Lessons Learned Conducting Dialectical Behavior Therapy via Telehealth in the Age of COVID-19.

Given the severity and suicide risk of patients typically treated by Dialectical Behavior Therapy (DBT) and the absence of guidelines regarding delivery of DBT via telehealth, it is crucial that the DBT treatment community gather and rapidly disseminate information about effective strategies for delivering DBT via telehealth. The current study surveyed DBT providers (N = 200) to understand challenges and lessons learned as they transitioned to conducting DBT via telehealth during the COVID-19 pandemic. Open-ended responses to challenges and lessons-learned were coded. Most frequently noted challenges were Therapy-Interfering Behaviors and elements related to the provision of Individual Therapy and Skills Training Group. The majority of providers offered advice for implementing group skills training, avoiding or overcoming therapist burnout, and emphasized continued adherence to treatment principles, even in the context of this new treatment modality. Overall, this qualitative study marks a starting point on identifying best practices delivering DBT via telehealth for which it is anticipated that clinical recommendations in this area will evolve, informed by clinician, researcher, and consumer input.

Is a 'guideline-compliant' primary cesarean delivery associated with a modified risk for maternal and neonatal morbidity?: a clinical evaluation of the 2014 ACOG/SMFM obstetric care consensus statement.

BACKGROUND: It is currently unknown whether primary CDs performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement guidelines ("guideline-compliant") are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines ("guideline-noncompliant"). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD. METHODS: A retrospective cohort study of all primary CDs at one tertiary referral center in the calendar year following publication of the Consensus Statement. Logistic regression was performed to calculate the risk of adverse maternal and neonatal outcomes for guideline-compliant primary CDs, when compared to guideline-noncompliant and guideline-not addressed, and when adjusted for maternal age, BMI, hypertension, gestational age at delivery, insurance carrier, and provider practice. RESULTS: Eight hundred twenty-seven primary CDs were included during the study period, of which 34.8, 26.0, and 39.2% were guideline compliant, guideline-noncompliant, and guideline-not addressed. No statistically significant differences in the frequency of adverse maternal outcomes across these three groups were observed with the exception of maternal ICU admission, which was significantly associated with a guideline-not addressed primary CD (p = 0.0002). No statistical difference in rates of NICU admissions, 5 min APGAR < 5, or umbilical artery cord pH < 7 were observed between guideline-compliant and guideline-noncompliant primary CDs. CONCLUSION: Women undergoing guideline-compliant primary CDs were not significantly more likely to experience a maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs.

Deep water acoustic range estimation based on an ocean general circulation model: Application to PhilSea10 data.

This study identifies general characteristics of methods to estimate the absolute range between an acoustic transmitter and a receiver in the deep ocean. The data are from three days of the PhilSea10 experiment with a single fixed transmitter depth (∼998 m) and 150 receiver depths (∼210-5388 m) of known location, and a great-circle transmitter-receiver distance of ∼510 km. The proposed ranging methods compare observed acoustic records with synthetic records computed through the HYCOM (hybrid coordinate ocean model) model. More than 8900 transmissions over 3 days characterize the statistical variation of range errors. Reliable ranging methods de-emphasize the parts of the data records least likely to be reproduced by the synthetics, which include arrival amplitudes, the later parts of the acoustic records composed of nearly horizontally launched rays (i.e., the finale), and waves that sample a narrow span of ocean depths. The ranging methods proposed normalize amplitudes, measure travel times, or reject parts of the waveforms beyond a critical time. All deliver reliable range estimates based on the time and path-averaged HYCOM model, although the final method performs best. The principles behind these methods are transportable and expected to provide reliable range estimates in different deep water settings.

Internal tides and deep diel fades in acoustic intensity.

A mechanism is presented by which the observed acoustic intensity is made to vary due to changes in the acoustic path that are caused by internal-tide vertical fluid displacements. The position in range and depth of large-scale caustic structure is determined by the background sound-speed profile. Internal tides cause a deformation of the background profile, changing the positions of the caustic structures-which can introduce intensity changes at a distant receiver. Gradual fades in the acoustic intensity occurring over timescales similar to those of the tides were measured during a low-frequency (284-Hz) acoustic scattering experiment in the Philippine Sea in 2009 [White et al., J. Acoust. Soc. Am. 134(4), 3347-3358 (2013)]. Parabolic equation and Hamiltonian ray-tracing calculations of acoustic propagation through a plane-wave internal tide environmental model employing sound-speed profiles taken during the experiment indicate that internal tides could cause significant gradual changes in the received intensity. Furthermore, the calculations demonstrate how large-scale perturbations to the index of refraction can result in variation in the received intensity.

