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1.
Ecol Evol ; 14(3): e11067, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38435021

RESUMO

Climate change has the potential to disrupt species interactions across global ecosystems. Ectotherm-endotherm interactions may be especially prone to this risk due to the possible mismatch between the species in physiological response and performance. However, few studies have examined how changing temperatures might differentially impact species' niches or available suitable habitat when they have very different modes of thermoregulation. An ideal system for studying this interaction is the predator-prey system. In this study, we used ecological niche modeling to characterize the niche overlap and examine biogeography in past and future climate conditions of prairie rattlesnakes (Crotalus viridis) and Ord's kangaroo rats (Dipodomys ordii), an endotherm-ectotherm pair typifying a predator-prey species interaction. Our models show a high niche overlap between these two species (D = 0.863 and I = 0.979) and further affirm similar paleoecological distributions during the last glacial maximum (LGM) and mid-Holocene (MH). Under future climate change scenarios, we found that prairie rattlesnakes may experience a reduction in overall suitable habitat (RCP 2.6 = -1.82%, 4.5 = -4.62%, 8.5 = -7.34%), whereas Ord's kangaroo rats may experience an increase (RCP 2.6 = 9.8%, 4.5 = 11.71%, 8.5 = 8.37%). We found a shared trend of stable suitable habitat at northern latitudes but reduced suitability in southern portions of the range, and we propose future monitoring and conservation be focused on those areas. Overall, we demonstrate a biogeographic example of how interacting ectotherm-endotherm species may have mismatched responses under climate change scenarios and the models presented here can serve as a starting point for further investigation into the biogeography of these systems.

2.
Eur J Appl Physiol ; 2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38532177

RESUMO

Prior studies suggest resistance exercise as a potential form of motor learning due to task-specific corticospinal responses observed in single sessions of motor skill and resistance training. While existing literature primarily focuses on upper limb muscles, revealing a task-dependent nature in eliciting corticospinal responses, our aim was to investigate such responses after a single session of lower limb motor skill and resistance training. Twelve participants engaged in a visuomotor force tracking task, self-paced knee extensions, and a control task. Corticospinal, spinal, and neuromuscular responses were measured using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). Assessments occurred at baseline, immediately post, and at 30-min intervals over two hours. Force steadiness significantly improved in the visuomotor task (P < 0.001). Significant fixed-effects emerged between conditions for corticospinal excitability, corticospinal inhibition, and spinal excitability (all P < 0.001). Lower limb motor skill training resulted in a greater corticospinal excitability compared to resistance training (mean difference [MD] = 35%, P < 0.001) and control (MD; 37%, P < 0.001). Motor skill training resulted in a lower corticospinal inhibition compared to control (MD; - 10%, P < 0.001) and resistance training (MD; - 9%, P < 0.001). Spinal excitability was lower following motor skill training compared to control (MD; - 28%, P < 0.001). No significant fixed effect of Time or Time*Condition interactions were observed. Our findings highlight task-dependent corticospinal responses in lower limb motor skill training, offering insights for neurorehabilitation program design.

4.
J Dual Diagn ; 20(1): 29-38, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38145623

RESUMO

OBJECTIVE: Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU). METHOD: A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups. RESULTS: Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU. CONCLUSIONS: The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.


Assuntos
Alcoolismo , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Veteranos/psicologia , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Saúde Mental , Atenção Primária à Saúde
5.
Int J Offender Ther Comp Criminol ; : 306624X231219219, 2023 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-38149370

RESUMO

Previous research indicates that parental monitoring protects adolescents from delinquency. While, emerging adults spend increasing amounts of time outside the family setting, they often remain in or return to reside in the parental home, possibly prolonging the period of parental monitoring. We examine whether parental monitoring, differentiating between child disclosure, parental solicitation, and parental control, is a protective factor for delinquency for emerging adults. We also examine whether monitoring occurs in educational settings, by the partner or in employment settings, and whether this monitoring is associated with delinquency. We use data from a longitudinal survey of 970 Dutch emerging adults (18-24 years), to examine monitoring, using instruments based on Stattin and Kerr's parental monitoring scale. Results indicate that parental monitoring is not associated with delinquency in emerging adulthood. Furthermore, we find no evidence of the protective role of monitoring in educational settings, by the partner or in employment settings. However, the negative relationship between monitoring of the self, self-control, delinquency during emerging adulthood increases in strength.

