Intergenerational Attachment Styles, Emotional Regulation and Relational Outcomes in Couples Therapy

This chapter focuses on the theoretical basis behind intergenerational attachment styles and how they present in romantic relationships. In this chapter, we review the conceptual literature on attachment styles, their development and maintenance across the lifespan. We also explore the role of mutual emotional regulation in disrupting relational distress and improving relationship functioning. We proceed to synthesise efficacy studies and evidence-based research on relational interventions with couples, most commonly presenting concerns in couples therapy and the role of couples therapy in improving romantic relationships across cultural contexts, gender and sexuality identifications. We summarise what has worked, with whom and why while reviewing the various measures and types of clinical interventions offered to couples and report on change scores in outcomes of attachment avoidance/anxiety, relational conflict, relationship functioning and partner satisfaction. Finally, the book chapter presents three case studies with South-Asian couples across diverse life stages, relationship statuses, gender identities and sexual orientations using attachment-based and emotion-focused interventions

Learning by Doing: Student Experiences in a Mixed Methods Research Course

Aim/Purpose The purpose of this paper is to detail the experiential learning processes of an 11-week doctoral-level intermediate mixed methods research (MMR) course in which student-researchers conceptualized and implemented an MMR study to apply theoretical and methodological learning in a practical manner. Our aim is to emphasize the value of an applied MMR course for improved student learning and curriculum planning for faculty by highlighting meaningful insights on study design, data integration, team collaboration, and the challenges and opportunities involved in project execution within a time-limited academic course. Background MMR courses are increasingly being integrated into graduate programs, yet few offer intermediate or advanced courses that go beyond introductory topics and engage students in applied learning. Furthermore, most articles on MMR courses are written from the instructor perspective and not from the student perspective. Methodology This article is organized by each week of the course curriculum, and the output of the research project, couched within reflections of the applied process, is presented. While this paper is grounded in an experiential reflection of learning, the research project itself is referred to frequently to help elucidate and capture this learning in a systematic way. The applied study employed an explanatory sequential mixed methods design to examine career satisfaction and career preference changes over time in doctoral candidates and graduates. Contribution This paper contributes to higher education by providing a student-led exemplar of applied learning in MMR pedagogy for doctoral students irrespective of discipline and research topic. It provides a sample research project, executed start to finish with a guiding blueprint that can be adapted by faculty and students in various academic departments, within a quarter or semester long course. Findings Ultimately, this course led to increased confidence and preparation to conduct interdisciplinary mixed methods research. Unique to mixed methods research, the areas in which we witnessed the most growth included developing mixed methods research questions, choosing a design based on these questions, and engaging in data integration. Recommendations for Practitioners We provide the following recommendations to instructors interested in developing intermediate- or advanced-level MMR courses: a) obtain input from students on what they are most interested in learning during course conceptualization or early on in implementation; b) consider that a great deal of time outside of the classroom may need to be dedicated to the class project, which may impact the feasibility and successful execution of an experiential course; and c) sufficient class time is dedicated to data integration from quantitative and qualitative inputs. Recommendation for Researchers Researchers interested in further examining learning and proficiency garnered from MMR and other research courses may benefit from including students as co-researchers. In addition, engaging in systematic qualitative research on student and professor experiences in learning and teaching MMR courses could highlight further areas for course refinement and topics for future research. Impact on Society Given the increasing prevalence of MMR being included in research funding announcements as a preferred methodology, it is imperative to rigorously train researchers in mixed methods research at varying levels of advancement (i.e., introductory, intermediate, and advanced). Future Research Our small explanatory sequential mixed methods study began as a class project, yet highlighted areas that could be studied further for doctoral candidates and graduates in clinically oriented fields, such as learning what types or qualities of training and mentorship may yield more career preparedness and satisfaction

Numerical Study of Circularly Slotted Highly Sensitive Plasmonic Biosensor : A Novel Approach

Funding Information: This work was supported by the Deanship of the Scientific Research ( DSR ), King Abdulaziz University , Jeddah, under grant No. ( DF-773-135-1441 ). The authors, therefore, gratefully acknowledge DSR technical and financial support.Peer reviewe

Development of a transdiagnostic stepped care programme for common adolescent mental health problems in Indian secondary schools: lessons from a pilot study examining acceptability and feasibility

