Making Space a better Place: Just In Time Adaptive Interventions for Healthy Lifestyles

Just In Time Adaptive Interventions (JITAI) are a class of applications that provide tailored support at the right time and place to help people to maintain a healthy lifestyle. This paper presents the initial version of a JITAI application that helps users to make healthy food choices when walking in an urban environment. The app provides interventions based on location, time, and user characteristics. It adapts its interventions based on the type and goal of a user. The JITAI consist of an app for a mobile phone and a backend server. Using the backend, decision points and interventions can be managed as well as users. Moreover, it stores tracks and intervention data. A two-phased experiment will be set-up. The first phase will test the robustness and functionality of the application with a limited number of users. Based on this, the app will be adapted. The second phase will test the effectiveness of the different type of interventions by involving a large user group

How an understanding of our ability to adhere to verbal rules can increase insight into (mal)adaptive functioning in chronic pain

Research on chronic pain has traditionally focused on how direct pain experiences lead to maladaptive thoughts, feelings, and actions that set the stage for, and maintain, pain-related disability. Yet the capacity for language (and more specifically verbal instructions or rules) to put people into indirect contact with pain has never been systematically investigated. In this article, we introduce a novel theoretical perspective on verbal processes and discuss how the study of verbal rules may increase our understanding of both maladaptive and adaptive functioning in chronic pain. Several useful characteristics of verbal rules and rule-following in the context of chronic pain are outlined. Future research directions and implications for clinical practice are then discussed. Perspective: This focus article argues that, by studying verbal rules and rule-following, we will gain a better understanding of (mal)adaptive functioning in the context of chronic pain. Future research directions are outlined and suggestions for improving clinical practice are considered

Valoración de profesores de educación básica de cursos de formación continua

Fue realizado un estudio con el propósito de identificar la valoración de ocho cursos de formación continua, por parte de los maestros y maestras de educación básica del Estado de Morelos profesores de diferentes modalidades y/o niveles educativos (Educación Indígena; Educación Secundaria Técnica y General; Telesecundaria; Educación Preescolar; Educación Especial e Enciclomedia en Educación Primaria). En una primera etapa, 115 profesores completaron un cuestionario con seis dimensiones: Satisfacción, Aplicabilidad, Motivación, Reflexión, Relevancia y Desarrollo. La segunda etapa consistió en analizar la opinión de 16 profesores, a partir de una entrevista semiestructurada, acerca del curso tomado y del posible impacto en su práctica profesional. A juicio de los profesores, los cursos de formación continua satisfacen sólo de forma moderada sus expectativas y objetivos que tuvieron para tomarlo y la poca correspondencia de los contenidos de los cursos con las necesidades de su práctica profesional cotidiana, y a los problemas profesionales prioritarios en su contexto laboral

A network analysis of potential antecedents and consequences of pain-related activity avoidance and activity engagement in adolescents

Objective This study sets out to identify potential daily antecedents and consequences of pain-related activity avoidance and engagement behavior in adolescents with chronic pain. Methods Adolescents (N = 65, Mage = 14.41) completed baseline self-reports and a diary for 14 days. Afternoon and evening reports were used to infer a network structure of within-day associations between pain intensity, pain-related fear, pain catastrophizing, affect, and pain-related activity avoidance and engagement behavior. Baseline psychological flexibility was examined as a potential resilience factor. Results Activity avoidance in the evening was predicted by pain-related fear and avoidance earlier that afternoon. Activity engagement was predicted by positive affect and activity engagement in the afternoon. Pain-related behavior in the afternoon was not related to subsequent changes in pain intensity, pain-related fear, pain catastrophizing, or affect. Pain-related fear in the afternoon was predictive of increased levels of pain and pain catastrophizing in the evening. Both pain-related fear and pain catastrophizing in the evening were predicted by negative affect in the afternoon. Psychological flexibility was associated with lower levels of daily activity avoidance and buffered the negative association between pain intensity and subsequent activity engagement. Conclusions This study provides insight into unique factors that trigger and maintain activity avoidance and engagement and into the role of psychological flexibility in pediatric pain. Future work should focus on both risk and resilience factors and examine the role of psychological flexibility in chronic pediatric pain in greater detail

