Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep intervention for at-risk adolescents.

BACKGROUND: The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitive-behavioral and mindfulness-based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self-efficacy prior to the interventions. METHOD: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04-16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control 'study skills' intervention (n = 60). The sleep intervention ('Sleep SENSE') was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety-reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention ('Study SENSE') included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES-D), and General Self-Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True). RESULTS: The results showed that compared with the active control intervention, the effect of the sleep intervention on self-reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES-D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES-D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy-measured sleep onset latency and sleep diary-measured sleep efficiency at postintervention were not dependent on actigraphy-measured total sleep time, SCAS, CES-D, or GSE prior to the intervention. CONCLUSIONS: This study provides evidence that some sleep benefits of adolescent cognitive-behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self-efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals.

Navigating Bioethical Waters: Two Pilot Projects in Problem-Based Learning for Future Bioscience and Biotechnology Professionals.

We believe that the professional responsibility of bioscience and biotechnology professionals includes a social responsibility to contribute to the resolution of ethically fraught policy problems generated by their work. It follows that educators have a professional responsibility to prepare future professionals to discharge this responsibility. This essay discusses two pilot projects in ethics pedagogy focused on particularly challenging policy problems, which we call "fractious problems". The projects aimed to advance future professionals' acquisition of "fractious problem navigational" skills, a set of skills designed to enable broad and deep understanding of fractious problems and the design of good policy resolutions for them. A secondary objective was to enhance future professionals' motivation to apply these skills to help their communities resolve these problems. The projects employed "problem based learning" courses to advance these learning objectives. A new assessment instrument, "Skills for Science/Engineering Ethics Test" (SkillSET), was designed and administered to measure the success of the courses in doing so. This essay first discusses the rationale for the pilot projects, and then describes the design of the pilot courses and presents the results of our assessment using SkillSET in the first pilot project and the revised SkillSET 2.0 in the second pilot project. The essay concludes with discussion of observations and results.

Toxicity of Aluminum to Ceriodaphnia dubia in Low-Hardness Waters as Affected by Natural Dissolved Organic Matter.

We conducted a series of 7-d toxicity tests with Ceriodaphnia dubia in dilutions of low-hardness natural waters, which contained dissolved organic carbon (DOC) concentrations up to 10 mg/L. Stream waters were mixed with well water to achieve 2 target hardness levels (20 and 35 mg/L) and 4 DOC concentrations. Tests with aluminum (Al)-spiked waters were conducted in a controlled CO2 atmosphere to maintain the pH at a range of 6.0 to 6.5. The results were used to estimate effect concentrations for survival and reproduction, expressed as total (unfiltered) Al concentrations. There were small differences in total-Al thresholds between waters with 20 and 35 mg/L hardness, but effect concentrations for C. dubia survival (median lethal concentrations) and reproduction (effect concentrations, 20%) increased log-linearly with increasing DOC concentrations in the range, 0.3 to 6 mg/L. Slopes of these regressions were similar to slopes from data used to revise the US Environmental Protection Agency water quality criterion for Al, but toxic effects in the present study occurred at total-Al concentrations 8- to 10-fold greater than toxicity values used for criteria development. This difference probably reflects the long equilibration (aging) times of Al test waters used in the present study (up to 192 h) compared with short (3-h) equilibration times in other studies used for criteria development. These results confirm the importance of DOC as a control on Al toxicity in low-hardness waters, but they also demonstrate that total-Al concentrations are not predictive of Al toxicity, except under defined water quality (pH, hardness, DOC) and exposure conditions (e.g., aging of test waters). Environ Toxicol Chem 2019;38:2121-2127. Published 2019 Wiley Periodicals, Inc. on behalf of SETAC. This article is a US government work, and as such, is in the public domain in the United States of America.

A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality.