6.
Mov Ecol ; 11(1): 72, 2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-37919756

RESUMO

BACKGROUND: Kangaroo rats are small mammals that are among the most abundant vertebrates in many terrestrial ecosystems in Western North America and are considered both keystone species and ecosystem engineers, providing numerous linkages between other species as both consumers and resources. However, there are challenges to studying the behavior and activity of these species due to the difficulty of observing large numbers of individuals that are small, secretive, and nocturnal. Our goal was to develop an integrated approach of miniaturized animal-borne accelerometry and radiotelemetry to classify the cryptic behavior and activity cycles of kangaroo rats and test hypotheses of how their behavior is influenced by light cycles, moonlight, and weather. METHODS: We provide a proof-of-concept approach to effectively quantify behavioral patterns of small bodied (< 50 g), nocturnal, and terrestrial free-ranging mammals using large acceleration datasets by combining low-mass, miniaturized animal-borne accelerometers with radiotelemetry and advanced machine learning techniques. We developed a method of attachment and retrieval for deploying accelerometers, a non-disruptive method of gathering observational validation datasets for acceleration data on free-ranging nocturnal small mammals, and used these techniques on Merriam's kangaroo rats to analyze how behavioral patterns relate to abiotic factors. RESULTS: We found that Merriam's kangaroo rats are only active during the nighttime phases of the diel cycle and are particularly active during later light phases of the night (i.e., late night, morning twilight, and dawn). We found no reduction in activity or foraging associated with moonlight, indicating that kangaroo rats are actually more lunarphilic than lunarphobic. We also found that kangaroo rats increased foraging effort on more humid nights, most likely as a mechanism to avoid cutaneous water loss. CONCLUSIONS: Small mammals are often integral to ecosystem functionality, as many of these species are highly abundant ecosystem engineers driving linkages in energy flow and nutrient transfer across trophic levels. Our work represents the first continuous detailed quantitative description of fine-scale behavioral activity budgets in kangaroo rats, and lays out a general framework for how to use miniaturized biologging devices on small and nocturnal mammals to examine behavioral responses to environmental factors.

7.
Phys Occup Ther Pediatr ; : 1-16, 2023 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-37872764

RESUMO

AIMS: Animal-assisted therapy has gained increased attention in occupational therapy. Yet there remains minimal education opportunities available. In addition to supporting student learning, student-led clinics have the potential to provide a valuable, cost-effective health service to the community. This study aimed to explore the potential benefits to the children clients participating in a student-led, canine-assisted occupational therapy pediatric clinic from the perspectives of the students and parents. METHOD: Semi-structured interviews were conducted with nine occupational therapy students, and five parents to describe their experience. Transcripts were analyzed using inductive thematic analysis. RESULTS: Participants emphasized how the presence of the therapy dog supported child engagement within the therapy session. Ways in which participants believed the therapy dog influenced the children's engagement were described within three themes. The first highlighted the importance of the relationship between the children and the therapy dog. The second described how this relationship facilitated a sense of safety within the sessions. The third captured how this sense of safety supported the children's participation within their meaningful occupations. CONCLUSIONS: Parents and students involved in the canine-assisted occupational therapy clinic perceived that canine-assisted therapy was supportive of child engagement in therapy.

