Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees.

BACKGROUND: Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons' manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees. METHODS: A total of 48 orthopaedic surgeons (postgraduate year: PGY 2-18) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although four open conventional knots with four throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30 cm long custom made smooth polished surface with two cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann-Whitney U test or Fisher exact probability test, respectively. RESULTS: Twenty-four instructors (PGY6-PGY18) and 24 trainees (PGY2-PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0 ± 27.7 N) than in instructors (49.9 ± 34.4 N, P = 0.0246). The ratio of slippage was significantly larger in instructors than in trainees (P < 0.001). Knot slippage (31.8 ± 17.7 N) was significantly worse than suture rupture (89.9 ± 22.2 N, P < 0.001) in tensile strength. CONCLUSIONS: Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.

Parent-child conflict and drug use in college women: a moderated mediation model of self-control and mindfulness.

This cross-sectional study examined the association between parent-child conflict and illicit drug use in a sample of female college students (N = 928). The mediating roles of self-control and mindfulness, as well as an interaction between self-control and mindfulness, were examined in a moderated mediation model for the purposes of expanding etiological theory and introducing targets for the prevention and treatment of drug abuse. Whereas deficits in self-control were found to facilitate the positive relation observed between parent-child conflict and the likelihood of experiencing drug-related problems, an interaction between mindfulness and self-control helped explain the association between parent-child conflict and intensity of drug-related problems. Parent-child conflict was related to low mindfulness when self-control was low, and low mindfulness in turn was related to a higher intensity of drug-related problems. This association did not exist for women with high self-control. Findings are consistent with developmental research on the etiology of drug use and the protective properties of mindfulness and self-control. Mindfulness as a potential target of intervention for drug users with low self-control to prevent drug-related problems is explored.

Single-case research design in pediatric psychology: considerations regarding data analysis.

OBJECTIVE: Single-case research allows for an examination of behavior and can demonstrate the functional relation between intervention and outcome in pediatric psychology. This review highlights key assumptions, methodological and design considerations, and options for data analysis. METHODS: Single-case methodology and guidelines are reviewed with an in-depth focus on visual and statistical analyses. RESULTS: Guidelines allow for the careful evaluation of design quality and visual analysis. A number of statistical techniques have been introduced to supplement visual analysis, but to date, there is no consensus on their recommended use in single-case research design. CONCLUSIONS: Single-case methodology is invaluable for advancing pediatric psychology science and practice, and guidelines have been introduced to enhance the consistency, validity, and reliability of these studies. Experts generally agree that visual inspection is the optimal method of analysis in single-case design; however, statistical approaches are becoming increasingly evaluated and used to augment data interpretation.

Simulation study for design of long counter for standard neutron fields from 1 keV to 20 MeV at NMIJ/AIST.

A De-Pangher-type long counter was designed for neutron measurements in standard neutron fields based on the results of simulations using the MCNP6 code at the National Metrology Institute of Japan, the National Institute of Advanced Industrial Science and Technology. The effects of six parameters in the design on the energy response of the long counter were investigated. The energy response was then quantitatively evaluated for eight design candidates selected from the investigation. The calculation results show that these candidates have a flatter energy response from 100 eV to 10 MeV compared to that of the current long counter. These candidates also reduce the difference between the average energy response from 10 eV to 1 MeV and that from 10 to 20 MeV.

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation.

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'aina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

The relation between mindfulness and fear of negative evaluation over the course of cognitive behavioral therapy for social anxiety disorder.

OBJECTIVES: This study examined the relation between mindfulness and fear of negative evaluation over the course of nonmindfulness based cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). We expected that higher levels of mindfulness would be associated with a more positive response to treatment. METHOD: This study is a secondary report from a randomized controlled trial in which participants (N = 65) diagnosed with SAD were randomly assigned to receive 8 weeks of 1 of 2 manualized treatments (exposure group therapy, n = 33; or virtual reality exposure therapy, n = 32) either immediately or following an 8 week waiting period. RESULTS: Fear of negative evaluation decreased following treatment and was negatively related to mindfulness throughout treatment and follow-up. Mindfulness did not moderate treatment outcome. CONCLUSIONS: These findings indicate that while mindfulness is related to fear, it is not a moderator of symptom reduction in nonmindfulness-based treatment. Implications for treatment and future research are discussed.

