Comparing In-Person to Videoconference-Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial

Background: Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective: The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. Methods: A total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction.Results: Retention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81),and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62). Conclusions: The findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two

Dispersion, accumulation, and the ultimate fate of microplastics in deep-marine environments: a review and future directions

An estimated 8.3 billion tons of non-biodegradable plastic has been produced over the last 65 years. Much of this is not recycled and is disposed into the natural environment, has a long environmental residence time and accumulates in sedimentary systems worldwide, posing a threat to important ecosystems and potentially human health. We synthesize existing knowledge of seafloor microplastic distribution, and integrate this with process-based sedimentological models of particle transport, to provide new insights, and critically, to identify future research challenges. Compilation of published data shows that microplastics pervade the global seafloor, from abyssal plains to submarine canyons and deep-sea trenches (where they are most concentrated). However, few studies relate microplastic accumulation to sediment transport and deposition. Microplastics may enter directly into the sea as marine litter from shipping and fishing, or indirectly via fluvial and aeolian systems from terrestrial environments. The nature of the entry-point is critical to how terrestrially sourced microplastics are transferred to offshore sedimentary systems. We present models for physiographic shelf connection types related to the tectono-sedimentary regime of the margin. Beyond the shelf, the principal agents for microplastic transport are: (i) gravity-driven transport in sediment-laden flows; (ii) settling, or conveyance through biological processes, of material that was formerly floating on the surface or suspended in the water column; (iii) transport by thermohaline currents, either during settling or by reworking of deposited microplastics. We compare microplastic settling velocities to natural sediments to understand how appropriate existing sediment transport models are for explaining microplastic dispersal. Based on this analysis, and the relatively well-known behavior of deep-marine flow types, we explore the expected distribution of microplastic particles, both in individual sedimentary event deposits and within deep-marine depositional systems. Residence time within certain deposit types and depositional environments is anticipated to be variable, which has implications for the likelihood of ingestion and incorporation into the food chain, further transport, or deeper burial. We conclude that the integration of process-based sedimentological and stratigraphic knowledge with insights from modern sedimentary systems, and biological activity within them, will provide essential constraints on the transfer of microplastics to deep-marine environments, their distribution and ultimate fate, and the implications that these have for benthic ecosystems. The dispersal of anthropogenic across the sedimentary systems that cover Earth’s surface has important societal and economic implications. Sedimentologists have a key, but as-yet underplayed, role in addressing, and mitigating this globally significant issue

Hybrid turbidite-drift channel complexes: An integrated multiscale model

The interaction of deep-marine bottom currents with episodic, unsteady sediment gravity flows affects global sediment transport, forms climate archives, and controls the evolution of continental slopes. Despite their importance, contradictory hypotheses for reconstructing past flow regimes have arisen from a paucity of studies and the lack of direct monitoring of such hybrid systems. Here, we address this controversy by analyzing deposits, high-resolution seafloor data, and near-bed current measurements from two sites where eastward-flowing gravity flows interact(ed) with northward-flowing bottom currents. Extensive seismic and core data from offshore Tanzania reveal a 1650-m-thick asymmetric hybrid channel levee-drift system, deposited over a period of ∼20 m.y. (Upper Cretaceous to Paleocene). High-resolution modern seafloor data from offshore Mozambique reveal similar asymmetric channel geometries, which are related to northward-flowing near-bed currents with measured velocities of up to 1.4 m/s. Higher sediment accumulation occurs on the downstream flank of channel margins (with respect to bottom currents), with inhibited deposition or scouring on the upstream flank (where velocities are highest). Toes of the drift deposits, consisting of thick laminated muddy siltstone, which progressively step back into the channel axis over time, result in an interfingering relationship with the sandstone-dominated channel fill. Bottom-current flow directions contrast with those of previous models, which lacked direct current measurements or paleoflow indicators. We finally show how large-scale depositional architecture is built through the temporally variable coupling of these two globally important sediment transport processes. Our findings enable more-robust reconstructions of past oceanic circulation and diagnosis of ancient hybrid turbidite-drift systems

Does the Animal Fun program improve motor performance in children aged 4–6 years?