OBJECTIVE: The aim of this study was to test whether a cognitive-behavioral and mindfulness-based group sleep intervention would improve behavior problems in at-risk adolescents, and whether these improvements were specifically related to improvements in sleep. METHOD: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48, range 12.04-16.31 years) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into either a sleep improvement intervention (n = 63) or an active control "study skills" intervention (n = 60). Participants completed sleep and behavior problems questionnaires, wore an actiwatch and completed a sleep diary for five school nights, both before and after the intervention. RESULTS: Parallel multiple mediation models showed that postintervention improvements in social problems, attention problems, and aggressive behaviors were specifically mediated by moderate improvements in self-reported sleep quality on school nights, but were not mediated by moderate improvements in actigraphy-assessed sleep onset latency or sleep diary-measured sleep efficiency on school nights. CONCLUSION: This study provides evidence, using a methodologically rigorous design, that a cognitive-behavioral and mindfulness-based group sleep intervention improved behavior problems in at-risk adolescent by improving perceived sleep quality on school nights. These findings suggest that sleep interventions could be directed towards adolescents with behavior problems. CLINICAL TRIAL REGISTRATION: This study was part of The SENSE Study (Sleep and Education: learning New Skills Early). URL: ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True.

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents.

Objectives: The aim of this study was to test whether a cognitive behavioral and mindfulness-based group sleep intervention would improve sleep and anxiety on school nights in a sample of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and presleep hyperarousal. Methods: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into a sleep improvement intervention (n = 63) or active control "study skills" intervention (n = 60). Preintervention and postintervention, participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Sleep Beliefs Scale (SBS), and Presleep Hyperarousal Scale (PSAS) and wore an actiwatch and completed a sleep diary for five school nights. Results: The sleep intervention condition was associated with significantly greater improvements in actigraphy-measured sleep onset latency (SOLobj), sleep diary measured sleep efficiency (SEsubj), PSQI, SCAS, SBS, and PSAS, with medium to large effect sizes. Improvements in the PSQI and SCAS were specifically mediated by the measured improvements in the PSAS that resulted from the intervention. Improvements in SOLobj and SEsubj were not specifically related to improvements in any of the putative treatment mechanisms. Conclusions: This study provides evidence that presleep arousal but not sleep hygiene awareness is important for adolescents' perceived sleep quality and could be a target for new treatments of adolescent sleep problems.

The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents.

OBJECTIVE: Sleep problems are a major risk factor for the emergence of mental health problems in adolescence. The aim of this study was to investigate the post intervention effects of a cognitive-behavioral/mindfulness-based group sleep intervention on sleep and mental health among at-risk adolescents. METHOD: A randomized controlled trial (RCT) was conducted across High schools in Melbourne, Australia. One hundred forty-four adolescents (aged 12-17 years) with high levels of anxiety and sleeping difficulties, but without past or current depressive disorder, were randomized into either a sleep improvement intervention or an active control 'study skills' intervention. Both programs consisted of 7 90-min-long group sessions delivered over 7 weeks. One hundred twenty-three participants began the interventions (female = 60%; mean age = 14.48, SD = 0.95), with 60 in the sleep condition and 63 in the control condition. All participants were required to complete a battery of mood and sleep questionnaires, 7 days of wrist actigraphy (an objective measure of sleep), and sleep diary entry at pre- and-post intervention. RESULTS: The sleep intervention condition was associated with significantly greater improvements in subjective sleep (global sleep quality [with a medium effect size], sleep onset latency, daytime sleepiness [with small effect sizes]), objective sleep (sleep onset latency [with a medium effect size]), and anxiety (with a small effect size) compared with the control intervention condition. CONCLUSION: The SENSE study provides evidence that a multicomponent group sleep intervention that includes cognitive-behavioral and mindfulness-based therapies can reduce sleep initiation problems and related daytime dysfunction, along with concomitant anxiety symptoms, among at-risk adolescents. (PsycINFO Database Record

The temporal stability of cluster and switch scores using a modified COWAT procedure.

This study examined the impact of instructional changes on the temporal stability of cluster and switch scores for the Controlled Oral Word Association Test [COWAT; Benton, A. L., Hamsher, K., & Sivan, A. B. (1994). Multilingual Aphasia Examination (3rd ed.). Iowa City, IA: AJA Associates]. Healthy undergraduates were assigned randomly into experimental (N = 60) and control (N = 60) groups. Experimental group participants were administered three letters as customary, then informed about clustering strategies prior to completing three additional letters. Control group participants received the original instructions only for all six letters. All participants were examined on two separate occasions. The mean inter-assessment interval was 38.6 days (ranging from 29 to 47 days). Stability coefficients for cluster and switch scores on the last set of letters differed significantly between groups, as higher coefficients were observed for the experimental group. In contrast, stability coefficients for the total words produced and mean cluster size did not differ between groups. Although the temporal stability improved, the resulting coefficients were modest (e.g., r(icc) = .76 for clusters; r(icc) = .79 for switches). We present implications of these findings and considerations for future research.