8.
Exp Physiol ; 108(12): 1490-1499, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37768013

RESUMO

NEW FINDINGS: What is the central question of this study? What are the effects of compression garments on recovery from unaccustomed damaging exercise and subsequent protective adaptations? What is the main finding and its importance? Compression did not influence recovery, but was associated with blunted protective adaptations for isokinetic performance, which were completely absent at high velocities. Based on these findings, the use of compression garments for recovery would not be recommended following unaccustomed exercise, particularly if the maintenance of high-velocity performance following exercise-induced muscle damage is desirable. ABSTRACT: Whilst compression garments (CG) may enhance recovery from exercise-induced muscle damage (EIMD), many recovery strategies can attenuate adaptative responses. Therefore, the effects of CG on recovery from EIMD, and the rapid protective adaptations known as the repeated bout effect (RBE) were investigated. Thirty-four non-resistance-trained males (18-45 years) randomly received class II medical-grade CG or placebo for 72 h following eccentrically-focused lower-body exercise, in a double-blind, randomised controlled trial. Indices of EIMD were assessed at baseline, 0, 24, 48 and 72 h post-exercise, before exercise and testing were repeated after 14 days. Results were analysed using a three-way (time × condition × bout) linear mixed-effects model. Exercise impaired isometric and isokinetic strength, with soreness and thigh circumference elevated for 72 h (P < 0.001). Compression did not enhance recovery (P > 0.05), despite small to moderate effect sizes (ES, reported alongside 90% confidence intervals) for isokinetic strength (ES from 0.2 [-0.41, 0.82] to 0.65 [0.03, 1.28]). All variables recovered faster after the repeated bout (P < 0.005). However, RBE for peak isokinetic force was impaired in CG at 60° s-1 (group × bout interaction: χ2  = 4.24, P = 0.0395; ES = -0.56 [-1.18, 0.07]) and completely absent at 120° s-1 (χ2  = 16.2, P < 0.001, ES = -0.96 [-1.61, -0.32]) and 180° s-1 (χ2  = 10.4, P = 0.001, ES = -0.72 [-1.35, -0.09]). Compression blunted RBE at higher isokinetic velocities without improving recovery in non-resistance-trained males, potentially contraindicating their use following unaccustomed exercise in this population.


Assuntos
Exercício Físico , Músculo Esquelético , Masculino , Humanos , Músculo Esquelético/fisiologia , Exercício Físico/fisiologia , Dor , Terapia por Exercício , Vestuário , Mialgia
9.
Disabil Rehabil ; : 1-11, 2023 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-37578127

RESUMO

PURPOSE: The benefits of sport and exercise participation for people with disability are well acknowledged. However, people with disability report numerous barriers to participating in sport and exercise, including negative interactions with fitness professionals. Limited research is available from the perspective of fitness professionals. This study aimed to understand the experience of fitness professionals supporting people with disability to engage in sport and exercise. MATERIALS AND METHODS: A cross sectional survey study was used to gather quantitative and qualitative data on community-based fitness professionals from Australia, with or without experience working with a person with disability. RESULTS: A total of 72 fitness professionals took part in the study with most reporting experience and confidence in working with people with disabilities. Several barriers were identified with participants highlighting the lack of disability-specific training. Participants also identified potential facilitators, including effective collaboration with allied health professionals. CONCLUSION: There is emerging interest for fitness professionals to support people with disability to engage in sport and exercise. However, changes are required within the education provided to fitness professionals and with the current collaborative model with allied health professionals to better support the participation of people with disability in sport and exercise.


As physical activity is pertinent to ongoing health and wellbeing of people with disability, with support, fitness professionals could provide a cost-effective solution to assist in enabling people with disability to access sport and exercise activities.Fitness professionals require continuing disability-specific education and input from allied health professionals to appropriately support their clients with disability.Changes are required within the Australian fitness industry and in the model in which allied health and fitness professionals collaborate to better support people with disability to engage in sport and exercise.Additional barriers external to the fitness professional such as the physical environment, funding restrictions and lack of societal awareness, continue to impede on people with disabilities' participation in sport and exercise settings and should also be acknowledged.

10.
J Zoo Wildl Med ; 54(2): 292-300, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37428691

RESUMO

A coral reef system at the Steinhart Aquarium in San Francisco, CA, USA experienced a population explosion of pycnogonid sea spiders (Arthropoda: Class Pycnogonida) with subsequent deleterious health effects on the corals in the system. Sixteen coral colonies across three species (Stylophora pistillata, Pocillopora damicornis, and Acropora tenuis) were chosen from this system for milbemycin oxime immersion therapy trials, with the goal of decreasing or eradicating the sea spider population with minimal detrimental effect to the corals. Corals underwent two milbemycin immersion treatments, administered 1 wk apart, at the previously published aquatic invertebrate dose of 0.016 parts per million (ppm; mg/L), but therapy did not reduce the number of sea spiders. Doubling the dose to 0.032 ppm milbemycin and repeating this immersion therapy 1/wk for three treatments successfully reduced the sea spiders. Histopathology was used to assess the health of the corals and tolerance to therapy, and posttreatment biopsies confirmed that there were no adverse effects to any of the three species of coral. Repeated 1/ wk treatments of milbemycin oxime immersion therapy at 0.032 ppm appears to be both safe and effective for reducing the numbers of pycnogonid sea spiders in the stony corals S. pistillata, P. damicornis, and A. tenuis.