The Animal Fun program was designed to enhance the motor ability of young children by imitating the movements of animals in a fun, inclusive setting. The efficacy of this program was investigated through a randomized controlled trial using a multivariate nested cohort design. Pre-intervention scores were recorded for 511 children aged 4.83 years to 6.17 years (M =5.42 years, SD = 3.58 months). Six control and six intervention schools were compared 6 months later following the intervention, and then again at 18 months after the initial testing when the children were in their first school year. Changes in motor performance were examined using the Bruininks-Oseretsky Test of Motor Proficiency short form. Data were analyzed using multi-level-mixed effects linear regression. A significant Condition Time interaction was found, F(2,1219) = 3.35, p = .035, demonstrating that only the intervention group showed an improvement in motor ability. A significant Sex Time interaction was also found, (2,1219) = 3.84, p = .022, with boys improving over time, but not girls. These findings have important implications for the efficacy of early intervention of motor skills and understanding the differences in motor performance between boys and girls

Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014

Apapáchame 2. : Manual de entrenamiento para niños que presentan bajo estado de ánimo

Cada vez se presentan más situaciones familiares, sociales y académicas que afectan emocional y afectivamente a los niños, lo que conlleva a que se aumente el número de casos en esta población con síntomas de estado de ánimo bajo; razón por la cual se hace necesario desarrollar manuales que sirvan de apoyo en las sesiones de intervención que realizan los psicólogos infantiles.INTRODUCCIÓN. 1. TIPOS DE EMOCIONES. 2. RECONOCIMIENTOS DE LAS EMOCIONES. 3. IDENTIFICACIÓN DE LAS SITUACIONES DE TRISTEZA. 4. EXPRESIÓN DE LA TRISTEZA. 5. EXPRESIONES POSITIVAS HACIA SÍ MISMO. 6. AUTOVALIDACIÓN EMOCIONAL. 7. ACTIVIDADES AGRADABLES Y DE DOMINIO. REFERENCIAS.1ª ed

Interferon lambda is required for interferon gamma-expressing NK cell responses but does not afford antiviral protection during acute and persistent murine cytomegalovirus infection

Interferon lambda (IFNλ) is a group of cytokines that belong to the IL-10 family. They exhibit antiviral activities against certain viruses during infection of the liver and mucosal tissues. Here we report that IFNλ restricts in vitro replication of the β-herpesvirus murine cytomegalovirus (mCMV). However, IFNλR1-deficient (Ifnλr1-/-) mice were not preferentially susceptible to mCMV infection in vivo during acute infection after systemic or mucosal challenge, or during virus persistence in the mucosa. Instead, our studies revealed that IFNλ influences NK cell responses during mCMV infection. Ifnλr1-/- mice exhibited defective development of conventional interferon-gamma (IFNγ)-expressing NK cells in the spleen during mCMV infection whereas accumulation of granzyme B-expressing NK cells was unaltered. In vitro, development of splenic IFNγ+ NK cells following stimulation with IL-12 or, to a lesser extent, IL-18 was abrogated by IFNλR1-deficiency. Thus, IFNλ regulates NK cell responses during mCMV infection and restricts virus replication in vitro but is redundant in the control of acute and persistent mCMV replication within mucosal and non-mucosal tissues