Low-frequency pulse propagation over 510 km in the Philippine Sea: A comparison of observed and theoretical pulse spreading.

Observations of the spread of wander-corrected averaged pulses propagated over 510 km for 54 h in the Philippine Sea are compared to Monte Carlo predictions using a parabolic equation and path-integral predictions. Two simultaneous m-sequence signals are used, one centered at 200 Hz, the other at 300 Hz; both have a bandwidth of 50 Hz. The internal wave field is estimated at slightly less than unity Garrett-Munk strength. The observed spreads in all the early ray-like arrivals are very small, <1 ms (for pulse widths of 17 and 14 ms), which are on the order of the sampling period. Monte Carlo predictions show similar very small spreads. Pulse spread is one consequence of scattering, which is assumed to occur primarily at upper ocean depths where scattering processes are strongest and upward propagating rays refract downward. If scattering effects in early ray-like arrivals accumulate with increasing upper turning points, spread might show a similar dependence. Real and simulation results show no such dependence. Path-integral theory prediction of spread is accurate for the earliest ray-like arrivals, but appears to be increasingly biased high for later ray-like arrivals, which have more upper turning points.

A test of deep water Rytov theory at 284 Hz and 107 km in the Philippine Sea.

Predictions of log-amplitude variance are compared against sample log-amplitude variances reported by White, Andrew, Mercer, Worcester, Dzieciuch, and Colosi [J. Acoust. Soc. Am. 134, 3347-3358 (2013)] for measurements acquired during the 2009 Philippine Sea experiment and associated Monte Carlo computations. The predictions here utilize the theory of Munk and Zachariasen [J. Acoust. Soc. Am. 59, 818-838 (1976)]. The scattering mechanism is the Garrett-Munk internal wave spectrum scaled by metrics based on measured environmental profiles. The transmitter was at 1000 m depth and the receivers at nominal range 107 km and depths 600-1600 m. The signal was a broadband m-sequence centered at 284 Hz. Four classes of propagation paths are examined: the first class has a single upper turning point at about 60 m depth; the second and third classes each have two upper turning points at roughly 250 m; the fourth class has three upper turning points at about 450 m. Log-amplitude variance for all paths is predicted to be 0.04-0.09, well within the regime of validity of either Born or Rytov scattering. The predictions are roughly consistent with the measured and Monte Carlo log-amplitude variances, although biased slightly low. Paths turning in the extreme upper ocean (near the mixed layer) seem to incorporate additional scattering mechanisms not included in the original theory.

Wavefront intensity statistics for 284-Hz broadband transmissions to 107-km range in the Philippine Sea: observations and modeling.

In the spring of 2009, broadband transmissions from a ship-suspended source with a 284-Hz center frequency were received on a moored and navigated vertical array of hydrophones over a range of 107 km in the Philippine Sea. During a 60-h period over 19,000 transmissions were carried out. The observed wavefront arrival structure reveals four distinct purely refracted acoustic paths: One with a single upper turning point near 80 m depth, two with a pair of upper turning points at a depth of roughly 300 m, and one with three upper turning points at 420 m. Individual path intensity, defined as the absolute square of the center frequency Fourier component for that arrival, was estimated over the 60-h duration and used to compute scintillation index and log-intensity variance. Monte Carlo parabolic equation simulations using internal-wave induced sound speed perturbations obeying the Garrett-Munk internal-wave energy spectrum were in agreement with measured data for the three deeper-turning paths but differed by as much as a factor of four for the near surface-interacting path.

Outcomes of specialized foster care in a managed child welfare services network.

This study (N = 384) presents results from outcome measurement in a services network providing specialized foster care (SFC) to children in child protective service custody. A majority of participants improved on most outcomes. Global improvement was associated with increased length of stay up to two years, five months, and with younger age, fewer problems, and, paradoxically, the presence of a trauma history. Results suggest the value of SFC within managed services and of research using outcome measurement systems.