Assuntos
Antozoários , Animais , Macrolídeos/uso terapêutico
11.
Artigo em Inglês | MEDLINE | ID: mdl-37284962

RESUMO

Professional practice placements are an essential component of allied health and nursing programs. Whilst most students pass these placements, a small percentage of students will fail or be at risk of failing. Supporting students undergoing a failing experience is a time critical, time consuming, emotional and resource-heavy task which is often undertaken by key university staff and impacts all stakeholders. Whilst several studies have provided insight into this experience from the educator and/or university perspective, this scoping review aimed to identify the students' experience of failing or nearly failing a professional practice experience. Following Arskey and O'Malley's framework for scoping reviews, 24 papers were included in this review. This review generated six themes including the reasons for failure, how failure looks and feels, how supports, service and strategies influence the student experience of failure, the importance of communication, relationships and organisational culture, the impact infrastructure and policies have, and the consequences of failure. The outcomes of this scoping review highlighted three key characteristics of the research to date: (a) the student voice is still largely missing; (b) the student perspective is distinctly different to that of other stakeholders; and (c) the interventions used appear not to be student-informed or student-led. Better understanding this experience from the student's perspective could create a more sustainable practice education environment by designing and implementing more effective supports, services or strategies that reduce the overall impact a failing experience has on students and key stakeholders.

12.
Adm Policy Ment Health ; 50(5): 792-812, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37326899

RESUMO

Guidelines strongly recommend trauma-focused therapies to treat posttraumatic stress disorder. Implementation of cognitive processing therapy (CPT) and prolonged exposure (PE) in Veterans Health Administration (VHA) and non-VHA settings began in 2006. We conducted a systematic review of implementation facilitators and challenges and strategies to address barriers. We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for English-language articles. Two individuals reviewed eligibility and rated quality. Quantitative results were abstracted by one reviewer and verified by a second. Qualitative results were independently coded by two reviewers and finalized through consensus. We used RE-AIM and CFIR frameworks to synthesize findings. 29 eligible studies addressed CPT/PE, mostly conducted in VHA. Training/education with audit/feedback was the primary implementation strategy and was linked to improved provider CPT/PE perceptions and self-efficacy. Use was not widespread. Only six studies tested other implementation strategies with mixed impact. Following VHA implementation, strong support for training, perceived effectiveness for patients and benefits for clinics, and positive patient experiences and relationships with providers were reported. However, barriers persisted including perceived protocol inflexibility, complex referral processes and patient complexity and competing needs. In non-VHA settings, providers perceived fewer barriers, but few were CPT/PE trained. Across both settings, fewer studies targeted patient factors. Training/education with audit/feedback improved perceptions and the availability of CPT/PE, but not consistent use. Studies testing implementation strategies to address post-training challenges, including patient-level factors, are needed. A few studies are underway in VHA to test patient-focused and other implementation strategies. Research assessing actual vs perceived barriers in non-VHA settings is needed to elucidate unique challenges experienced.


Assuntos
Terapia Cognitivo-Comportamental , Terapia Implosiva , Transtornos de Estresse Pós-Traumáticos , Estados Unidos , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , United States Department of Veterans Affairs , Terapia Cognitivo-Comportamental/métodos , Escolaridade
13.
Animals (Basel) ; 13(12)2023 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-37370475

RESUMO

Human-animal bond is defined as the mutually beneficial relationship between humans and animals. Recent years have seen increasing research regarding the benefits of interaction with animals for autistic children. However, there continue to be limited studies exploring the impact of this interaction on the welfare of therapy dogs. As part of a pilot randomised control trial assessing the efficacy of canine-assisted occupational therapy with autistic children, this project assessed welfare markers of the therapy dog involved. A total of twenty-one saliva samples were taken from the therapy dog to assess cortisol, alpha amylase, and oxytocin concentrations at home and throughout the treatment days. Additionally, six hours of therapy session videos were analysed for stress indicators of canine behaviour. No significant differences were found between days spent at home and treatment days for any of the biomarkers or stress indicators. Results suggest that the therapy dog involved did not experience increased stress resulting from interaction with the autistic children throughout the therapy sessions. This study supports the need for further research regarding therapy dog welfare when interacting with autistic children including an increased sample size of therapy dogs and therapists.