Investigating how parental instructions and protective responses mediate the relationship between parental psychological flexibility and pain-related behavior in adolescents with chronic pain : a daily diary study

Background: Parental behavior can influence how well adolescents cope with chronic pain. Previous research has largely focused on how parents negatively impact adolescent functioning. Yet more recent work suggests that parents - and particularly parental psychological flexibility - can foster better adolescent pain-related functioning. In this study we examined if parental protective responses and instructions to engage in activities in the presence of pain mediate the impact of parental psychological flexibility and acceptance of adolescent pain on adolescents' daily pain-related behavior. Method: Fifty-six adolescents with chronic pain (Mage = 14.5 years, 86% girls) and one of their parents (93% mothers) were recruited at initial evaluation at two pediatric pain clinics in the US. Parents completed baseline questionnaires assessing psychologically flexible parenting and acceptance of adolescent pain. Next, parents and adolescents completed a 14-day self-report diary assessing adolescent activity-avoidance and activity-engagement in the presence of pain (adolescent report), and parental protective responses and instructions for their adolescent to engage in activities (parent report). Results: Psychologically flexible parenting and acceptance of adolescent pain in parents were indirectly related to lower daily adolescent activity-avoidance, via their negative association with daily parental protective responses. Positive associations also emerged between baseline psychologically flexible parenting and overall levels of adolescent activity-engagement via its negative association with overall levels of parental protectiveness across the 14-day period. Psychologically flexible parenting and parental acceptance of adolescent pain were also indirectly related to daily decreases in adolescent activity-avoidance via their association with daily increases in parental activity-engagement instructions. These baseline parental resilience factors were also positively related to overall levels of parental engagement instructions, a route via which an indirect association with both higher overall activity-engagement as well as higher overall activity-avoidance in the adolescent was observed. Conclusion: Our findings suggest an (indirect) adaptive role of parental psychological flexibility on adolescent daily pain-related behavior via its impact on parental protective behavior. If our findings replicate, they would suggest that these parental behaviors could be targeted in pain treatments that include both adolescents and their parents. Future research could further examine the impact of parental instructions on pain-related behavior in adolescents with chronic pain

Spatio-temporal evolution of intraplate strike-slip faulting: the Neogene-Quaternary Kuh-e-Faghan Fault, Central Iran

Central Iran provides an ideal region to study the long-term morphotectonic response to the nucleation and propagation of intraplate faulting. In this study, a multidisciplinary approach that integrates structural and stratigraphic field investigations with apatite (U+Th)/He (AHe) thermochronometry is used to reconstruct the spatio-temporal evolution of the Kuh-e-Faghan Fault (KFF) in northeastern Central Iran. The KFF is a narrow, ca. 80 km long, deformation zone that consists of three main broadly left stepping, E-W trending, dextral fault strands that cut through the Mesozoic-Paleozoic substratum and the Neogene-Quaternary sedimentary cover. The AHe thermochronometry results indicate that the intra-fault blocks along the KFF experienced two major episodes of fault-related exhumation at ~18 Ma and ~4 Ma. The ~18 Ma faulting/exhumation episode is chiefly recorded by the structure and depositional architecture of the Neogene deposits along the KFF. A source-to-sink scenario can be reconstructed for this time frame, where topographic growth caused the synchronous erosion/exhumation of the pre-Neogene units and deposition of the eroded material in the surrounding fault-bounded continental depocenters. Successively, the KFF gradually entered a period of relative tectonic quiescence and, probably, of regional subsidence during which a thick pile of fine-grained onlapping sediments were deposited. This may have caused resetting of the He ages of apatite in the pre-Neogene and the basal Neogene successions. The ~4 Ma faulting episode caused the final exhumation of the fault system, resulting in the current fault zone and topography. The two fault-related exhumation episodes fit with the regional early Miocene collision-enhanced uplift/exhumation, and the late Miocene–early Pliocene widespread tectonic reorganization of the Iranian plateau. The reconstructed long term, spatially and temporally punctuated fault system evolution in intraplate Central Iran during Neogene-Quaternary times may reflect states of far-field stress changes at the collisional boundaries

