Self-Coding of Fidelity as a Potential Active Ingredient of Consultation to Improve Clinicians' Fidelity.

A key goal for implementation science is the identification of evidence-based consultation protocols and the active ingredients within these protocols that drive clinician behavior change. The current study examined clinicians' self-coding of fidelity as a potential active ingredient of consultation for the Attachment and Biobehavioral Catch-up (ABC) intervention. It also examined two other potential predictors of clinician fidelity in response to consultation: dosage of consultation and working alliance. Twenty-nine clinicians (97% female, 62% White, M age = 34 years) participated in a year of weekly fidelity-focused ABC consultation sessions, for which clinicians self-coded fidelity and received consultant feedback on both their coding and their fidelity. Data from the ABC fidelity measure were available for 1067 sessions coded by consultants, and clinicians' self-coding accuracy was calculated from 1044 sessions coded by both clinicians and consultants. Alliance was measured with the Working Alliance Inventory-Trainee and Supervisor Versions. The study was observational, and fidelity and self-coding accuracy were modeled across time using hierarchical linear modeling. Clinicians' ABC fidelity, as well as their self-coding accuracy, increased over the course of consultation. Clinicians' self-coding accuracy predicted their initial fidelity and growth in fidelity. Working alliance was also linked to fidelity and self-coding accuracy. These results suggest that clinician self-coding should be further examined as an active ingredient of consultation. The study has important implications for the design of consultation procedures and fidelity assessments.

Intervention Adherence and Self-Efficacy as Predictors of Child Outcomes in School Nurse-Delivered Interventions for Anxiety.

This study examined the association between two implementation factors, nurse-reported intervention adherence and self-efficacy, and children's outcomes in school nurse-delivered anxiety interventions. Data were collected in a pilot randomized controlled effectiveness trial with 54 children and 21 school nurses. Nurses implemented either a cognitive behavioral or relaxation-skills-only intervention. Nurse questionnaires assessed implementation factors. Independent evaluators assessed changes in children's anxiety symptoms at postintervention and at 3-month follow-up using clinical improvement and global functioning scales. Regression analyses indicated that greater intervention adherence was associated with greater anxiety symptom improvement at follow-up. Nurse self-efficacy interacted with intervention group, such that nurses with higher self-efficacy who implemented the cognitive behavioral intervention tended to have children show improvement and higher postintervention functioning. The impact of implementation factors on children's outcomes may differ depending on intervention type. Self-efficacy may be important for nurses using relatively complex interventions. Intervention adherence should be supported through training and consultation.

Immunogenomic profiling and pathological response results from a clinical trial of docetaxel and carboplatin in triple-negative breast cancer.

PURPOSE: Patients with triple-negative breast cancer (TNBC) who do not achieve pathological complete response (pCR) following neoadjuvant chemotherapy have a high risk of recurrence and death. Molecular characterization may identify patients unlikely to achieve pCR. This neoadjuvant trial was conducted to determine the pCR rate with docetaxel and carboplatin and to identify molecular alterations and/or immune gene signatures predicting pCR. EXPERIMENTAL DESIGN: Patients with clinical stages II/III TNBC received 6 cycles of docetaxel and carboplatin. The primary objective was to determine if neoadjuvant docetaxel and carboplatin would increase the pCR rate in TNBC compared to historical expectations. We performed whole-exome sequencing (WES) and immune profiling on pre-treatment tumor samples to identify alterations that may predict pCR. Thirteen matching on-treatment samples were also analyzed to assess changes in molecular profiles. RESULTS: Fifty-eight of 127 (45.7%) patients achieved pCR. There was a non-significant trend toward higher mutation burden for patients with residual cancer burden (RCB) 0/I versus RCB II/III (median 80 versus 68 variants, p 0.88). TP53 was the most frequently mutated gene, observed in 85.7% of tumors. EGFR, RB1, RAD51AP2, SDK2, L1CAM, KPRP, PCDHA1, CACNA1S, CFAP58, COL22A1, and COL4A5 mutations were observed almost exclusively in pre-treatment samples from patients who achieved pCR. Seven mutations in PCDHA1 were observed in pre-treatment samples from patients who did not achieve pCR. Several immune gene signatures including IDO1, PD-L1, interferon gamma signaling, CTLA4, cytotoxicity, tumor inflammation signature, inflammatory chemokines, cytotoxic cells, lymphoid, PD-L2, exhausted CD8, Tregs, and immunoproteasome were upregulated in pre-treatment samples from patients who achieved pCR. CONCLUSION: Neoadjuvant docetaxel and carboplatin resulted in a pCR of 45.7%. WES and immune profiling differentiated patients with and without pCR. TRIAL REGISTRATION: Clinical trial information: NCT02124902, Registered 24 April 2014 & NCT02547987, Registered 10 September 2015.

