EFFICACIA DELLA RIABILITAZIONE FUNZIONALE SUL FUNZIONAMENTO COGNITIVO E PSICOSOCIALE NEI PAZIENTI CON DISTURBO BIPOLARE: UNO STUDIO CONTROLLATO RANDOMIZZATO

Introduzione: La compromissione cognitiva è una caratteristica fondamentale del disturbo bipolare (DB), fortemente associata all'esito funzionale dei pazienti. La Riabilitazione Funzionale (RF) è un intervento psicosociale, sviluppato dall'Unità Disturbi Bipolari e Depressivi dell’Hospital Clinic di Barcelona, progettato esclusivamente sulle caratteristiche specifiche dei pazienti bipolari, finalizzato a migliorare la neurocognizione al fine di raggiungere il recupero funzionale (Martinez-Arán et al., 2011). Il programma RF si basa su un approccio neuro-cognitivo-comportamentale, manualizzato e basato sull'evidenza, e la sua caratteristica distintiva è che si concentra sul funzionamento psicosociale complessivo, in un formato di gruppo (Martinez-Arán et al., 2011; Torrent & Vieta 2016). RF, in un contesto altamente ecologico, fornisce strategie e tecniche neurocognitive, includendo la psicoeducazione sui principali disturbi neurocognitivi associati al DB, come l'attenzione, la memoria e le funzioni esecutive (Martinez-Aran et al. 2004) e la loro influenza sulla vita quotidiana, che può portare a difficoltà psicosociali (Vieta et al., 2018). L'obiettivo principale della RF è di facilitare la generalizzazione e il trasferimento delle abilità cognitive apprese e le strategie utili per gestire meglio la vita quotidiana, con l'obiettivo finale di ripristinare il funzionamento psicosociale nel DB (Martínez-Arán et al., 2011; Bonnin et al., 2014). L'efficacia della RF è stata dimostrata in uno studio multicentrico, randomizzato, in cieco, che ha confrontato la RF con la psicoeducazione e il trattamento come al solito - TAU, e ha indicato un miglioramento generale del funzionamento psicosociale, principalmente nel campo interpersonale e professionale (Torrent et al., 2013). RF è inoltre efficace nel migliorare il funzionamento psicosociale sia nel disturbo bipolare di tipo I che II (Solé et al., 2015). Obiettivo: valutare l'efficacia della RF nel migliorare il funzionamento psicosociale (misurato con il Functioning Assessment Short Test - FAST) e i disturbi neurocognitivi (stimati con l’utilizzo della Brief Assessment of Cognition in Affective Disorders - BAC-A), in un campione di pazienti eutimici con DB. Metodo: Studio randomizzato, controllato, in singolo cieco, che ha coinvolto 24 pazienti con BD-I e BD-II, secondo i criteri del DSM-5, RF (N=12) è stata confrontata con TAU (N=12) durante 21 settimane. Il trattamento farmacologico è stato mantenuto stabile in entrambi i gruppi. Il principale obiettivo è stato il cambiamento nel funzionamento psicosociale misurato attraverso il FAST, dal basale al termine dell’intervento. Risultati: Al termine dello studio, tutti i 24 pazienti hanno finalizzato la fase di trattamento. Le analisi statistiche hanno rivelato che il gruppo RF è migliorato significativamente rispetto alle variabili funzionali di esito (p=.011), dal basale alla fine del programma, a 6 mesi, rispetto al gruppo TAU. Miglioramenti significativi sono stati individuati nei sotto-domini del FAST relativamente all'autonomia, al funzionamento professionale, alle questioni finanziarie e alle relazioni interpersonali. Non sono stati rilevati effetti significativi del gruppo di intervento RF sulle variabili neurocognitive. Conclusioni: I risultati sono promettenti e confermano l'importanza di nuovi interventi non farmacologici personalizzati nel DB, al fine di migliorare non solo i sintomi affettivi, ma anche le disfunzioni cognitive e funzionali, con l'obiettivo finale di ottenere il pieno recupero funzionale e migliorare la qualità di vita dei pazienti affetti da DB.Introduction: Cognitive dysfunction is a major feature of bipolar disorder (BD), strongly associated with patients’ functional outcome. Functional Remediation (FR) is a psychosocial intervention, developed by the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona, exclusively designed on the specific characteristics of bipolar patients, aimed at improving neurocognition in order to achieve a functional recovery (Martinez-Arán et al., 2011). FR program is built on a neuro-cognitive-behavioral approach, manualized and evidence-based, and its distinctive feature is that it focuses on the overall psychosocial functioning, in a group format (Martinez-Arán et al., 2011; Torrent & Vieta 2016). FR, within a highly ecological context, provide neurocognitive strategies and techniques, including psychoeducation about the main neurocognitive impairments associated with BD, such as attention, memory and executive functions (Martinez-Aran et al. 2004) and their influence on everyday life, which can result in psychosocial difficulties (Vieta et al., 2018). The main aim of FR is to facilitate generalization and the transfer of learned cognitive abilities and useful strategies to better manage daily life, with the ultimate goal to restore psychosocial functioning in BD (Martínez-Arán et al., 2011; Bonnin et al., 2014). FR efficacy was validated in a multicentric, randomized, rater-blind trial, comparing FR with psychoeducation and treatment as usual - TAU, which indicated an improvement in general psychosocial functioning, principally in the interpersonal and occupational domains (Torrent et al., 2013). FR is also effective in improving psychosocial functioning in both bipolar disorder type I and II (Solé et al., 2015).¬¬ Objectives: to evaluate the effectiveness of FR in improving psychosocial functioning (measured by Functioning Assessment Short Test - FAST) and neurocognitive impairments (measured by Brief Assessment of Cognition in Affective Disorders - BAC-A), in a sample of euthymic patients with BD. Methods: In a randomized, rater-blinded, controlled study of 24 out-patients with BD-I and BD-II, according to DSM-5 criteria, FR (N=12) was compared with TAU (N=12) over 21 weeks. Pharmacological treatment was kept stable in both two groups. The primary outcome was change in psychosocial functioning measured by means of the FAST, from baseline to endpoint. Results: At the end of the study, all 24 patients finalized the treatment phase. Statistical analyses revealed that the FR group improved significantly with respect to functional outcome variables (p=.011), from the baseline to the end of the programme, at 6 months, compared to the TAU group. Significant improvements have been identified in the FAST sub-domains relating to autonomy, professional functioning, financial issues and interpersonal relations. No significant effects of the FR intervention group on neurocognitive variables were detected. Conclusions: Findings are promising and confirm the importance to new personalized non-pharmacological interventions in BD, in order to improve not only affective symptoms, but also cognitive and functional dysfunctions, with the final goal to achieve full functional recovery and ameliorate the quality of life of BD patients’