Bottom current modification of turbidite lobe complexes

Submarine lobes form at the distal end of sediment gravity flow systems and are globally important sinks for sediment, anthropogenic pollutants and organic carbon, as well as forming hydrocarbon and CO2 reservoirs. Deep-marine, near bed or bottom currents can modify gravity flow pathways and sediment distribution by directly interacting with the flow or by modifying seafloor morphology. Deciphering the nature of gravity- and bottom currents interaction, particularly in ancient systems, remains a challenge due to the lack of integrated datasets and the necessary oceanographic framework. Here we analyse high-resolution 3D seismic reflection and core data from the Upper Cretaceous interval offshore Tanzania to reveal the interaction of turbidite lobes with fine-grained sediment waves and contourite drift deposits. Contourite drift morphology governs the large-scale confinement style and shape of lobes that range from frontally confined and crescent shaped, to laterally confined and elongated, to semi-confined lobes. Core data reveals massive to cross-laminated high density turbidites in the lobe axis position that show no direct interaction between gravity flows and contour currents. Lobe off-axis and fringe deposits consist of parallel- and ripple-laminated, low density turbidites, which are inter-bedded with bioturbated, muddy siltstones that represent the toes of contourite drifts. Starved ripples, and streaks of up to fine-grained sandstone above individual turbidite beds indicate reworking by bottom currents. This facies distribution reflects the temporal interaction of quasi-steady bottom currents and turbidity currents that interact with the topography and build lobes over short periods of time. Frontally confined turbidity currents form lobes in a fill-and-spill fashion, in which the confinement of turbidity currents causes rapid deposition and obscures any bottom current signal. Lateral confinement causes increased turbidity current runout length, and promotes the development of lobe fringes with a high proportion of bottom current reworked sands. During times when sediment gravity flows are subordinate, contourites accumulate on top of the lobe, confining the next flow and thus modifying the overall stacking pattern of the lobe complex. Although sediment volumes of these bottom current modified lobe complexes are comparable to other deep-marine systems, bottom currents considerably influence facies distribution and deposit architecture

Efficacy of the Aussie Optimism Program: Promoting pro-social behavior and preventing suicidality in primary school students. A randomised-controlled trial

The efficacy of an enhanced version of the Aussie Optimism Program (AOP) was investigated in a cluster randomized controlled trial. Grade 6 students aged 10–11 years of age (N = 2288) from 63 government primary schools in Perth, Western Australia, participated in the pre, post, and follow-up study. Schools were randomly assigned to one of three conditions: Aussie Optimism with teacher training, Aussie Optimism with teacher training plus coaching, or a usual care condition that received the regular Western Australian Health Education Curriculum. Students in the Aussie Optimism conditions received 20, 1-h lessons relating to social and interpersonal skills and optimistic thinking skills over the last 2 years of primary school. Parents in the active conditions received a parent information booklet each year, plus a self-directed program in Grade 7. Students and parents completed the Extended Strengths and Difficulties Questionnaire. Students who scored in the clinical range on the Emotional Symptoms Scale were given The Diagnostic Interview for Children and Adolescents IV, to assess suicidal ideation and behavior, and depressive and anxiety disorders. Results indicated that Aussie Optimism with teacher training plus coaching was associated with the best outcomes: a significant increase in student-reported pro-social behavior from pre-test to post-test 1 (maintained at post-test 2) and significantly lower incidence rates from suicidal ideation at post-test 2 and follow-up. No significant intervention effects on anxiety and depressive disorders, and total difficulties were reported. These findings suggest that the AOP with teacher training along with coaching may have the potential to positively impact on suicidality and pro-social behavior in the pre-adolescent years

Efficacy of the Aussie Optimism Program: Promoting pro-social behavior and preventing suicidality in primary school students. A randomised-controlled trial

The efficacy of an enhanced version of the Aussie Optimism Program (AOP) was investigated in a cluster randomized controlled trial. Grade 6 students aged 10–11 years of age (N = 2288) from 63 government primary schools in Perth, Western Australia, participated in the pre, post, and follow-up study. Schools were randomly assigned to one of three conditions: Aussie Optimism with teacher training, Aussie Optimism with teacher training plus coaching, or a usual care condition that received the regular Western Australian Health Education Curriculum. Students in the Aussie Optimism conditions received 20, 1-h lessons relating to social and interpersonal skills and optimistic thinking skills over the last 2 years of primary school. Parents in the active conditions received a parent information booklet each year, plus a self-directed program in Grade 7. Students and parents completed the Extended Strengths and Difficulties Questionnaire. Students who scored in the clinical range on the Emotional Symptoms Scale were given The Diagnostic Interview for Children and Adolescents IV, to assess suicidal ideation and behavior, and depressive and anxiety disorders. Results indicated that Aussie Optimism with teacher training plus coaching was associated with the best outcomes: a significant increase in student-reported pro-social behavior from pre-test to post-test 1 (maintained at post-test 2) and significantly lower incidence rates from suicidal ideation at post-test 2 and follow-up. No significant intervention effects on anxiety and depressive disorders, and total difficulties were reported. These findings suggest that the AOP with teacher training along with coaching may have the potential to positively impact on suicidality and pro-social behavior in the pre-adolescent years