Improving social-emotional competence in internationally adopted children with the Attachment and Biobehavioral Catch-up intervention.

Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social-emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social-emotional competence. Participants included 131 parent-child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent-child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social-emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social-emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social-emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social-emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social-emotional competence among children adopted internationally.

Enhancing Parenting Quality for Young Children Adopted Internationally: Results of a Randomized Controlled Trial.

Children adopted internationally are often dysregulated biologically and behaviorally due to prior experiences of institutional care or caregiving changes and thus are in need of enhanced parental care. The present study assessed whether parents randomized to receive Attachment and Biobehavioral Catch-up (ABC) demonstrated significant improvements in parenting quality when compared to parents receiving a control intervention. Participants were 120 internationally adopted children and their adoptive parents. Sixty-three (52.5%) of the children and 113 (94.2%) of the primary caregivers were female. Children were adopted from several countries and predominantly from China, Russia, South Korea, and Ethiopia. The majority of parents identified themselves as White/non-Hispanic (95.0%). At the start of intervention, parents ranged in age from 26.2 to 51.1 years old (M= 39.7, SD = 6.0), and children ranged in age from 6.8 months to 48.4 months (M = 21.9, SD = 9.0). Sensitivity (i.e., contingent responsiveness to a child's cues), intrusiveness (i.e., physical and/or verbal behavior that interferes with a child's autonomy), and positive regard (i.e., positive affect expressed towards a child) were assessed at preintervention, immediately postintervention, and at annual follow-up visits. Parents who received ABC showed better parenting quality at postintervention than parents who received a control intervention, and these effects persisted at a 2-year follow-up. Findings add to the growing evidence that ABC improves parenting abilities, extending findings to adoptive parents and demonstrating that improvements in parenting quality were sustained several years after completion of the intervention. Trial registration: ClinicalTrials.gov NCT00816621.

Concordance between clinician, supervisor and observer ratings of therapeutic competence in CBT and treatment as usual: does clinician competence or supervisor session observation improve agreement?

BACKGROUND: Lowering the cost of assessing clinicians' competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT). AIMS: This study examined the concordance between clinicians', supervisors' and independent observers' session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement. METHOD: Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians' competence after each supervision session (n = 613). Independent observers rated clinicians' competence from audio recordings (n = 395). RESULTS: Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians. CONCLUSIONS: These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.

Effects of Fidelity-Focused Consultation on Clinicians' Implementation: An Exploratory Multiple Baseline Design.

Identification of effective consultation models could inform implementation efforts. This study examined the effects of a fidelity-focused consultation model among community-based clinicians implementing Attachment and Biobehavioral Catch-up. Fidelity data from 1217 sessions from 7 clinicians were examined in a multiple baseline design. In fidelity-focused consultation, clinicians received feedback from consultants' fidelity coding, and also coded their own fidelity. Clinicians' fidelity increased after fidelity-focused consultation began, but did not increase during other training periods. Fidelity was sustained for 30 months after consultation ended. Findings suggest that consultation procedures involving fidelity coding feedback and self-monitoring of fidelity may promote implementation outcomes.

In Vivo Feedback Predicts Parent Behavior Change in the Attachment and Biobehavioral Catch-up Intervention.