Ecological system influences in the treatment of pediatric chronic pain.

Family, school and the peer network each shape the chronic pain experience of the individual child, and each of these contexts also represents a domain of functioning often impaired by chronic pain. The goal of the present article is to summarize what is known about these bidirectional influences between children with pain and the social systems that surround them. Case reports that illustrate these complex, transactional forces and their ultimate impact on the child's pain-related functioning are included. A case involving siblings participating in an intensive interdisciplinary program for functional restoration and pain rehabilitation highlights how parents change through this treatment approach and how this change is vital to the child's outcomes. Another case involving a child undergoing intensive interdisciplinary treatment illustrates how school avoidance can be treated in the context of pain rehabilitation, resulting in successful return to the regular school environment. Finally, an acceptance and commitment therapy-focused group intervention for children with sickle cell disease and their parents demonstrates the benefits of peer contact as an element of the therapeutic intervention.

Cognitive processes mediate the relation between mindfulness and social anxiety within a clinical sample.

OBJECTIVES: The researchers investigated the relation between mindfulness and social anxiety symptoms, and examined whether this relation is mediated by cognitive appraisals commonly associated with social anxiety. PARTICIPANTS: Ninety-eight individuals diagnosed with social phobia. DESIGN: Using a cross-sectional design, ordinary least squares regression and bootstrapping mediation analyses were used to test the study hypotheses. RESULTS: Mindfulness was negatively related to symptoms of social anxiety. This relation was partially mediated by cognitive appraisals about the likelihood and cost of a negative social outcome. CONCLUSION: Further research using a longitudinal design and other measures of mindfulness is needed to replicate these findings and further explicate the mechanism by which mindfulness might be associated with negative cognitive appraisals.

Mindful awareness moderates the association between psychological inflexibility and distress variables: A cross-sectional investigation.

OBJECTIVE: Informed by the contextual behavioral science (CBS) model of behavioral health, the present cross-sectional study examined whether mindful awareness moderated the associations between psychological inflexibility and four distress variables. PARTICIPANTS: Cross-sectional data were collected from 402 ethnically diverse undergraduate college students from September 2015 to October 2015. METHODS: Participants competed an online self-report survey. RESULTS: Mindful awareness moderated the associations between psychological inflexibility and distress variables, with stronger associations for somatization and anxiety, and weaker associations for general distress and depression. Specifically, the strength of the positive associations between psychological inflexibility and these distress variables were substantially greater among those low in mindful awareness. CONCLUSION: These findings suggest that a greater degree of mindful awareness may buffer the effects of psychological inflexibility on distress variables, particularly somatization and anxiety. Theoretical and applied implications as well as limitations of the study are discussed.

A case study: Acceptance and commitment therapy for pediatric sickle cell disease.

OBJECTIVE: Sickle cell disease (SCD) negatively impacts patients' functioning and quality of life. Acceptance and Commitment Therapy (ACT) promotes acceptance of difficult sensations, emotions, and thoughts when doing so facilitates living a values-based life. This study describes ACT for improving functioning and quality of life for an adolescent with SCD and his parents. METHODS: A 16-year old with SCD and his parents attended an eight-session ACT program. Process (adolescent psychological flexibility, parent acceptance) and outcome (adolescent social anxiety, pain, functioning, quality of life; parent distress) measures were conducted prior to and following treatment and at 3-month follow-up. RESULTS AND CONCLUSIONS: Improvements were evident, especially at follow-up. Process measures suggest adolescent psychological flexibility and parent acceptance might explain positive effects. Anecdotal comments support these findings and provide additional evidence that ACT might effectively promote functioning and quality of life in adolescents with chronic diseases.

Pain intensity, psychological inflexibility, and acceptance of pain as predictors of functioning in adolescents with juvenile idiopathic arthritis: a preliminary investigation.

Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disease associated with pain and maladjustment. This study investigated whether pain, acceptance of pain, and psychological inflexibility uniquely predicted functional disability, anxiety, general quality of life (QOL), and health-related quality of life (HQOL) among adolescents with JIA. Twenty-three adolescents with JIA and pain were recruited from a pediatric rheumatology clinic. Participants completed self-report measures pertaining to the key study variables. A series of multiple regression analyses demonstrated that higher pain uniquely predicted higher functional disability. Greater psychological inflexibility uniquely predicted higher anxiety, lower general QOL, and lower HQOL. Increases in acceptance of pain were found to be uniquely related to increases in general QOL. These data confirm prior findings that pain impacts functioning, and provide preliminary findings that psychological inflexibility and acceptance may be important targets of psychological intervention for youth with JIA and pain to improve functioning and QOL.