Background The ‘PRemIum for aDolEscents’ (PRIDE) project has developed a school-based, transdiagnostic stepped care programme for common adolescent mental health problems in India. The programme comprises a brief problem-solving intervention (‘Step 1’) followed by a personalised cognitive-behavioural intervention (‘Step 2’) for participants who do not respond to the first step. Methods A mixed-method design was used to evaluate the acceptability and feasibility of the stepped care programme in five schools in New Delhi. Participants were N = 80 adolescents (mean age = 15.3 years, females = 55%) with elevated mental symptoms and associated distress/impairment. Results 61 (76%) of the enrolled sample were assessed following Step 1, from which 33 (54%) met non-remission criteria. Among these 33 non-remitted cases, 12 (36%) opted for Step 2 and five (42%) completed the full programme. The remaining non-remitted cases (n = 21, 64%) opted out of further treatment. Perceived resolution of the primary problem (n = 9, 43%) was the most common reason for opting out. The median time to complete each step was 22 and 70 days respectively, with a gap of 31 days between steps. Qualitative feedback from adolescents and counsellors indicated requirements for a shorter delivery schedule, greater continuity across steps and more collaborative decision-making. Conclusions This study provides preliminary evidence for a stepped care programme aimed at common adolescent mental health problems. Modifications are recommended to enhance the acceptability and feasibility of the programme in low-resource settings

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Extreme learning machine for structured output spaces

Recently, extreme learning machine (ELM) has attracted increasing attention due to its successful applications in classification, regression, and ranking. Normally, the desired output of the learning system using these machine learning techniques is a simple scalar output. However, there are many applications in machine learning which require more complex output rather than a simple scalar one. Therefore, structured output is used for such applications where the system is trained to predict structured output instead of simple one. Previously, support vector machine (SVM) has been introduced for structured output learning in various applications. However, from machine learning point of view, ELM is known to offer better generalization performance compared to other learning techniques. In this study, we extend ELM to more generalized framework to handle complex outputs where simple outputs are considered as special cases of it. Besides the good generalization property of ELM, the resulting model will possesses rich internal structure that reflects task-specific relations and constraints. The experimental results show that structured ELM achieves similar (for binary problems) or better (for multi-class problems) generalization performance when compared to ELM. Moreover, as verified by the simulation results, structured ELM has comparable or better precision performance with structured SVM when tested for more complex output such as object localization problem on PASCAL VOC2006. Also, the investigation on parameter selections is presented and discussed for all problems

Behavioral Activation as an active ingredient of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis.

BACKGROUND: Psychological interventions such as behavioral activation (BA) that focus on overt behaviors rather than complex cognitive skills may be developmentally well-suited to address youth mental health problems. The current systematic review synthesized evidence on the characteristics, effectiveness and acceptability of behavioral activation (BA) to examine its role as a potential active ingredient for alleviating depression and anxiety among young people aged 14 to 24 years. METHODS: Evidence across the following sources were synthesized: (i) randomized control trials (RCT) evaluating interventions where BA has been used as a standalone intervention or as part of a multicomponent intervention, (ii) qualitative studies examining the acceptability of BA as an intervention or as a coping strategy among young people with lived experiences. Consultations with a youth advisory group (YAG) from India were used to draw inferences from existing evidence and identify future research priorities. RESULTS: As part of the review, 23 RCTs were identified; three studies examined BA as a standalone intervention, and the remaining studies examined multicomponent intervention where BA was a constituent element. The intervention protocols varied in composition, with the number of intervention elements ranging between 5 to 18. There was promising but limited evidence in standalone interventions for thse effectiveness of BA for depression. The impact of BA in multicomponent interventions was difficult to evaluate in the absence of focal assessment of activation outcomes. Evidence from 37 additional qualitative studies of youth lived experience literature, corroborated by the YAG inputs, indicated that young people preferred using behavioral strategies similar to BA to cope with depression in their own life. Themes indicated that the activities that are important to an individual and their socio-contextual factors need to be considered in the planning and implementing BA intervention. Evidence for the use of BA in anxiety was limited across data sources. CONCLUSIONS: Overall, there was preliminary empirical evidence for the effectiveness and acceptability of BA for youth depression. Further research is needed to examine the components and mechanisms that contribute to its effectiveness as an active intervention ingredient for depression and anxiety