Understanding mechanisms and active ingredients of intervention is critical to training clinicians, particularly when interventions are transported from laboratories to communities. One promising active ingredient of parenting programs is clinicians' in vivo feedback regarding parent-child interactions. The present study examined whether a form of in vivo feedback, in the moment commenting, predicted treatment retention and parent behavior change when the Attachment and Biobehavioral Catch-up (ABC) intervention was implemented in a community setting. Observational data were collected from 78 parent-child dyads (96% mothers; M age = 29 years; 81% minority; infants' M age = 12 months; 90% minority) across 640 sessions conducted by 9 clinicians (100% female, M age = 39; 67% minority) in Hawaii. Parental behavior was assessed with a semistructured play task before and after intervention. Clinicians' in-the-moment feedback to parents was assessed from intervention session videos. Clinicians' frequency and quality of in-the-moment feedback predicted change in parental intrusiveness and sensitivity at posttreatment. Frequency of in-the-moment feedback also predicted likelihood of retention. Hierarchical linear modeling demonstrated strong support for these associations at the between-clinician level, and limited additional support at the within-clinician (i.e., between-case) level. Thus, a hypothesized active ingredient of treatment, in-the-moment feedback, predicted community-based ABC outcomes. The results complement lab-based evidence to suggest that in vivo feedback may be a mechanism of change in parenting interventions. Helping clinicians to provide frequent, high-quality in vivo feedback may improve parenting program outcomes in community settings.

Novel Methods for Screening: Contributions from Attachment and Biobehavioral Catch-up.

Preventative interventions are needed across the lifespan, including for children who have experienced maltreatment. However, interventions' effect sizes are typically smaller in real-world settings than in clinical trials. Identifying providers who are likely to implement interventions with fidelity could promote implementation outcomes through targeted allocation of training resources. This study tested two pre-training screening measures as predictors of provider fidelity to Attachment and Biobehavioral Catch-up (ABC), a preventative intervention for maltreated infants. One measure assessed valuing of attachment/openness, and the other used vignettes to assess initial skill in a key intervention component. In a sample of 42 providers across 197 sessions, both screening measures predicted future ABC fidelity, even when controlling for experience and education. These results support the development of screening measures for other interventions, suggesting approaches that target specific qualities and behaviors are likely to predict implementation fidelity.

Moving an Evidence-Based Parenting Program Into the Community.

Attachment and Biobehavioral Catch-up (ABC) is a parenting program developed to enhance sensitivity among parents of infants who experience early adversity. In several randomized clinical trials, the intervention's efficacy has been demonstrated. Moving interventions into the community with adequate fidelity is challenging, though, and intervention effects are often much smaller than when tested in randomized clinical trials. To enhance the likelihood that ABC is delivered with high fidelity, a microanalytic fidelity assessment was developed. Using this fidelity tool as a central component of training, supervision, and certification, changes in parent sensitivity for 108 families with children ages 6 months to 2 years were as large as those seen in laboratory settings. These findings are discussed with regard to implications for moving other evidence-based interventions into the community.

Enhancing executive functioning among toddlers in foster care with an attachment-based intervention.

Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.

The Case for Assessing and Reporting on Facilitator Fidelity: Introducing the Fidelity of Implementation in Parenting Programs Guideline.

The sizeable body of evidence indicating that parenting programs have a positive impact on children and families highlights the potential public health benefits of their implementation on a large scale. Despite evidence and global attention, beyond the highly controlled delivery of parenting programs via randomized trials, little is known about program effectiveness or how to explain the poorer results commonly observed when implemented in community settings. Researchers, practitioners, and policymakers must work together to identify what is needed to spur adoption and sustainment of evidence-based parenting programs in real-world service systems and how to enhance program effectiveness when delivered via these systems. Collecting, analyzing, and using facilitator fidelity data is an important frontier through which researchers and practitioners can contribute. In this commentary, we outline the value of assessing facilitator fidelity and utilizing the data generated from these assessments; describe gaps in research, knowledge, and practice; and recommend directions for research and practice. In making recommendations, we describe a collaborative process to develop a preliminary guideline-the Fidelity of Implementation in Parenting Programs Guideline or FIPP-to use when reporting on facilitator fidelity. Readers are invited to complete an online survey to provide comments and feedback on the first draft of the guideline. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-023-00092-5.