14.
J Sports Sci ; 41(4): 350-357, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37183452

RESUMO

This case study reports on a professional football player (age: 17.6 years) who was referred for sleep monitoring and intervention after reporting excessive night-time awakenings. The player undertook a series of subjective sleep assessments and objective sleep monitoring (activity monitor). Based on the data presented, a sleep hygiene intervention was prescribed. Numerical comparisons were made between pre-intervention (Pre) and post-intervention (Post) values. Objective values were also compared to reference data from a similarly aged professional cohort from the same club (n = 11). Wake episodes per night (Pre: 7.9 ± 3, Post: 4.5 ± 1.9; -43%) and wake after sleep onset (WASO; Pre: 74.3 ± 31.8 mins, Post: 50.0 ± 22.8 mins, -33%) were improved from Pre to Post. Compared to the reference data, mean wake episodes per night (Pre: 7.9 ± 3.0, reference: 4.6 ± 2.6; -42%) and WASO (Pre: 74.3 ± 31.8 mins, reference: 44.3 ± 36.5 mins; -40%) were all lower compared to Pre levels. Whilst causality cannot be proven, we observed multiple sleep metrics improving following an intervention. This provides a potential framework for practitioners looking to provide targeted sleep assessment and intervention.


Assuntos
Futebol Americano , Higiene do Sono , Humanos , Idoso , Adolescente , Polissonografia , Actigrafia , Sono
15.
Genetics ; 224(4)2023 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-37183501

RESUMO

ELT-2 is the major transcription factor (TF) required for Caenorhabditis elegans intestinal development. ELT-2 expression initiates in embryos to promote development and then persists after hatching through the larval and adult stages. Though the sites of ELT-2 binding are characterized and the transcriptional changes that result from ELT-2 depletion are known, an intestine-specific transcriptome profile spanning developmental time has been missing. We generated this dataset by performing Fluorescence Activated Cell Sorting on intestine cells at distinct developmental stages. We analyzed this dataset in conjunction with previously conducted ELT-2 studies to evaluate the role of ELT-2 in directing the intestinal gene regulatory network through development. We found that only 33% of intestine-enriched genes in the embryo were direct targets of ELT-2 but that number increased to 75% by the L3 stage. This suggests additional TFs promote intestinal transcription especially in the embryo. Furthermore, only half of ELT-2's direct target genes were dependent on ELT-2 for their proper expression levels, and an equal proportion of those responded to elt-2 depletion with over-expression as with under-expression. That is, ELT-2 can either activate or repress direct target genes. Additionally, we observed that ELT-2 repressed its own promoter, implicating new models for its autoregulation. Together, our results illustrate that ELT-2 impacts roughly 20-50% of intestine-specific genes, that ELT-2 both positively and negatively controls its direct targets, and that the current model of the intestinal regulatory network is incomplete as the factors responsible for directing the expression of many intestinal genes remain unknown.


Assuntos
Proteínas de Caenorhabditis elegans , Caenorhabditis elegans , Animais , Caenorhabditis elegans/metabolismo , Proteínas de Caenorhabditis elegans/metabolismo , Redes Reguladoras de Genes , Fatores de Transcrição GATA/genética , Intestinos , Perfilação da Expressão Gênica , Transcriptoma
16.
J Gen Intern Med ; 38(12): 2782-2791, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37012538