Constraints on the Structure and Evolution of the Malawi Rift from Active- and Passive-Source Seismic Imaging

Located at the southernmost sector of the Western Branch of the East African Rift System, the Malawi Rift exemplifies an active, magma-poor, weakly extended continental rift. This work focuses on the northern portion of the Malawi Rift, which is flanked by long (>100 km) basin-bounding border faults and crosses several significant remnant structures. This combination of characteristics makes the Malawi Rift the ideal location to investigate the controlling processes governing present-day extension throughout the lithosphere. To investigate these processes I image shallow basin- to uppermost-mantle structure beneath the region using a combination of passive- and active-source seismic datasets. I conduct passive-source imaging of the crust and upper mantle using ambient-noise and teleseismic Rayleigh-wave phase velocities between 9 and 100 s period. This study includes six lake-bottom seismometers located in Lake Malawi (Nyasa), the first time seismometers have been deployed in any of the African rift lakes. I utilize the resulting phase-velocity maps to invert for a shear velocity model of the Malawi Rift discussed below. I utilize active-source tomographic imaging to obtain new constraints on rift basin structure in the Malawi Rift from a 3-D compressional velocity (Vp) model. The velocity model uses observations from the first wide-angle refraction study conducted using lake-bottom seismometers in one of the great lakes of East Africa. The 3-D velocity model reveals up to ~5 km of synrift sediments, which smoothly transition from eastward thickening against the Livingstone Border Fault in the North Basin to westward thickening against the Usisya Border Fault in the Central Basin. I use new constraints on synrift sediment thickness to construct displacement profiles for both faults. Both faults accommodate large throws (> 7 km) but the Livingstone Fault is ~30 km longer. The dimensions of these faults suggest they are nearing their maximum size. The presence of >4 km of sediment within the accommodation zone suggests fault length was established early pointing the "constant length" model of fault growth. The presence of an intermediate velocity unit with velocities of 3.75-4.5 km/s is interpreted to represent prior rifting (Permo-Triassic and/or Cretaceous) sedimentary deposits beneath Lake Malawi. These thick (up to 4.6 km) packages of preexisting sedimentary strata improve the understanding of the Tanganyika-Rukwa-Malawi rift system and the role of earlier stretching phases on synrift basin development. I use the previously obtained local-scale measurements of Rayleigh wave phase velocities between 9 and 100 s combined with constraints on basin structure and crustal thickness to robustly invert for shear velocity from the surface to 135 km for the Malawi Rift. We compare our resulting 3-D model to a 3-D model of shear velocity obtained for the mature Main Ethiopian Rift and Afar Depression using commensurate datasets and identical methodologies. Comparing the Vs models for the two regions reveals markedly different seismic velocities particularly pronounced in the upper mantle (average velocities in the Malawi Rift are ~9% faster than the Main Ethiopian Rift). Our 3-D Vs model of the Malawi Rift reveals a strong, localized low velocity anomaly associated with the Rungwe Volcanic Province within the crust and upper mantle that can be explained without requiring the presence of partial melt. Away from the Rungwe Volcanic Province, velocities within the plateau regions are fast (> 4.6 km/s) and representative of depleted lithospheric mantle to depths of 100 and >135 km to the west and east of the rift, respectively. Thinned lithosphere, represented by the absence of similarly high velocities, is centered directly beneath the rift axis and footwall escarpments of the rift basins. The correlation between the localization of lithospheric thinning, the boundaries between abutting Proterozoic mobile belts, and the positions of the basin-bounding border faults may point to the controlling role of preexisting large-scale structures in localizing strain and allowing extension to occur here

