Determinants of cue-elicited alcohol craving and perceived realism in Virtual Reality environments among patients with alcohol use disorder

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving

¿Depende el desarrollo de la RAN de la edad de inicio de la lectoescritura?

Background: The ability of the student to quickly name familiar stimuli (RAN) is a factor involved in reading performance that can be evaluated indiscriminately throughout the first years of schooling. The objectiveof this study, then, is to analyze if the acquisition of this ability depends on variables related to an early initiation to the reading-writing or if its development is related to factors of chronological maturity. Method: To this end, the RAN test was applied to 71 6-7 years old children from Croatia (culture in which the initiation to reading is later); to 44 4-5 years old Spanish children (equating the two groups by age of beginning of the reading-writing) and to 43 6-7 years old Spanish children (equating the two groups by chronological age). The results show that by comparing the group of Croatian children with the group of Spanish children aged 4-5 years, significant differences stand out in the appointment times of the stimuli of the 4 different components of the test. Older children recognize numbers and letters more quickly while younger ones take longer in these stimuli, recognizing objects and colors more quickly. However, comparing the two groups of children aged 6-7 years (Croatians and Spanish), no statistically significant differences were found. It is concluded that the development of the RAN is characterized by an earlier acquisition of nonsymbolic stimuli (objects-colors) than symbolic stimuli (letters-numbers) and that this acquisition is related more to factors of chronological maturity than of age of beginning of the reading-writing. This ability, therefore, despite being closely related to the learning of reading and writing, seems to develop independently of the age at which such learning begins.Antecedentes:La habilidad del alumno para nombrar rápidamente estímulos familiares (RAN) es un factor implicado en el rendimiento lector evaluable de forma indiscriminada a lo largo de los primeros años de escolarización. El objetivode este estudio, pues, es analizar si la adquisición de dicha habilidad depende de variables relacionadas con una iniciación temprana a la lecto-escritura o si su desarrollo se relaciona con factores de madurez cronológica. Método: Para ello se aplicó la prueba RAN a 71 niños de 6-7 años croatas (cultura en la que la iniciación a la lectura es más tardía); a 44 niños de 4-5 años españoles (equiparando los dos grupos por edad de inicio de la lecto-escritura) y a 43 niños españoles de 6-7 años (equiparando los dos grupos por edad cronológica). Los resultados muestran que comparando el grupo de niños croatas con el grupo de niños españoles de 45 años, se destacan diferencias significativas en los tiempos de nombramiento de los estímulos de los 4 diferentes componentes de la prueba. Los niños mayores reconocen más rápidamente los números y letras mientras que los más pequeños tardan más en estos estímulos reconociendo más rápidamente los objetos y colores. Sin embargo, comparando los dos grupos de niños de 6-7 años (los croatas y los españoles) no se han encontrado diferencias estadísticamente significativas. Se concluye pues, que el desarrollo de la RAN se caracteriza por una adquisición más temprana de los estímulos no simbólicos (objetos-colores) que de los estímulos simbólicos (letras-números) y que dicha adquisición se relaciona más con factores de madurez cronológica que de edad de inicio de la lecto-escritura. Esta habilidad, por lo tanto, a pesar de estar estrechamente relacionada con el aprendizaje de la lectura y de la escritura, parece desarrollarse de forma independiente a la edad de inicio de dicho aprendizaje.

Craving and Anxiety Responses as Indicators of the Efficacy of Virtual Reality-Cue Exposure Therapy in Patients Diagnosed with Alcohol use Disorder