Best evidence topic: What is the best management of the appendix-stump in acute appendicitis: Simple ligation or stump invagination?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: for patients undergoing appendicectomy for complicated acute appendicitis is simple ligation or invagination of the appendix-stump safer? Using the reported search, 587 papers were found. Five studies were deemed to be suitable to answer the question. In conclusion, the literature is more in favour of the appendix stump being managed with simple ligation rather than stump invagination. All 5 studies assessed are prospective, randomised studies, though overall the quality of these studies is poor. The outcomes assessed were incidence of post-operative complications (pyrexia, wound infection, abscess, caecal fistula and post-operative ileus), post-operative length of stay and mean operating time. The analysis indicates no significant difference between the groups in rates of post-operative pyrexia, intra-abdominal abscess or caecal fistula. Only one study showed a significant difference in rates of wound infection in favour of simple ligation. One study demonstrated a significant difference in favour of simple ligation when comparing rates of post-operative ileus. Overall, simple ligation was found to reduce patient length of stay when compared with stump invagination; one study found this difference to be significant. Simple ligation also produced shorter operating times compared with stump invagination--a risk factor for the development of post-operative ileus. All studies suffered limitations that make the quality of the evidence assessed poor. Although this evidence does favour simple ligation of the stump as compared to invagination, higher quality randomised studies are needed to answer the question definitively.

Effect of surfactant treatment on swelling behaviour of normal and waxy cereal starches.

Starch swelling behaviour greatly affects its functionality in a food matrix. For some granular starches pre-treatment with the surfactant, sodium dodecyl sulphate, is known to dramatically affect swelling behaviour. The purpose of this study was to assess the effect of this surfactant treatment on the swelling behaviour of a variety of waxy and normal cereal starches. A concurrent mid-infrared spectroscopy study was carried out to investigate the chemical nature of variations in swelling behaviour. The native normal starches (amylose content 23-28%) showed significant variation in their pasting properties, which was largely eliminated by surfactant treatment. Surfactant treatment had less effect on the behaviour of the waxy starches (amylose contents 1-8%), which still exhibited some residual variation. Waxy durum appeared to be unique within the waxy starches, behaving more similarly to the normal starches. The spectroscopic data highlighted the carbohydrate fingerprint region as the main source of variation between samples.

The SENSE Study (Sleep and Education: learning New Skills Early): a community cognitive-behavioural therapy and mindfulness-based sleep intervention to prevent depression and improve cardiac health in adolescence.

BACKGROUND: Sleep problems are a major risk factor for the emergence of depression in adolescence. The aim of this study was to test whether an intervention for improving sleep habits could prevent the emergence of depression, and improve well-being and cardiovascular indices amongst at-risk adolescents. METHODS/DESIGN: A longitudinal randomised controlled trial (RCT) is being conducted across Victorian Secondary Schools in Melbourne, Australia. Adolescents (aged 12-17 years) were defined as at-risk for depression if they reported high levels of anxiety and sleep problems on in-school screening questionnaires and had no prior history of depression (assessed by clinical diagnostic interview). Eligible participants were randomised into either a sleep improvement intervention (based on cognitive behavioral and mindfulness principles) or an active control condition teaching study skills. Both programs consisted of seven 90 minute-long sessions over seven weeks. All participants were required to complete a battery of mood and sleep questionnaires, seven-days of actigraphy, and sleep diary entry at pre- and post-intervention. Participants also completed a cardiovascular assessment and two days of saliva collection at pre-intervention. Participants will repeat all assessments at two-year follow up (ongoing). DISCUSSION: This will be the first efficacy trial of a selective group-based sleep intervention for the prevention of depression in an adolescent community sample. If effective, the program could be disseminated in schools and greatly improve health outcomes for anxious adolescents. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612001177842. Date of Registration: 06-Nov-2012.