The relationship between perceived multicultural disability competence, multicultural counseling coursework, and disability-related life experience

The aim of this study was to explore the perceived multicultural disability competence of master’s-level counseling students in CACREP-accredited programs given their disability-related life experience(s) and multicultural counseling course completion and to assess the extent to which the topic of ability/disability is addressed in multicultural counseling coursework. Participants (n = 285) were electronically surveyed using the Counseling Clientswith Disabilities Survey (CCDS; Strike, 2001) and a researcher developed biographical questionnaire. Collectively, study results indicated that both disability-related life experience(s) and multicultural counseling course completion positively impacted participant perceived multicultural disability competence. However, disability-related life experience(s) seemed to have a greater level of impact and significantly predicted self-awareness, perceived knowledge, and perceived skills. Results of this study indicated that the topic of ability/disability or persons with disabilities is given less attention than other topics covered in multicultural counseling courses within CACREP-accredited programs

The relationship between perceived multicultural disability competence, multicultural counseling coursework, and disability-related life experience

The aim of this study was to explore the perceived multicultural disability competence of master’s-level counseling students in CACREP-accredited programs given their disability-related life experience(s) and multicultural counseling course completion and to assess the extent to which the topic of ability/disability is addressed in multicultural counseling coursework. Participants (n = 285) were electronically surveyed using the Counseling Clientswith Disabilities Survey (CCDS; Strike, 2001) and a researcher developed biographical questionnaire. Collectively, study results indicated that both disability-related life experience(s) and multicultural counseling course completion positively impacted participant perceived multicultural disability competence. However, disability-related life experience(s) seemed to have a greater level of impact and significantly predicted self-awareness, perceived knowledge, and perceived skills. Results of this study indicated that the topic of ability/disability or persons with disabilities is given less attention than other topics covered in multicultural counseling courses within CACREP-accredited programs

Imbalanced decision hierarchy in addicts emerging from drug-hijacked dopamine spiraling circuit

Despite explicitly wanting to quit, long-term addicts find themselves powerless to resist drugs, despite knowing that drug-taking may be a harmful course of action. Such inconsistency between the explicit knowledge of negative consequences and the compulsive behavioral patterns represents a cognitive/behavioral conflict that is a central characteristic of addiction. Neurobiologically, differential cue-induced activity in distinct striatal subregions, as well as the dopamine connectivity spiraling from ventral striatal regions to the dorsal regions, play critical roles in compulsive drug seeking. However, the functional mechanism that integrates these neuropharmacological observations with the above-mentioned cognitive/behavioral conflict is unknown. Here we provide a formal computational explanation for the drug-induced cognitive inconsistency that is apparent in the addicts' “self-described mistake”. We show that addictive drugs gradually produce a motivational bias toward drug-seeking at low-level habitual decision processes, despite the low abstract cognitive valuation of this behavior. This pathology emerges within the hierarchical reinforcement learning framework when chronic exposure to the drug pharmacologically produces pathologicaly persistent phasic dopamine signals. Thereby the drug hijacks the dopaminergic spirals that cascade the reinforcement signals down the ventro-dorsal cortico-striatal hierarchy. Neurobiologically, our theory accounts for rapid development of drug cue-elicited dopamine efflux in the ventral striatum and a delayed response in the dorsal striatum. Our theory also shows how this response pattern depends critically on the dopamine spiraling circuitry. Behaviorally, our framework explains gradual insensitivity of drug-seeking to drug-associated punishments, the blocking phenomenon for drug outcomes, and the persistent preference for drugs over natural rewards by addicts. The model suggests testable predictions and beyond that, sets the stage for a view of addiction as a pathology of hierarchical decision-making processes. This view is complementary to the traditional interpretation of addiction as interaction between habitual and goal-directed decision systems

Oral dosing of rodents using a palatable tablet

Rationale: Delivering orally bioavailable drugs to rodents is an important component to investigating that route of administration in novel treatments for humans. However, the traditional method of oral gavage requires training, is stressful, and can induce oesophageal damage in rodents. Objectives: To demonstrate a novel administrative technique – palatable gelatine tablets – as a stress-free route of oral delivery. Methods: 24 male Lister hooded rats were sacrificed for brain tissue analysis at varying time-points after jelly administration of 30 mg/kg of the wake-promoting drug modafinil. A second group of 22 female rats were tested on locomotor activity after 30 mg/kg modafinil, or after vehicle jellies, with the locomotor data compared to the brain tissue concentrations at the corresponding times. Results: Modafinil was present in the brain tissue at all time-points, reducing in concentration over time. The pattern of brain tissue modafinil concentration is comparable to previously reported results following oral gavage. Modafinil-treated rats were more active than control rats, with greater activity during the later time-periods – similar to that previously reported following intraperitoneal injection of 40 mg/kg modafinil. Conclusions: Palatable jelly tablets are an effective route of administration of thermally-stable orally-bioavailable compounds, eliminating the stress/discomfort and health risk of oral gavage and presenting as an alternative to previously reported palatable routes of administration where high protein and fat levels may adversely affect appetite for food reward, and uptake rate in the gastrointestinal tract.Publisher PDFPeer reviewe

