Qualitative Assessment of the PAX Good Behavior Game Implementation

This paper reports on a program evaluation of the PAX Good Behavior Game (GBG), an evidence-based practice intervention designed to create a nurturing environment conducive to learning in elementary schools. To evaluate and improve the PAX Good Behavior Game, a focus group was conducted at the end of the 2016-17 academic year. A total of ten teachers and school administrators from schools who implemented the PAX Good Behavior Game (PAX professionals) participated in a focus group session and provided feedback about the program. Focus group questions assessed four program objectives: (1) environmental change, (2) personal well-being and stress levels, (3) engagement with parents, and (4) networking with other PAX professionals. Results indicated that the PAX GBG decreased problematic classroom behaviors, provided more instructional time for teachers, and generated public interest of the program in the home and community

Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery.

BACKGROUND: Following cataract surgery and intraocular lens (IOL) implantation, loss of accommodation or postoperative presbyopia occurs and remains a challenge. Standard monofocal IOLs correct only distance vision; patients require spectacles for near vision. Accommodative IOLs have been designed to overcome loss of accommodation after cataract surgery. OBJECTIVES: To define (a) the extent to which accommodative IOLs improve unaided near visual function, in comparison with monofocal IOLs; (b) the extent of compromise to unaided distance visual acuity; c) whether a higher rate of additional complications is associated the use of accommodative IOLs. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 9), Ovid MEDLINE, Ovid MEDLINE in-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily Update, Ovid OLDMEDLINE (January 1946 to October 2013), EMBASE (January 1980 to October 2013), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 October 2013. SELECTION CRITERIA: We include randomised controlled trials (RCTs) which compared implantation of accommodative IOLs to implantation of monofocal IOLs in cataract surgery. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results, assessed risk of bias and extracted data. All included trials used the 1CU accommodative IOL (HumanOptics, Erlangen, Germany) for their intervention group. One trial had an additional arm with the AT-45 Crystalens accommodative IOL (Eyeonics Vision). We performed a separate analysis comparing 1CU and AT-45 IOL. MAIN RESULTS: We included four RCTs, including 229 participants (256 eyes), conducted in Germany, Italy and the UK. The age range of participants was 21 to 87 years. All studies included people who had bilateral cataracts with no pre-existing ocular pathologies. We judged all studies to be at high risk of performance bias. We graded two studies with high risk of detection bias and one study with high risk of selection bias.Participants who received the accommodative IOLs achieved better distance-corrected near visual acuity (DCNVA) at six months (mean difference (MD) -3.10 Jaeger units; 95% confidence intervals (CI) -3.36 to -2.83, 2 studies, 106 people, 136 eyes, moderate quality evidence). Better DCNVA was seen in the accommodative lens group at 12 to 18 months in the three trials that reported this time point but considerable heterogeneity of effect was seen, ranging from 1.3 (95% CI 0.98 to 1.68; 20 people, 40 eyes) to 6 (95% CI 4.15 to 7.85; 51 people, 51 eyes) Jaeger units and 0.12 (95% CI 0.05 to 0.19; 40 people, binocular) logMAR improvement (low quality evidence). The relative effect of the lenses on corrected distant visual acuity (CDVA) was less certain. At six months there was a standardised mean difference of -0.04 standard deviations (95% CI -0.37 to 0.30, 2 studies, 106 people, 136 eyes, low quality evidence). At long-term follow-up there was heterogeneity of effect with 18-month data in two studies showing that CDVA was better in the monofocal group (MD 0.12 logMAR; 95% CI 0.07 to 0.16, 2 studies, 70 people,100 eyes) and one study which reported data at 12 months finding similar CDVA in the two groups (-0.02 logMAR units, 95% CI -0.06 to 0.02, 51 people) (low quality evidence).The relative effect of the lenses on reading speed and spectacle independence was uncertain, The average reading speed was 11.6 words per minute more in the accommodative lens group but the 95% confidence intervals ranged from 12.2 words less to 35.4 words more (1 study, 40 people, low quality evidence). People with accommodative lenses were more likely to be spectacle-independent but the estimate was very uncertain (risk ratio (RR) 8.18; 95% CI 0.47 to 142.62, 1 study, 40 people, very low quality evidence).More cases of posterior capsule opacification (PCO) were seen in accommodative lenses but the effect of the lenses on PCO was uncertain (Peto odds ratio (OR) 2.12; 95% CI 0.45 to 10.02, 91 people, 2 studies, low quality evidence). People in the accommodative lens group were more likely to require laser capsulotomy (Peto OR 7.96; 95% CI 2.49 to 25.45, 2 studies, 60 people, 80 eyes, low quality evidence). Glare was reported less frequently with accommodative lenses but the relative effect of the lenses on glare was uncertain (RR any glare 0.78; 95% CI 0.32 to 1.90, 1 study, 40 people, and RR moderate/severe glare 0.45; 95% CI 0.04 to 4.60, low quality evidence). AUTHORS' CONCLUSIONS: There is moderate-quality evidence that study participants who received accommodative IOLs had a small gain in near visual acuity after six months. There is some evidence that distance visual acuity with accommodative lenses may be worse after 12 months but due to low quality of evidence and heterogeneity of effect, the evidence for this is not clear-cut. People receiving accommodative lenses had more PCO which may be associated with poorer distance vision. However, the effect of the lenses on PCO was uncertain.Further research is required to improve the understanding of how accommodative IOLs may affect near visual function, and whether they provide any durable gains. Additional trials, with longer follow-up, comparing different accommodative IOLs, multifocal IOLs and monofocal IOLs, would help map out their relative efficacy, and associated late complications. Research is needed on control over capsular fibrosis postimplantation.Risks of bias, heterogeneity of outcome measures and study designs used, and the dominance of one design of accommodative lens in existing trials (the HumanOptics 1CU) mean that these results should be interpreted with caution. They may not be applicable to other accommodative IOL designs