RESUMO

BACKGROUND: Improving access to evidence-based psychotherapies (EBPs) is a Veterans Health Administration (VHA) priority. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) are effective for chronic pain and several mental health conditions. We synthesized evidence on implementation strategies to increase EBP access and use. METHODS: We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for articles on EBP implementation within integrated health systems to treat chronic pain or chronic mental health conditions. Reviewers independently screened articles, extracted results, coded qualitative findings, and rated quality using modified criteria from Newcastle-Ottawa (quantitative results) or Critical Appraisal Skills Programme (qualitative results). We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework and classified outcomes using RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance). RESULTS: Twelve articles (reporting results from 10 studies) evaluated CBT (k = 11) and ACT (k = 1) implementation strategies in large integrated healthcare systems. No studies evaluated MBSR implementation. Eight articles evaluated strategies within VHA. Six articles reported on national VHA EBP implementation programs; all involved training/education, facilitation, and audit/feedback. CBT and ACT implementation demonstrated moderate to large improvements in patient symptoms and quality of life. Trainings increased mental health provider self-efficacy in delivering EBPs, improved provider EBP perceptions, and increased provider EBP use during programs, but had unclear impacts on Reach. It was unclear whether external facilitation added benefit. Provider EBP maintenance was modest; barriers included competing professional time demands and patient barriers. DISCUSSION: Multi-faceted CBT and ACT implementation programs increased provider EBP Adoption but had unclear impacts on Reach. Future implementation efforts should further evaluate Reach, Adoption, and Maintenance; assess the added value of external facilitation; and consider strategies targeting patient barriers. Future work should use implementation frameworks to guide evaluations of barriers and facilitators, processes of change, and outcomes. REGISTRATION: PROSPERO registration number CRD42021252038.


Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Terapia Cognitivo-Comportamental , Atenção Plena , Humanos , Atenção Plena/métodos , Dor Crônica/terapia , Qualidade de Vida , Terapia Cognitivo-Comportamental/métodos
17.
J Pain ; 24(5): 742-769, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36934826

RESUMO

Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) have demonstrated effectiveness for improving outcomes in chronic pain. These evidence-based psychotherapies (EBPs) remain underutilized in clinical practice, however. To identify research gaps and next steps for improving uptake of EBPs, we conducted a systematic review of patient-, provider-, and system-level barriers and facilitators of their use for chronic pain. We searched MEDLINE, Embase, PsycINFO, and CINAHL databases from inception through September 2022. Prespecified eligibility criteria included outpatient treatment of adults with chronic pain; examination of barriers and facilitators and/or evaluation of implementation strategies; conducted in the United States (US), United Kingdom (UK), Ireland, Canada or Australia; and publication in English. Two reviewers independently assessed eligibility and rated quality. We conducted a qualitative synthesis of results using a best-fit framework approach building upon domains of the Consolidated Framework for Implementation Research (CFIR). We identified 34 eligible studies (33 moderate or high quality), most (n = 28) of which addressed patient-level factors. Shared barriers across EBPs included variable patient buy-in to therapy rationale and competing responsibilities for patients; shared facilitators included positive group or patient-therapist dynamics. Most studies examining ACT and all examining MBSR assessed only group formats. No studies compared barriers, facilitators, or implementation strategies of group CBT to individual CBT, or of telehealth to in-person EBPs. Conceptual mismatches of patient knowledge and beliefs with therapy principles were largely analyzed qualitatively, and studies did not explore how these mismatches were addressed to support engagement. Future research on EBPs for chronic pain in real-world practice settings is needed to explore provider and system-level barriers and facilitators, heterogeneity of effects and uptake, and both effects and uptake of EBPs delivered in various formats, including group vs individual therapy and telehealth or asynchronous digital approaches. PERSPECTIVE: This systematic review synthesizes evidence on barriers and facilitators to uptake of cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based stress reduction for chronic pain. Findings can guide future implementation work to increase availability and use of evidence-based psychotherapies for treatment of chronic pain. REGISTRATION: PROSPERO number CRD42021252038.


Assuntos
Terapia de Aceitação e Compromisso , Dor Crônica , Humanos , Adulto , Dor Crônica/terapia , Psicoterapia , Austrália , Canadá
18.
PLoS One ; 18(2): e0280883, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36780485