Explosive eruption style modulates volcanic electrification signals.

Volcanic lightning detection has proven useful to volcano monitoring by providing information on eruption onset, source parameters, and ash cloud directions. However, little is known about the influence of changing eruptive styles on the generation of charge and electrical discharges inside the eruption column. The 2021 Tajogaite eruption (La Palma, Canary Islands) provided the rare opportunity to monitor variations in electrical activity continuously over several weeks using an electrostatic lightning detector. Here we show that throughout the eruption, silicate particle charging is the main electrification mechanism. Moreover, we find that the type of electrical activity is closely linked to the explosive eruption style. Fluctuations in the electrical discharge rates are likely controlled by variations in the mass eruption rate and/or changes in the eruption style. These findings hold promise for obtaining near real-time information on the dynamic evolution of explosive volcanic activity through electrostatic monitoring in the future.

Parent Coaching Fidelity Trajectories of In-Person and Telehealth Sessions during the COVID-19 Pandemic.

The COVID-19 pandemic has posed significant challenges to delivery of preventive and mental health services, and providers have rapidly transitioned to telehealth service provision. Factors such as sudden isolation, financial strain, and physical and mental health stress presented unique challenges for providers and families and highlight the need for accessible and effective services. Thus, providers' fidelity of implementation during the pandemic is an important area for research. The current observational study compared providers' fidelity across in-person and telehealth-delivered sessions before and during the COVID-19 pandemic in Attachment and Biobehavioral Catch-up (ABC), a preventive parent coaching intervention for infants and toddlers. Participants included 24 providers (95% female, 42% White, M age = 37) who participated in ABC training and consultation during the COVID-19 pandemic. Providers' fidelity data (N = 593 sessions) were modeled longitudinally using hierarchical linear modeling, and separate intercepts and slopes were estimated for in-person and telehealth-delivered sessions. When data were modeled across all available sessions, results indicated that providers demonstrated improving fidelity over the course of training. When in-person and telehealth-delivered sessions were compared, providers' fidelity in telehealth-delivered ABC sessions was not significantly different from their fidelity in in-person sessions. Providers demonstrated improving fidelity over time in telehealth-delivered sessions. Thus, providers were able to maintain and improve ABC fidelity during the COVID-19 pandemic when provided with implementation support. Rapid transition to telehealth delivery can be successful when ongoing support such as consultation is provided.

The electrical signature of mafic explosive eruptions at Stromboli volcano, Italy.

Volcanic lightning is commonly observed in explosive volcanic eruptions of Volcanic Explosivity Index (VEI) > 2 and can be detected remotely providing real-time volcano monitoring information. However, little is known about the electrical activity accompanying the lower-magnitude spectrum of explosive eruptions, often involving mafic magmas. We narrow this gap in knowledge by presenting the electrical signature of the explosive activity (VEI ≤ 1) of Stromboli volcano (Italy) recorded by an electrostatic thunderstorm detector. The persistent eruptive activity of mild Strombolian explosions is occasionally interrupted by larger-scale major explosions and paroxysmal events.Here, we present electrical observations of three major explosions and unprecedented measurements of the 3 July 2019 paroxysm. The electrical signals of the major explosions show apparent similarities, with movements of charge and tens of electrical discharges, arising the question of whether these observations could be used to supplement the classification scheme of explosions on Stromboli. The electrical signals from the 3 July 2019 paroxysm exceed those from the major explosions in amplitude, discharge rate and complexity, showing characteristic variations during different phases of the eruption.These results show that also impulsive lower-magnitude explosions generate detectable electrical activity, which holds promise for monitoring low VEI activity at mafic volcanoes.

Strategies that Promote Therapist Engagement in Active and Experiential Learning: Micro-Level Sequential Analysis.