Model-based spacecraft and mission design for the evaluation of technology

In order to meet the future vision of robotic missions, engineers will face intricate mission concepts, new operational approaches, and technologies that have yet to be developed. The concept of smaller, model driven projects helps this transition by including life-cycle cost as part of the decision making process. For example, since planetary exploration missions have cost ceilings and short development periods, heritage flight hardware is utilized. However, conceptual designs that rely solely on heritage technology will result in estimates that may not be truly representative of the actual mission being designed and built. The Laboratory for Spacecraft and Mission Design (LSMD) at the California Institute of Technology is developing integrated concurrent models for mass and cost estimations. The purpose of this project is to quantify the infusion of specific technologies where the data would be useful in guiding technology developments leading up to a mission. This paper introduces the design-to-cost model to determine the implications of various technologies on the spacecraft system in a collaborative engineering environment. In addition, comparisons of the benefits of new or advanced technologies for future deep space missions are examined

Comparing Effects of Acceptance Training and Psychoeducation on Hoarding Symptoms

Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effects of acceptance training to psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed self-report measures at baseline, posttest, and one-week follow-up and an in vivo discarding behavioral task at posttest. There were no differences in self-reported outcomes between conditions over time, suggesting acceptance training was not more effective than psychoeducation. Significant and large effect sizes for hoarding severity and maladaptive hoarding cognitions were found from baseline to one-week follow-up, indicating both interventions improved hoarding symptoms in our sample. There was a medium and marginally significant effect favoring acceptance training for number of items discarded (p = .05). These findings tentatively support the utility of acceptance-based techniques and psychoeducation in the treatment of hoarding. In addition, brief early interventions may be effective for people who present with moderate hoarding severity. Limitations of the study include lack of a true control group to estimate placebo effects, lack of assessment of processes of change, and use of a nonclinical, demographically homogeneous sample

Effects of Body Shape on Literal Objectification: When Ideal May Be Less Than Ideal

Objectification, or the tendency to adopt an externalized view of self/other, is a ubiquitous process disproportionately affecting women (Fredrickson & Roberts, 1997). Recent work has examined literal objectification, defined as “any outcome in which a person is perceived as, or behaves, objectlike, relative to humanlike” (Heflick & Goldenberg, 2014, p. 225). Focusing on women’s physical appearance heightens literal objectification, including reduced perceptions of warmth, competence, and morality (Heflick et al., 2011). We investigated whether participants’ ratings of literal objectification vary as a function of body type. Seventy-one college women (Mage = 19.23) viewed three photos of women, manipulated to depict low, average, and high ideal body shapes. Participants rated the degree to which each woman possessed competence, warmth and morality, and their desire to collaborate on a group project with them. Average images were rated as significantly higher on warmth, morality, and collaboration desirability than high ideal and low ideal images, and marginally more competent than high ideal images. High ideal images were rated as significantly lower on warmth and marginally lower on collaboration desirability than low ideal images. Future research should extend this work to evaluate behavioral manifestations of literal objectification and explore what other factors might moderate these effects

Assessing Psychological Inflexibility in Hoarding: The Acceptance and Action Questionnaire for Hoarding (AAQH)

Psychological inflexibility is a psychopathological process referring to the tendency for behavior to be overly controlled by internal experiences to an extent that interferes with quality of life. Some studies indicate that psychological inflexibility is linked to hoarding, but findings have been mixed. This inconsistency may be due to reliance on general measures of psychological inflexibility in prior research as there was previously no validated measure to assess psychological inflexibility as it relates to hoarding. The present study developed and validated a measure of hoarding-related psychological inflexibility, the Acceptance and Action Questionnaire for Hoarding (AAQH) in a college student sample with elevated hoarding symptoms (n = 201). The AAQH demonstrated a two-factor structure and good internal consistency, construct validity, and incremental validity over a general measure of psychological inflexibility, the AAQ-II. The potential research and clinical utility of the AAQH as well as limitations of this preliminary validation study are discussed

A Systematic Review and Psychometric Evaluation of Self-Report Measures for Hoarding Disorder