RESUMO

Organ-on-a-chip platforms are utilized in global bioanalytical and toxicological studies as a way to reduce materials and increase throughput as compared to in vivo based experiments. These platforms bridge the infrastructure and regulatory gaps between in vivo animal work and human systems, with models that exemplify active biological pathways. In conjunction with the advent of increased capabilities associated with next generation sequencing and mass spectrometry based '-omic' technologies, organ-on-a-chip platforms provide an excellent opportunity to investigate the global changes at multiple biological levels, including the transcriptome, proteome and metabolome. When investigated concurrently, a complete profile of cellular and regulatory perturbations can be characterized following treatment with specific agonists. In this study, global effects were observed and analyzed following liver chip exposure to the chemical warfare agent, VX. Even though the primary mechanism of action of VX (i.e. acetylcholinesterase inhibition) is well characterized, recent in vivo studies suggest additional protein binding partners that are implicated in metabolism and cellular energetic pathways. In addition, secondary toxicity associated with peripheral organ systems, especially in human tissues, is not well defined. Our results demonstrate the potential of utilizing an organ-on-a-chip platform as a surrogate system to traditional in vivo studies. This is realized by specifically indicating significant dysregulation of several cellular processes in response to VX exposure including but not limited to amino acid synthesis, drug metabolism, and energetics pathways.


Assuntos
Substâncias para a Guerra Química , Animais , Humanos , Substâncias para a Guerra Química/toxicidade , Acetilcolinesterase , Sistemas Microfisiológicos , Multiômica
19.
Exp Brain Res ; 241(3): 807-824, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36740653

RESUMO

Motor skill training alters the human nervous system; however, lower limb motor tasks have been less researched compared to upper limb tasks. This meta-analysis with best evidence synthesis aimed to determine the cortical and subcortical responses that occur following lower limb motor skill training, and whether these responses are accompanied by improvements in motor performance. Following a literature search that adhered to the PRISMA guidelines, data were extracted and analysed from six studies (n = 172) for the meta-analysis, and 11 studies (n = 257) were assessed for the best evidence synthesis. Pooled data indicated that lower limb motor skill training increased motor performance, with a standardised mean difference (SMD) of 1.09 being observed. However, lower limb motor skill training had no effect on corticospinal excitability (CSE), Hoffmann's reflex (H-reflex) or muscle compound action potential (MMAX) amplitude. The best evidence synthesis found strong evidence for improved motor performance and reduced short-interval cortical inhibition (SICI) following lower limb motor skill training, with conflicting evidence towards the modulation of CSE. Taken together, this review highlights the need for further investigation on how motor skill training performed with the lower limb musculature can modulate corticospinal responses. This will also help us to better understand whether these neuronal measures are underpinning mechanisms that support an improvement in motor performance.


Assuntos
Destreza Motora , Treinamento de Força , Humanos , Destreza Motora/fisiologia , Tratos Piramidais/fisiologia , Músculo Esquelético/fisiologia , Extremidade Superior , Potencial Evocado Motor/fisiologia , Estimulação Magnética Transcraniana
20.
Vet Rec ; 192(11): e2484, 2023 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-36607140

RESUMO

BACKGROUND: Surgical safety checklist (SSC) use benefits veterinary patients, but endorsement and implementation are essential for these benefits to be observed. METHODS: A cross-sectional survey assessed UK veterinary professionals' attitudes towards and usage of SSCs and identified factors associated with poorer attitude or failure to use SSCs. RESULTS: Of 513 respondents, 70% used SSCs. Of these, 87.1% used SSCs for every surgical procedure, 19.1% adapted SSCs for different procedures and 61.1% had a standard operating procedure detailing how to use SSCs. Attitudes towards SSC use were favourable, with increased positive attitude associated with employing at least one registered veterinary nurse with a post-qualifying qualification (p < 0.001), current SSC use (p < 0.001), undertaking self-directed reading (p = 0.033) or completing SSC-relevant post-qualification continuing professional development (p = 0.005). Factors associated with veterinary practices not using SSCs included Practice Standards Scheme (PSS) non-membership (odds ratio [OR] 2.0, 1.1-3.4), no RCVS hospital status (OR 1.9, 1.1-3.5) or being a mixed first-opinion veterinary practice (OR 2.4, 1.2-5.0). LIMITATIONS: Study limitations include sampling methodology and non-validated attitudinal scale usage. CONCLUSION: Most respondents used SSCs. Familiarity, education and the RCVS PSS were associated with improved uptake and attitudes, but mixed practice was associated with reduced usage.


Assuntos
Lista de Checagem , Hospitais , Animais , Lista de Checagem/métodos , Estudos Transversais , Atitude do Pessoal de Saúde , Reino Unido , Segurança do Paciente
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