Introduction: Virtual Reality (VR) technology has shown promising results as an assessment and treatment instrument in substance use disorders, particularly in attempts to reduce craving. A common application of the VR technology in treatment is based on cue-exposure therapy (CET). Following from previous results, the present case series is part of a larger project aiming to test the efficacy of the Virtual Reality-Cue Exposure Therapy (VR-CET) versus Cognitive-Behavioral Therapy (CBT). Method: Eight patients between ages 40 and 55 (Mage = 49, SD = 5.54) from the Addictive Behaviors Unit at the Hospital Clinic of Barcelona participated in this study after providing written informed consent. Patients were randomly assigned to the VR-CET group (three patients) or the CBT group (five patients). The protocol of the clinical trial consisted of a pre-treatment session (the initial assessment session), six sessions of CBT or VR-CET, and a post-treatment session (post-assessment session). The VR-CET sessions consisted of exposure to alcohol-related cues and environments aiming to reduce anxiety and craving responses to alcohol-related stimuli. The CBT sessions consisted of classical standardized therapy for the treatment of addictions, as previously applied in other clinical trials. In the pre- and post-treatment sessions, patients completed several measures of alcohol craving and anxiety and visual analog scales (VAS) during VR exposure. Results: Our data indicated a significant reduction in both groups in all scores of craving and anxiety responses, as assessed by the different instruments. In addition, the VR-CET group obtained lower scores on anxiety and craving responses than the CBT group. Conclusions: In this ongoing project, the first phase of the clinical trial showed significant improvements in terms of craving and anxiety reduction in both groups, emphasizing that VR-CET can be as efficient as CBT. In addition, patients in the VR-CET group obtained slightly better scores than patients in the CBT group, suggesting the clinical potential of the VR technology in the treatment of substance use disorders. We propose that VR-based CET can be a useful complement to existing treatment methods for AUD patients

Attentional bias, alcohol craving, and anxiety implications of the virtual reality cue-exposure therapy in severe alcohol use disorder: a case report

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed

Predictors of Changes in alcohol craving levels during a virtual reality cue exposure treatment among patients with alcohol use disorder

Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). Method: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-a ective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. Results: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group ( 2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group ( 2 = 13.818; p = 0.003) but not within the TAU group ( 2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. Conclusions: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment

Structural basis for the biological relevance of the invariant apical stem in IRES-mediated translation

RNA structure plays a fundamental role in internal initiation of translation. Picornavirus internal ribosome entry site (IRES) are long, efficient cis-acting elements that recruit the ribosome to internal mRNA sites. However, little is known about long-range constraints determining the IRES RNA structure. Here, we sought to investigate the functional and structural relevance of the invariant apical stem of a picornavirus IRES. Mutation of this apical stem revealed better performance of G:C compared with C:G base pairs, demonstrating that the secondary structure solely is not sufficient for IRES function. In turn, mutations designed to disrupt the stem abolished IRES activity. Lack of tolerance to accept genetic variability in the apical stem was supported by the presence of coupled covariations within the adjacent stem–loops. SHAPE structural analysis, gel mobility-shift and microarrays-based RNA accessibility revealed that the apical stem contributes to maintain IRES RNA structure through the generation of distant interactions between two adjacent stem–loops. Our results demonstrate that a highly interactive structure constrained by distant interactions involving invariant G:C base pairs plays a key role in maintaining the RNA conformation necessary for IRES-mediated translation

Gitanas y gitanos en la universidad : dificultades y acciones para su superación

Aumentar el nivel educativo es imprescindible para revertir la situación de pobreza y exclusión social en la que se encuentra la población gitana en España. En las últimas décadas, se han realizado esfuerzos en este sentido. No obstante, las acciones se han centrado frecuentemente en las etapas obligatorias, mientras que se ha dedicado poca atención a la educación superior. Pese a que la juventud gitana está alcanzando la educación superior con mayor frecuencia que las generaciones anteriores, una vez en la universidad enfrentan barreras específicas que limitan sus oportunidades educativas y dificultan su trayectoria académica. A través de un diseño mixto, que combina técnicas cuantitativas y cualitativas, el proyecto UNIROMA profundiza en estas barreras con el objetivo de formular recomendaciones para superarlas. Los resultados, en la línea de otras investigaciones sobre minorías étnicas y estudiantes de primera generación en la universidad, evidencian la existencia de barreras fruto de la interseccionalidad de diversos factores de discriminación que afectan a estos estudiantes: por su pertenencia a una minoría étnica, por ser con mayor frecuencia estudiantes de primera generación y no tradicionales y por su situación socioeconómica. Cada uno de estos factores deriva en barreras específicas que dificultan la trayectoria universitaria de estos estudiantes. En el caso de las mujeres, se añaden además barreras que derivan de la discriminación por razón de sexo. Es necesario, por tanto, implementar actuaciones que contribuyan a superarlas, para potenciar la equidad de nuestro sistema universitario