Therapists' active learning increases treatment fidelity, but research is needed on supervisory strategies to engage therapists in active learning. This study used sequential analysis to examine consultant behaviors associated with increased and decreased probability of eliciting therapists' active learning. The study included 162 consultation sessions from 27 community therapists implementing Attachment and Biobehavioral Catch-up. Consultants' client discussion, information provision, and modeling were associated with reduced likelihood of active learning. Consultants' questions, engagement in active learning strategies, use of video, and silence were associated with greater likelihood of therapist active learning. These findings inform supervisors' attempts to encourage active learning.

Neurological sequelae after cerebral anoxia.

PRIMARY OBJECTIVE: Cardiac arrest can cause neurological impairment. The aim of this study is to confirm the disability and the predominant part of executive and behavioural impairments after cardiac arrest. RESEARCH DESIGN: A retrospective study is proposed. METHODS AND PROCEDURES: All consecutive patients admitted to the Department of Rehabilitation for Neurological Impairments following cerebral anoxia after cardiac arrest between 1995-2007 were included. Clinical and neuropsychological assessment was proposed. MAIN OUTCOMES AND RESULTS: Thirty patients, 19 men, were examined. Ages ranged from 16-58 (mean = 39.5). Fourteen patients presented with severe disability and 16 patients presented with moderate disability. In the first group (severe disability) no patients were autonomous for daily life activities. They presented with dysexecutive syndrome and behavioural disorders associated with amnesia syndrome; 64% of them presented with motor disorders. In the second group, patients with moderate disability were autonomous in daily life but not for the complex activities or functioning. They had no motor impairment but suffered from executive and memory impairments. Behavioural changes were noted. Medical history or demographic data did not differ between the two groups. CONCLUSION: The study confirms the predominant part of executive, memory and behavioural impairments after cardiac arrest. This retrospective study cannot provide prognosis factors and further prognosis studies are needed.

Décrypthon grid - grid resources dedicated to neuromuscular disorders.

Thanks to the availability of computational grids and their middleware, a seamless access to computation and storage resources is provided to application developers and scientists. The Décrypthon project is one example of such a high performance platform. In this paper, we present the architecture of the platform, the middleware developed to facilitate access to several servers deployed in France, and the data center for integrating large biological datasets over multiple sites, supported by a new query language and integration of various tools. The SM2PH project represents an example of a biological application that exploits the capacities of the Décrypthon grid. The goal of SM2PH is a better understanding of mutations involved in human monogenic diseases, their impact on the 3D structure of the protein and the subsequent consequences for the pathological phenotypes.

The C. elegans PH domain protein CED-12 regulates cytoskeletal reorganization via a Rho/Rac GTPase signaling pathway.

The C. elegans gene ced-12 functions in the engulfment of apoptotic cells and in cell migration, acting in a signaling pathway with ced-2 Crkll, ced-5 DOCK180, and ced-10 Rac GTPase and acting upstream of ced-10 Rac. ced-12 encodes a protein with a pleckstrin homology (PH) domain and an SH3 binding motif, both of which are important for ced-12 function. CED-12 acts in engulfing cells for cell corpse engulfment and interacts physically with CED-5, which contains an SH3 domain. CED-12 has Drosophila and human counterparts. Expression of CED-12 and its counterparts in murine Swiss 3T3 fibroblasts induced Rho GTPase-dependent formation of actin filament bundles. We propose that through interactions with membranes and with a CED-2/CED-5 protein complex, CED-12 regulates Rho/Rac GTPase signaling and leads to cytoskeletal reorganization by an evolutionarily conserved mechanism.

Identification of two distinct mechanisms of phagocytosis controlled by different Rho GTPases.

The complement and immunoglobulin receptors are the major phagocytic receptors involved during infection. However, only immunoglobulin-dependent uptake results in a respiratory burst and an inflammatory response in macrophages. Rho guanosine triphosphatases (molecular switches that control the organization of the actin cytoskeleton) were found to be essential for both types of phagocytosis. Two distinct mechanisms of phagocytosis were identified: Type I, used by the immunoglobulin receptor, is mediated by Cdc42 and Rac, and type II, used by the complement receptor, is mediated by Rho. These results suggest a molecular basis for the different biological consequences that are associated with phagocytosis.