SIMULATION OF NEUTRON RESPONSE FUNCTIONS OF SILICON SENSOR APPLIED TO REAL-TIME PERSONAL ALBEDO NEUTRON DOSEMETER IN THE ENERGY RANGE BETWEEN 0.01 EV AND 10 KEV.

Neutron response functions of a silicon sensor, which is applied to a new real-time personal albedo neutron dosemeter, have been simulated for low energy neutrons from 0.01 eV to 10 keV using the Monte Carlo technique. The angular neutron response functions were obtained by multiplying simulated neutron energy spectra crossing the neutron sensor and the cross-section of the 6Li(n,t)4He reaction. The neutron response functions have been closed to the dose conversion coefficient of personal doses, Hp(10) recommended by the International Commission on Radiological Protection by selecting neutrons incident from angles of 105° to 180° with respect to an axis perpendicular to an acrylic phantom surface. From these simulation results, the neutron energy response function has been improved by shielding the sensor with cadmium box without a face toward the phantom. The neutron sensor provides a good conformance to the Hp(10) conversion coefficients within 15% for low energy neutrons.

Development of a real-time neutron beam detector for boron neutron capture therapy using a thin silicon sensor.

We have developed a new real-time neutron detector, which is able to measure a direct neutron beam of boron neutron capture therapy. The detector consists of both a 40-µm-thick pn diode and around 0.09-µm-thick LiF neutron converter. Experimental results indicate that this neutron detector can measure neutron flux up to 1 × 109 (cm-2 s-1), separately from gamma rays around 500 mGy/h. The measured depth distribution of neutron flux in an acrylic block is in agreement with the activation results of gold.

Effects of Brief Acceptance and Cognitive Reappraisal Interventions on Experiential Avoidance in Socially Anxious Individuals: A Preliminary Investigation.

The current study compared the effects of 15-min acceptance-based and cognitive reappraisal-based interventions on experiential avoidance (EA) in socially anxious college students who participated in an experimental public speaking task. Participants were randomly assigned to receive one of the two interventions designed to aid in preparation for a 5-min laboratory-based public speaking task. Results indicated that participants receiving the acceptance-based intervention reported significantly lower levels of EA at the post-public speaking task measurement time, indicating that this brief acceptance-based intervention yielded the proposed mechanism of action in the sample used for this study. These findings highlight the importance of process-based accounts of cognitive-behavioral psychotherapy and shed light on the importance of developing interventions for alleviating social anxiety.

IMPROVEMENT OF GAMMA-RAY SUBTRACTION PROCEDURE FOR A CURRENT-MODE NEUTRON DETECTOR WITH A PAIR OF 6Li- AND 7Li-GLASS SCINTILLATORS.

A current-mode neutron detector with a pair of 6Li- and 7Li-glass scintillators has been developed to measure high-flux neutrons in a boron neutron capture therapy field. Neutrons are basically measured by subtracting gamma-ray component using current outputs from the 7Li-glass scintillator. In the present study, the difference in the gamma-ray sensitivity between the 6Li- and 7Li-glass scintillators and the neutron sensitivity for the 7Li-glass scintillator due to the 6Li contamination were also considered to improve the gamma-ray subtraction precision. The gamma-ray subtraction procedure was experimentally investigated in thermal neutron fields with 252Cf and 241Am-Be neutron sources, which have different gamma-ray intensities per unit neutron fluence. A linear relation between neutron fluence and current output was obtained for the neutron detector in the two types of thermal neutron fields with different gamma-ray intensities. It was found that the gamma-ray subtraction procedure is useful for current-mode neutron detectors.

Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model.