Validation of Bact/Alert automathic system in the microbiological control of cell medicinal products of Advanced Therapies

Objetivo. El Control de calidad para demostrar que un producto está libre de agentes microbianos adventicios es un aspecto clave de control de procesos y evaluación de la calidad de todas las preparaciones medicinales celulares y en la ingeniería tisular. El objetivo de este estudio es validar el sistema de detección por hemocultivo BacT / ALERT para el control microbiológico de las células mesenquimales para terapia celular, según la Farmacopea Europea (EU.PH), 2.6.27. “Control microbiológico de productos celulares” (1). Método. Para el cálculo del límite de detección las botellas de hemocultivo fueron inoculadas e incubadas con 4 réplicas de 30 UFC, 5 réplicas de 15 UFC y 5 réplicas de 6 UFC de los microorganismos en ausencia de producto celular. Se llevaron a cabo también experimentos en presencia de producto con 400.000 células mesenquimales. Este método se ha comparado con el método de referencia de Esterilidad de la EU.PH (2). La especificidad se ensayó inoculando 5 réplicas con 400.000 células mesenquimales sin microorganismos. Resultados. Todas las botellas inoculadas con células mesenquimales sin microorganismos permanecieron negativas después de 7 días de incubación. Todas las botellas inoculadas con cepas bacterianas aerobias y anaerobias fueron detectadas como positivas por el sistema, en el caso del límite inferior (6 UFC) en menos de 36 horas. Se detectaron como positivas las botellas inoculadas con Candida albicans (6 UFC) en menos de 48 horas y con Aspergillus niger (6 UFC) en menos de 72 horas. No hubo diferencias notables en el tiempo de detección entre botellas inoculadas con y sin la presencia de células mesenquimales. Conclusión: El sistema de detección de hemocultivos Bact/Alert es un método fiable para la detección de la contaminación microbiana de medicamentos a base de células mesenquimales y cumple los requisitos de la UE PH, 2.6.27, para el control microbiológico de productos celulares.Objective. Quality control to demonstrate that a product is free from adventitious microbial agents is a key aspect of process control and quality evaluation of all cell medicinal preparations and in tisular engineering. Evaluate the validation of the BacT/ALERT Blood Culture System for the microbial control of mesenchymal cells for cell therapy according European Pharmacopoeia (EU.PH), 2.6.27. “Microbiological control of cellular products” (1). Method. Blood culture bottles were challenged with 4 replica of 30 cfu, 5 replica of 15 cfu and 5 replica of 6 cfu of the test microorganisms. Test were also carried out in the presence in each contaminated culture bottle of 400.000 mesenchymal cells. This method has been compared with the reference method for Sterility of the EU.PH (2). Specificity was tested inoculating 5 replicas of broth culture media with 400.000 cells without microorganisms. Results. All bottles challenged with mesenchymal cells without microorganisms remained negative after 7 days of incubation. All inoculated bottles with aerobic and anaerobic bacterial strains were flagged as positive for the system, in case of low inoculum (6 cfu) in less than 36 hours. Candida inoculated bottles (6 cfu) were detected in less than 48 hours and Aspergillus (6 cfu) in less than 72 hours. There were no significant differences in the detection time between bottles inoculated with and without the presence of mesenchymal cells. Conclusion: The BacT/ALERT blood culture detection system and is a reliable method for detection of microbial contamination of mesenchymal cells medicinal products that fulfils the requirements of the EU PH, 2.6.27, for the microbiological control of cellular products

Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD : Results from the VERNE study

Altres ajuts: Takeda Farmacéutica España S.A.Background: Anti-TNFα represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs. Aims: To assess the treatment patterns with the first anti-TNFα in IBD. Methods: Retrospective, observational study. Results: 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC. Conclusions: Around one-third of IBD biologic-naive patients treated with an anti-TNFα required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNFα due to inappropriate disease control