Background: Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequently, formulate appropriate interventions. Methods: We identified measures specific to HD and evaluated their psychometric properties using rating criteria formulated by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) group. Results: The 17 included measures were developed to assess adult and pediatric hoarding severity, functional impairment, and maladaptive processes (e.g., material scrupulosity). The Saving Inventory—Revised, the most widely used measure of HD severity showed the strongest psychometric properties. However, psychometric investigations were generally of poor quality across all measures and results indicated unsatisfactory performance of measures. Limitations: The current review excluded non-English measures and ratings inherently contain some element of subjectivity despite use of predetermined criteria and two independent reviewers. Conclusions: We suggest that clinical researchers continue to develop and modify measures used to conceptualize and, ultimately, improve treatment for HD

Preliminary Findings on Processes of Change and Moderators for Cognitive Defusion and Restructuring Delivered Through Mobile Apps

A process-based therapy approach emphasizes examining how and for whom specific therapeutic components linked to specific processes of change function. This preliminary study explored the processes of change for cognitive defusion and restructuring with daily ratings of self-criticism from a larger component trial as well as self-compassion as a moderator of these daily effects. A sample of 51 adults high in self-criticism (M age = 22.69, 78% female, 88% non-Hispanic White) were randomized to a cognitive defusion or restructuring mobile app for two weeks and completed daily assessments. Both conditions improved over time on daily frequency, defused noticing, challenging, and believability of self-critical thoughts as well as valued actions, with larger improvements in the defusion condition only for thought frequency and defused noticing. Global self-compassion moderated several effects such that only participants lower in self-compassion improved over time on daily self-criticism processes in the restructuring condition, while effects over time in the defusion condition generally did not vary by level of self-compassion. Improvements in daily frequency, defused noticing, and challenging self-critical thoughts as well as valued action each predicted global improvements in self-criticism at post-intervention across conditions. Overall, these preliminary results suggest cognitive defusion and restructuring may have some similar effects on self-criticism related processes of change, particularly for those low in self-compassion. However, defusion may produce larger effects on some targeted processes, especially among those with higher self-compassion

Trauma-sensitive yoga: a collective case study of the trauma recovery of women impacted by Intimate Partner Violence (IPV)

Intimate Partner Violence (IPV) is defined as a pattern of abusive and controlling behaviors that an individual perpetuates physically, psychologically, emotionally, spiritually, economically, and/or sexually against his or her intimate partner (World Health Organization, 2013b). More than 1 in 3 women in the United States have experienced IPV at some point in their lifetime (The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report, 2010). Further, more than a third of women who have been impacted by Intimate Partner Violence (IPV) develop PTSD (DeJonghe, Bogat, Levendosky, & Von Eye, 2008; Van der Kolk et al., 2014). Despite the high incidence of PTSD in women impacted by IPV, there seems to be a gap addressing the needs of this clinical population due to the ambiguity on the efficacy of current treatment interventions for PTSD. Serious limitations such as high drop out rates and nonresponse rates persist in studies of even well-established and heavily researched interventions such as Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), suggesting that these interventions may not be effective for all trauma survivors (Schottenbauer et al., 2008). In recent years, neuroscientists such as Porges (2001, 2003) have shed new light and understanding on trauma by suggesting that social behavior has a neurobiological basis. It may be that until traumatized individuals increase physiological awareness of their body, conventional trauma treatment approaches that are cognitively oriented may have limited effectiveness (Emerson, 2011; Scaer, 2005). Trauma-sensitive yoga (TSY), a structured body-oriented yoga practice, is one of the novel approaches specifically designed to help trauma survivors recover from trauma. Although research on TSY is in its infancy, several scholars have found evidence for its efficacy as an intervention for significantly reducing participants’ PTSD symptoms (Dick, Niles, Street, DiMartino, & Mitchell, 2014; Mitchell et al., 2014; Van der Kolk et al., 2014). While this is useful information, these researchers have not yet considered how TSY facilitates trauma recovery beyond what is reflected in PTSD scores. However, identifying nuances in individual recovery is central to informing more tailored interventions specific to survivors’ diverse trauma recovery needs (Dutton, 2009). To fill this gap in the extant literature, the purpose of this study was to study adult female IPV survivors’ perceptions of trauma recovery as facilitated by TSY. In particular, the researcher sought to develop an in-depth and unique contextual understanding on five women’s trauma recovery experiences using a collective case study research design. Findings from this study revealed individual and collective themes across cases that support the use of TSY to facilitate trauma recovery in multidimensional ways. Themes from the benefits of TSY on women’s trauma recovery included (a) physiological benefits, (b) emotional benefits, (c) spiritual benefits, (d) cognitive benefits, (e) enhanced perception of self and others, (f) shift in perspective on time, (f) self-care, and (g) application of positive coping strategies. The findings indicate that TSY offers a versatile approach to meeting the diverse needs of women impacted by IPV-related trauma. Contrary to the proposition that TSY is suited for all complex trauma survivors, the findings also suggest that TSY classes may be contraindicated for certain complex trauma survivors