Stress-Induced Reinstatement of Drug Seeking: 20 Years of Progress

In human addicts, drug relapse and craving are often provoked by stress. Since 1995, this clinical scenario has been studied using a rat model of stress-induced reinstatement of drug seeking. Here, we first discuss the generality of stress-induced reinstatement to different drugs of abuse, different stressors, and different behavioral procedures. We also discuss neuropharmacological mechanisms, and brain areas and circuits controlling stress-induced reinstatement of drug seeking. We conclude by discussing results from translational human laboratory studies and clinical trials that were inspired by results from rat studies on stress-induced reinstatement. Our main conclusions are (1) The phenomenon of stress-induced reinstatement, first shown with an intermittent footshock stressor in rats trained to self-administer heroin, generalizes to other abused drugs, including cocaine, methamphetamine, nicotine, and alcohol, and is also observed in the conditioned place preference model in rats and mice. This phenomenon, however, is stressor specific and not all stressors induce reinstatement of drug seeking. (2) Neuropharmacological studies indicate the involvement of corticotropin-releasing factor (CRF), noradrenaline, dopamine, glutamate, kappa/dynorphin, and several other peptide and neurotransmitter systems in stress-induced reinstatement. Neuropharmacology and circuitry studies indicate the involvement of CRF and noradrenaline transmission in bed nucleus of stria terminalis and central amygdala, and dopamine, CRF, kappa/dynorphin, and glutamate transmission in other components of the mesocorticolimbic dopamine system (ventral tegmental area, medial prefrontal cortex, orbitofrontal cortex, and nucleus accumbens). (3) Translational human laboratory studies and a recent clinical trial study show the efficacy of alpha-2 adrenoceptor agonists in decreasing stress-induced drug craving and stress-induced initial heroin lapse

Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries.

Objective: To project the 10-year clinical outcomes associated with single pill combination (SPC) therapies compared with multi-pill regimens for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico). Methods: A microsimulation model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and combination therapy in the form of a single pill (SPC). Model inputs were derived from the Global Burden of Disease 2017 dataset. Simulated outcomes of mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD), and disability-adjusted life years (DALYs) were estimated for 1,000,000 patients on each treatment pathway. Results: SPC therapy was projected to improve clinical outcomes over SLGS, FCC and CTP in all countries. SPC reduced mortality by 5.4% in Italy, 4.9% in Russia, 4.5% in China, 2.3% in South Korea and 3.6% in Mexico versus CTP and showed greater reductions in mortality than SLGS and FCC. The projected incidence of clinical events was reduced by 11.5% in Italy, 9.2% in Russia, 8.4% in China, 4.9% in South Korea and 6.7% in Mexico for SPC versus CTP. Conclusions: Ten-year projections indicated that combination therapies (FCC and SPC) are likely to reduce the burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence

Lessons learnt from the introduction of the contraceptive implant in South Africa

In 2014, South Africa (SA) introduced the subdermal contraceptive implant with the aim of expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector. Three years on, concerns have been raised about the decline in uptake, early implant removals and challenges in service delivery. This article explores the lessons learnt from the introduction of contraceptive technologieselsewhere and applies these to the SA context. Drawing on the World Health Organization’s conceptual framework for the introduction of new contraceptive methods, and subsequent literature on the topic, lessons are classified into six cross-cutting themes. Recommendations highlight the need for SA to review and explore strategies to strengthen current implant services, including the provision of improved provider training aimed at sensitive, client-centred approaches; increased community engagement; and improved systems for programmatic monitoring and evaluation. With implementation of these recommendations, worrying trends in the provision of implants could be reversed

Dynamic networks differentiate the language ability of children with cochlear implants

Background: Cochlear implantation (CI) in prelingually deafened children has been shown to be an effective intervention for developing language and reading skill. However, there is a substantial proportion of the children receiving CI who struggle with language and reading. The current study–one of the first to implement electrical source imaging in CI population was designed to identify the neural underpinnings in two groups of CI children with good and poor language and reading skill. Methods: Data using high density electroencephalography (EEG) under a resting state condition was obtained from 75 children, 50 with CIs having good (HL) or poor language skills (LL) and 25 normal hearing (NH) children. We identified coherent sources using dynamic imaging of coherent sources (DICS) and their effective connectivity computing time-frequency causality estimation based on temporal partial directed coherence (TPDC) in the two CI groups compared to a cohort of age and gender matched NH children. Findings: Sources with higher coherence amplitude were observed in three frequency bands (alpha, beta and gamma) for the CI groups when compared to normal hearing children. The two groups of CI children with good (HL) and poor (LL) language ability exhibited not only different cortical and subcortical source profiles but also distinct effective connectivity between them. Additionally, a support vector machine (SVM) algorithm using these sources and their connectivity patterns for each CI group across the three frequency bands was able to predict the language and reading scores with high accuracy. Interpretation: Increased coherence in the CI groups suggest overall that the oscillatory activity in some brain areas become more strongly coupled compared to the NH group. Moreover, the different sources and their connectivity patterns and their association to language and reading skill in both groups, suggest a compensatory adaptation that either facilitated or impeded language and reading development. The neural differences in the two groups of CI children may reflect potential biomarkers for predicting outcome success in CI children

Cross-modal plasticity in children with cochlear implant: converging evidence from EEG and functional near-infrared spectroscopy

Over the first years of life, the brain undergoes substantial organization in response to environmental stimulation. In a silent world, it may promote vision by (i) recruiting resources from the auditory cortex and (ii) making the visual cortex more efficient. It is unclear when such changes occur and how adaptive they are, questions that children with cochlear implants can help address. Here, we examined 7–18 years old children: 50 had cochlear implants, with delayed or age-appropriate language abilities, and 25 had typical hearing and language. High-density electroencephalography and functional near-infrared spectroscopy were used to evaluate cortical responses to a low-level visual task. Evidence for a ‘weaker visual cortex response’ and ‘less synchronized or less inhibitory activity of auditory association areas’ in the implanted children with language delays suggests that cross-modal reorganization can be maladaptive and does not necessarily strengthen the dominant visual sense