Effective Practices and Teacher Self-efficacy in Teaching Reading Comprehension to Learners with Autism Spectrum Disorder

Learners with Autism Spectrum Disorder (ASD) often exhibit difficulty in the area of reading comprehension, yet a conducted research synthesis revealed a lack of related evidence-based practices (EBPs) specific to teaching comprehension to learners with ASD. Research connecting the learning needs of students with ASD, existing effective practices, teacher training, and teacher perceptions of their own ability to teach reading comprehension is scarce. The purpose of this study was to address this scarcity, through a focus on teacher perceived self-efficacy, teacher outcome expectancy, and teacher preparedness to use effective practices emerging from the extant research. Quantitative survey methodology and hierarchical regression analysis were utilized to investigate teacher preparedness to use effective practices, along with the job-related factors of experience, administrator support, learner verbal language, and instructional setting, as predictors of (1) teacher perceived self-efficacy, and (2) teacher perceived outcome expectancy teaching reading comprehension to learners with ASD. Study findings, based on 112 teacher participants, revealed a discrepancy between teacher reported effective practices to teach comprehension to learners with ASD, and the practices identified as effective from the research, indicating a potential research to practice gap. Results of the regression analyses identified the variables of teacher preparedness to use effective practices, teacher years of experience, and administrator support as predictors of self-efficacy; and the variables of teacher preparedness to use effective practices, administrator support, and verbal language ability of students as predictors of outcome expectancy. Findings provide a potential roadmap for helping teachers become more self-efficacious in teaching comprehension to learners with ASD through professional development in effective practices, and through provision of ongoing support from principals and administrators

O-sode no furiawase : the touching of sleeves : an original story based on the early life of a Japanese-American dancer for ages nine to eleven

Based on a true story, this fictionalized memoir is about a second generation Japanese-American girl growing up in a large family in California during the 1930\u27s and 1940\u27s. Set against the backdrop of the Depression and the internment of West Coast persons of Japanese ancestry during World War II, the story follows the protagonist\u27s childhood interest in dance as it blossoms into a true calling

Research Synthesis: Effective Practices for Improving the Reading Comprehension of Students with Autism Spectrum Disorder

The incidences of autism spectrum disorder (ASD) continue to rise steadily increasing the need for research-based strategies to support this population in the core academic content area of reading comprehension. A research synthesis was conducted with the purpose of (1) reviewing existing research to determine effective practices for teaching reading comprehension to students with ASD, (2) identifying the features of effective practices that appear to influence comprehension outcomes, and (3) assessing the quality of the research related to comprehension strategies and students with ASD. A functional relation was identified between the increased reading comprehension of students with ASD and each of the instructional practices of anaphoric cueing, compare & contrast charts, cooperative learning, explicit/direct instruction, graphic organizers, question generation, read-alouds, reciprocal questioning, story structure and character event maps, and systematic prompts. Research in this area is limited and suggestions for both educators and researchers are provided