Cochlear implant positioning:development and validation of an automatic method using computed tomography image analysis

The aim of this study was to preoperatively asses the feasibility of drilling a bony recess for the fixation of a cochlear implant in the temporal bone. Even though complications are rare with cochlear implantations, drilling at the site of implantation have resulted in hematoma or cerebrospinal fluid leakage. Mainly in cases with a reduced temporal bone thickness, the risk for complications has increased, such as in paediatric patients.Methods An in-house designed semi-automatic algorithm was developed to analyse a 3D model of the skull. The feasibility of drilling the recess was determined by a gradient descent method to search for the thickest part of the temporal bone. Feasibility was determined by the residual bone thickness which was calculated after a simulated drilling of the recess at the thickest position. An initial validation of the algorithm was performed by measuring the accuracy of the algorithm on five 3D models with known thickest locations for the recess. The accuracy was determined by a part comparison between the known position and algorithm provided position.Results In four of the five validation models a standard deviation for accuracy below the predetermined cut-off value of 4.2 mm was achieved between the actual thickest position and the position determined by the algorithm. Furthermore, the residual thickness calculated by the algorithm showed a high agreement (max. 0.02 mm difference) with the actual thickness.Conclusion With the developed algorithm, a semi-automatic method was created to analyse the temporal bone thickness within a specified region of interest on the skull. Thereby, providing indications for surgical feasibility, potential risks for anatomical structures and impact on procedure time of cochlear implantation. This method could be a valuable research tool to objectively assess feasibility of drilling a recess in patients with thin temporal bones preoperatively

The interaction between stress and chronic pain through the lens of threat learning

Stress and pain are interleaved at multiple levels - interacting and influencing each other. Both are modulated by psychosocial factors including fears, beliefs, and goals, and are served by overlapping neural substrates. One major contributing factor in the development and maintenance of chronic pain is threat learning, with pain as an emotionally-salient threat – or stressor. Here, we argue that threat learning is a central mechanism and contributor, mediating the relationship between stress and chronic pain. We review the state of the art on (mal)adaptive learning in chronic pain, and on effects of stress and particularly cortisol on learning. We then provide a theoretical integration of how stress may affect chronic pain through its effect on threat learning. Prolonged stress, as may be experienced by patients with chronic pain, and its resulting changes in key brain networks modulating stress responses and threat learning, may further exacerbate these impairing effects on threat learning. We provide testable hypotheses and suggestions for how this integration may guide future research and clinical approaches in chronic pain

“You don’t accept he’s completely ok”:A reflexive thematic analysis of parents’ roles in monitoring their child’s health and symptoms after finishing childhood cancer treatment

Objectives/purpose: Childhood cancer survival brings continued mental and physical health challenges both for the child and for the family. In this study, we investigated how parents viewed their roles in their child’s health and symptom monitoring during the survivorship period. Methods: Twenty-one parents of childhood cancer survivors (n = 18 mothers; parent mage = 49.78 years, child mage = 18.50 years; range = 12–25 years), whose children were at least one year off-treatment (m = 3.67 years; SD = 2.25; various diagnoses), completed semi-structured interviews. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. Results: Analyses generated three themes which reflect roles that parents may adopt in the context of monitoring symptoms in their childhood cancer survivor. “Vigilant Mama and Papa” (theme 1) described parents who expressed a strong sense of responsibility for protecting their child’s health during survivorship resulting in careful monitoring of their child’s symptoms and health. “Pragmatic Mamas and Papas” (theme 2) described parents who adopted an approach to symptom and health monitoring that emphasized moving past cancer and focusing on the future. Finally, “Encouraging Mamas and Papas” (theme 3) described parents who focused on educating and preparing their child to develop an autonomous approach to health and symptom self-monitoring as they transitioned to survivorship and adulthood. Conclusion: Parents take on varying roles in monitoring their child’s symptoms and health after finishing childhood cancer treatment. Implications for Cancer Survivors: Understanding the ways in which parents continue to be involved in their child’s cancer journey helps researchers develop interventions to support dyadic coping in survivorship.</p