replicated earlier compelling outcomes, yet the reasons for the failure of such programs to produce desired effects are unclear. The purpose of the current article is to discuss the role of intervention fidelity in elucidating the relationships between a parent training program, the implementation and sustainability of an intervention, and important child outcomes. The article will discuss the importance of assessing intervention fidelity for the identification and successful use of effective treatment strategies and will propose an integrative conceptual framework for approaching the study and evaluation of intervention fidelity with respect to ASD parent training programs.     

Improving attention control in dysphoria through cognitive training: Transfer effects on working memory capacity and filtering efficiency

Impaired filtering of irrelevant information from working memory is thought to underlie reduced working memory capacity for relevant information in dysphoria. The current study investigated whether training‐related gains in working memory performance on the adaptive dual n‐back task could result in improved inhibitory function. Efficacy of training was monitored in a change detection paradigm allowing measurement of a sustained event‐related potential asymmetry sensitive to working memory capacity and the efficient filtering of irrelevant information. Dysphoric participants in the training group showed training‐related gains in working memory that were accompanied by gains in working memory capacity and filtering efficiency compared to an active control group. Results provide important initial evidence that behavioral performance and neural function in dysphoria can be improved by facilitating greater attentional control.     

The Language of Dissociation

ABSTRACT

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.     

自信心心理训练对社交焦虑障碍患者社交回避与苦恼及社会的支持影响

目的 探讨自信心心理训练对社交焦虑症患者社交回避与苦恼以及社会支持的影响.方法 将80例16～30岁社交焦虑症患者随机分为自信心训练治疗组（研究组）和空白组（对照组）,研究组每周进行两次自信心训练,每次3小时,持续5周,共10次;对照组不采取任何治疗手段.干预前与干预结束3个月后分别对两组进行社交回避与苦恼（SAD）以及社会支持评定量表（SSRS）评定,了解患者社交回避与苦恼及社会支持的改善状况.结果 入组时两组SAD评定无差异（t=-0.242,P＞0.05）,SSRS评定无差异（t=0.208,P＞0.05）;两组心理干预后SAD比较有显著性差异（t=-3.326,P＜0.001）;SSRS有显著性差异（t =2.390,P＜0.05）.结论 自信心心理训练可以明显改善社交焦虑症患者的社交回避与苦恼症状,并可有效提高患者的社会支持水平.     

The acute effects of strength,endurance and concurrent exercises on the Akt/mTOR/p70S6K1 and AMPK signaling pathway responses in rat skeletal muscle

The activation of competing intracellular pathways has been proposed to explain the reduced training adaptations after concurrent strength and endurance exercises (CE). The present study investigated the acute effects of CE, strength exercises (SE), and endurance exercises (EE) on phosphorylated/total ratios of selected AMPK and Akt/mTOR/p70^S6K1 pathway proteins in rats. Six animals per exercise group were killed immediately (0 h) and 2 h after each exercise mode. In addition, 6 animals in a non-exercised condition (NE) were killed on the same day and under the same conditions. The levels of AMPK, phospho-Thr¹⁷²AMPK (p-AMPK), Akt, phospho-Ser⁴⁷³Akt (p-Akt), p70^S6K1, phospho-Thr³⁸⁹-p70^S6K1 (p-p70^S6K1), mTOR, phospho-Ser²⁴⁴⁸mTOR (p-mTOR), and phospho-Thr¹⁴⁶²-TSC2 (p-TSC2) expression were evaluated by immunoblotting in total plantaris muscle extracts. The only significant difference detected was an increase (i.e., 87%) in Akt phosphorylated/total ratio in the CE group 2 h after exercise compared to the NE group (P = 0.002). There were no changes in AMPK, TSC2, mTOR, or p70^S6K1 ratios when the exercise modes were compared to the NE condition (P ≥ 0.05). In conclusion, our data suggest that low-intensity and low-volume CE might not blunt the training-induced adaptations, since it did not activate competing intracellular pathways in an acute bout of strength and endurance exercises in rat skeletal muscle.     

中等强度训练干预大鼠骨骼肌抗增殖蛋白PHB1表达及线粒体呼吸功能的变化

背景:研究显示长期中等强度规律运动可以改善骨骼肌细胞线粒体电子呼吸链复合体酶的活性,从而提高其做功能力和抵抗疲劳能力。目的:探讨中等强度训练对大鼠骨骼肌内抗增殖蛋白及线粒体呼吸功能的影响。方法:32只健康雄性SD大鼠随机分为2组:安静对照组、中等强度训练组,每组16只。中等强度训练组的训练方案:第1周以10 m/min速度跑,每周6 d,每天10 min,坡度10°;第2周以15 m/min速度跑,每周6 d,每天增加10 min至60 min结束,坡度10°;第3-8周以15 m/min速度跑,每周6 d,每天60 min,坡度10°。末次实验后48 h处死大鼠,提取骨骼肌以及线粒体,检测线粒体呼吸控制率、ATP含量、活性氧水平、复合体V活性及PHB1蛋白表达。结果与结论:①与安静对照组相比,中等强度训练组骨骼肌线粒体呼吸控制率显著性升高(P<0.001)、ATP含量显著性升高(P<0.05)、活性氧水平显著降低(P<0.001)、复合体V活性显著升高(P<0.05)、PHB1表达显著升高(P<0.01);②通过相关性分析得出:经过8周中等强度训练后大鼠骨骼肌内PHB1的表达分别与ATP含量、复合体V活性呈正相关,与活性氧水平呈负相关;③结果表明,中等强度训练通过促进PHB1表达提高线粒体氧化磷酸化功能,维持线粒体膜结构,增强线粒体呼吸功能。     

Aceptación de actividades de fomento de la investigación en estudiantes de Grado en Medicina

AimTo present activities for the initiation of research in the medical degree.MethodResearch skills have been included as a compulsory subject with methodological contents (theoretical and practical) and seminars related to scientific discoveries, as well as in three optional subjects in which students perform a scientific project supervised by a tutor.ResultsThe grades of the tasks of the compulsory subject are high (3.7 ± 0.07 out of 4 points), and 43.8% of the enrolled students completed the three optional subjects. Satisfaction with the activities was high (3.46 and 3.9 out of 5 points), which suggests that they contribute to acquiring scientific skills in medical education, and that the work of the tutors is important (4.4 out of 5 points).ConclusionExposure to research tasks in the medical degree is well accepted by the students.     

The emotional and cognitive impact of the unexpected death in the simulation lab

IntroductionThe impact of animal death on surgeons during training in laparoscopic techniques is unknown.MethodsEmotions and cognitive load were assessed depending on animal survival.ResultsThose exposed to animal death (n = 14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21 ± 12.865 in the exposed and 64.74 ± 14.632 in the non-exposed (p > 0.05).ConclusionsEmotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure.     

Clinicians’ accounts of communication with patients in end-of-life care contexts: A systematic review

ObjectiveCommunication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians’ understandings of communication in end-of-life care.MethodsA systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms “palliative care,” “terminal care” or “end-of-life care,” and “communication”. Articles were assessed for quality using a modified JQI-QARI tool.ResultsThe findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication.ConclusionTraining needs for effective communication in end-of-life contexts are not currently being met.Practice ImplicationsClinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.