BACKGROUND: Obesity is a growing epidemic. Weight control interventions can achieve weight loss, but most is regained over time. Stigma and low quality of life are significant problems that are rarely targeted. PURPOSE: A new model aimed at reducing avoidant behavior and increasing psychological flexibility, has shown to be relevant in the treatment of other chronic health problems and is worth examining for improving the lives of obese persons. METHODS: Patients who had completed at least 6 months of a weight loss program (N = 84) were randomly assigned to receive a 1-day, mindfulness and acceptance-based workshop targeting obesity-related stigma and psychological distress or be placed on a waiting list. RESULTS: At a 3-month follow-up, workshop participants showed greater improvements in obesity-related stigma, quality of life, psychological distress, and body mass, as well as improvements in distress tolerance, and both general and weight-specific acceptance and psychological flexibility. Effects on distress, stigma, and quality of life were above and beyond the effects due to improved weight control. Mediational analyses indicated that changes in weight-specific acceptance coping and psychological flexibility mediated changes in outcomes. CONCLUSION: Results provide preliminary support for the role of acceptance and mindfulness in improving the quality of life of obese individuals while simultaneously augmenting their weight control efforts.

Using Acceptance and Commitment Therapy during Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report.

Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from a MM client who voluntarily participated in an Acceptance and Commitment Therapy (ACT) - based methadone detoxification program are presented. The program consisted of a 1-month stabilization and 5-month gradual methadone dose reduction period, combined with weekly individual ACT sessions. Urine samples were collected twice weekly to assess for use of illicit drugs. The participant successfully completed the program and had favorable drug use outcomes during the course of treatment, and at the one-month and one-year follow-ups. Innovative behavior therapies, such as ACT, that focus on acceptance of the inevitable distress associated with opiate withdrawal may improve methadone detoxification outcomes.

Internalized Weight Bias and Disordered Eating: The Mediating Role of Body Image Avoidance and Drive for Thinness.

Internalized weight bias has been linked with undesirable physical and psychological health outcomes, including disordered eating. Interventions have targeted internalized weight bias and associated outcomes, but little is known about underlying mechanisms of change. Existing treatment literature suggests that drive for thinness and body image avoidance may sustain the link between internalized weight bias and disordered eating. The present study aimed to determine if drive for thinness and body image avoidance mediated the relationship between internalized weight bias and disordered eating in an ethnically diverse sample. Participants included 225 female college students aged 18-49 years (mean age = 20.4 years, SD = 4.4), with a mean BMI of 23.3 kg/m2 who completed a computer-based survey for partial course credit. As expected, internalized weight bias was positively associated with disordered eating, and results supported the hypothesis of the mediating role of drive for thinness and body image avoidance. These results are important given the shortage of intervention efforts targeting internalized weight bias. Future intervention efforts aimed at reducing internalized weight bias and associated outcomes may benefit from simultaneously targeting drive for thinness and body image avoidance.

Laboratory analogue investigation of defusion and reappraisal strategies in the context of symbolically generalized avoidance.

The present study examined and compared the effects of 2 analogues of cognitive treatments-cognitive defusion and cognitive reappraisal-on symbolically generalized avoidance established using a basic behavioral laboratory paradigm. This back-translation design contributes to the development and validation of principle-based definitions of the applied constructs of defusion and reappraisal. Eighty-eight participants first underwent basic laboratory procedures designed to establish symbolically generalized avoidance in response to an arbitrary stimulus (a nonsense word). Participants were then randomized to defusion, reappraisal, or control conditions. The response variables were (a) equivalence responding-indicative of the trained relational network and analogous to the cognitive content responsible for symbolic generalization-and (b) avoidance-the behavioral impact of symbolic generalization. A between-groups analysis revealed that defusion and reappraisal significantly increased the odds of nonavoidance responding. Discrete-time survival mediation analyses provided preliminary support for the classification of defusion as a functional context intervention and reappraisal as a relational context intervention.

Mindfulness as a Moderator of the Association Between Eating Disorder Cognition and Eating Disorder Behavior Among a Non-clinical Sample of Female College Students: A Role of Ethnicity.

The present cross-sectional study examined whether mindfulness moderated the association between eating disorder cognition and eating disorder behaviors among Asian American, Black American, and White American female college students in the United States. Participants (N = 463, age range = 18-25 years) completed self-report measures online. Results revealed that mindfulness moderated the association between eating disorder cognition and eating disorder behavior in the White American group, but not in Asian American or Black American samples. Future research should replicate these differential findings across ethnic groups and investigate the factors that may contribute to this group difference.