Study protocol for a single-blind, parallel-group, randomized, controlled superiority trial of intensive versus weekly delivered prolonged exposure for adults with post-traumatic stress disorder.

BACKGROUND: Prolonged exposure (PE) therapy is widely recognized as an effective treatment for post-traumatic stress disorder (PTSD) and is often considered one of the primary options for addressing this condition. Nevertheless, a significant proportion of patients (30-51%) fail to demonstrate clinically significant symptom changes. One of the reasons is that a high proportion of patients drop out from treatment, which often lasts for a minimum of 3-4 months. Hence, there is an urgent need for PTSD treatments that can be delivered to decrease dropout rates. A more intensive PE treatment approach has been suggested to decrease dropout rates and in addition achieve faster recovery rates and has shown promising effects on reducing PTSD symptoms but needs to be tested against firsthand treatment. METHODS: This single-blind, randomized controlled trial (N = 140) will compare an intensive delivery format of prolonged exposure (iPE) against standard weekly delivered sessions of PE. The primary outcome is change on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Secondary outcomes include self-rated measures of symptoms of PTSD and complex PTSD, depression and quality of life, speed of recovery, cost effectiveness, dropout rates, and adverse events. DISCUSSION: This study will be the first to compare iPE with first-line treatment in a psychiatric outpatient setting. One of the key strengths of this study lies in its implementation within a clinical setting and the broad eligibility criteria. Additionally, the utilization of gold-standard assessment measures ensures the accuracy and reliability of the outcomes. However, several potential challenges may arise during the study's execution. These challenges may include difficulties in participant recruitment, ensuring adequate participant retention, adherence to the treatment protocol, and maintaining therapist retention mostly due to recruitment taking place at one single clinic. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT05934175. Registered on June 6, 2023. Open Science Framework (OSF) https://osf.io/7qsb3 . Registered on September 2, 2023.

Constructing a New Biomass-Based Bistatic Window for Solar Regulation.

Smart windows effectively respond to the ever-changing climatic conditions, offering a smart solution for low-carbon buildings. However, current smart windows derived from chromic materials often have inferior solar modulation ability, or showcase high haze that obstructs outdoor views. Here, instead of developing new chromic materials, a new bistatic window is proposed for ultra-high solar modulation and luminous transmission. The new developed window can reduce the indoor surface temperature for ≈11 °C, and reduce the building space cooling and heating energy consumption by 30% to 40%, providing significant energy-related advances over traditional smart windows. In detail, the bistatic window exhibits excellent solar modulation ability (ΔTsol = 61%), high visible transmittance in both bleached (Tlum,bleached = 91%) and colored (Tlum,colored = 56%) states, low haze (< 1%), rapid switching response (switching time < 1 min), high color rendering index (CRI > 80), and long-cyclic stability after 1000 cycles. With the advantages of facile fabrication and scalability, it is foreseen the developed bistatic window holds promising prospect for the next-generation low-carbon buildings, paving a new way for future advancements in the fields of smart windows.

12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity.

BACKGROUND: Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. METHODS: All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. RESULTS: The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46-60% of patients achieved recovery with respect to PTSD symptoms, and that 44-48% no longer met diagnostic criteria for PTSD. CONCLUSIONS: Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. TRIAL REGISTRATION: The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.

No difference between using short and long intervals for distributed proficiency-based laparoscopy simulator training: a randomized trial.

BACKGROUND: Simulation-based training is increasingly used to acquire basic laparoscopic skills. Multiple factors can influence training, e.g., distributed practice is superior to massed practice in terms of efficiency. However, the optimal interval between training sessions is unclear. The objective of this trial was to investigate if shorter intervals between sessions are more efficient than longer intervals during proficiency-based laparoscopy simulator training. METHODS: A randomized simulation-based trial where medical students (n = 39) were randomized to proficiency-based training with either 1-2 days (intervention group) or 6-8 days (control group) between training sessions. Both groups practiced a series of basic tasks and a procedural module until proficiency level on the LapSim® simulator. Both groups were given instructor feedback upon request. After reaching proficiency, participants were invited back for a retention test 3-5 weeks later and practiced the same tasks to proficiency again. RESULTS: The mean time to reach proficiency during training was 291 (SD 89) and 299 (SD 89) min in the intervention and control group, respectively (p = 0.81). During the retention test, the mean time to reach proficiency was 94 (SD 53) and 96 (SD 39) minutes in the intervention and control groups, respectively (p = 0.91). CONCLUSION: We found no difference whether practicing with shorter intervals or longer intervals between training sessions when examining time to proficiency or retention.

Substance Use after Completion of an Intensive Treatment Program with Concurrent Treatment for Posttraumatic Stress Disorder and Substance Use among Veterans: Examining the Role of PTSD Symptoms.

OBJECTIVE: Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are costly and highly co-occurring diagnoses, particularly among veterans, suggesting a need to understand this comorbidity and effectively treat both disorders among this population. METHODS: The current study aimed to examine substance use outcomes among post-9/11 veterans and service members (N = 48) who completed a two-week intensive outpatient program with concurrent treatment for and PTSD using Prolonged Exposure and substance use. Substance use was assessed at two weeks and three months posttreatment. RESULTS: The intensive program had high completion rates and demonstrated decreases in substance use at two weeks and three months posttreatment. Additionally, lower PTSD symptoms at treatment completion were related to less substance use posttreatment. CONCLUSIONS: Concurrent intensive treatment of PTSD and SUDs can lead to symptom improvement in a short period of time. Findings support the self-medication model, such that PTSD symptoms at treatment completion were related to substance use at follow-up.

Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

Background: Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals' treatment response to more or less comprehensive ITPs is poorly understood.Objective: To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or less comprehensive ITPs.Methods: The PAI was developed and tested on a sample of 747 veterans with PTSD who completed a 3-week (more comprehensive; n = 360) or 2-week (less comprehensive; n = 387) ITP.Results: Approximately 12.32% of the sample had a PAI value that suggests that individuals would have experienced greater PTSD symptom change (5 points) on the PTSD Checklist for DSM-5 in either a more- or less comprehensive ITP. For individuals with the highest 25% of PAI values, effect sizes for the amount of PTSD symptom change between those in their optimal vs. non-optimal programs was d = 0.35.Conclusions: Although a minority was predicted to have benefited more from a program, there generally was not a substantial difference in predicted outcomes. Less comprehensive and thus more financially sustainable ITPs appear to work well for most individuals with PTSD.

A Personalized Advantage Index (PAI) was developed for a 3-week (more comprehensive) and a 2-week (less comprehensive) intensive PTSD treatment program to predict treatment responses.Using the PAI, approximately 12% of the sample was predicted to have experienced meaningfully greater in another program than the one in which they participated.Findings suggest a less comprehensive and more financially sustainable 2-week intensive PTSD treatment program would work well for most veterans in the present study.

Using machine learning to predict sudden gains in intensive treatment for PTSD.

Sudden gains have been found in PTSD treatment across samples and treatment modality. Sudden gains have consistently predicted better treatment response, illustrating clear clinical implications, though attempts to identify predictors of sudden gains have produced inconsistent findings. To date, sudden gains have not been examined in intensive PTSD treatment programs (ITPs). This study explored the occurrence of sudden gains in a 3-week and 2-week ITP (n = 465 and n = 235), evaluated the effect of sudden gains on post-treatment and follow-up PTSD severity while controlling for overall change, and used three machine learning algorithms to assess our ability to predict sudden gains. We found 31% and 19% of our respective samples experienced a sudden gain during the ITP. In both ITPs, sudden gain status predicted greater PTSD symptom improvement at post-treatment (t2 W=-8.57, t3 W=-14.86, p < .001) and at 3-month follow-up (t2 W=-3.82, t3 W=-5.32, p < .001). However, the effect for follow-up was no longer significant after controlling for total symptom reduction across the ITP (t2 W=-1.59, t3 W=-0.32, p > .05). Our ability to predict sudden gains was poor (AUC <.7) across all three machine learning algorithms. These findings demonstrate that sudden gains can be detected in intensive treatment for PTSD, though their implications for treatment outcomes may be limited. Moreover, despite the use of three machine-learning methods across two fairly large clinical samples, we were still unable to identify variables that accurately predict whether an individual will experience a sudden gain during treatment. Implications for clinical application of these findings and for future studies are discussed.

Effective Delivery of Vagus Nerve Stimulation Requires Many Stimulations Per Session and Many Sessions Per Week Over Many Weeks to Improve Recovery of Somatosensation.

BACKGROUND: Chronic sensory loss is a common and undertreated consequence of many forms of neurological injury. Emerging evidence indicates that vagus nerve stimulation (VNS) delivered during tactile rehabilitation promotes recovery of somatosensation. OBJECTIVE: Here, we characterize the amount, intensity, frequency, and duration of VNS therapy paradigms to determine the optimal dosage for VNS-dependent enhancement of recovery in a model of peripheral nerve injury (PNI). METHODS: Rats underwent transection of the medial and ulnar nerves in the forelimb, resulting in chronic sensory loss in the paw. Eight weeks after injury, rats were implanted with a VNS cuff and received tactile rehabilitation sessions consisting of repeated mechanical stimulation of the previously denervated forepaw paired with short bursts of VNS. Rats received VNS therapy in 1 of 6 systematically varied dosing schedules to identify a paradigm that balanced therapy effectiveness with a shorter regimen. RESULTS: Delivering 200 VNS pairings a day 4 days a week for 4 weeks produced the greatest percent improvement in somatosensory function compared to any of the 6 other groups (One Way analysis of variance at the end of therapy, F[4 70] P = .005). CONCLUSIONS: Our findings demonstrate that an effective VNS therapy dosage delivers many stimulations per session, with many sessions per week, over many weeks. These results provide a framework to inform the development of VNS-based therapies for sensory restoration.

Widening the scope of intensive treatment for PTSD in the military health system.

Recent trends have exacerbated existing problems accessing mental health care for military service members. To address these problems, lawmakers and military leaders have been busy introducing new legislation and changing policies in order to improve access. While these initiatives are critical for long-term change, military service members need solutions that can help them now. Although it may not be a panacea, intensive outpatient treatments may be part of the solution for the MHS, especially when considering posttraumatic stress disorder (PTSD). This commentary begins by describing the history of intensive treatments in the military health system, which has been largely offered as intensive outpatient treatments (IOPs). Next, it describes a decade of research on intensive treatments for PTSD, which has included a diverse array of IOP formats as well as stand-alone, massed treatments. Lastly, this commentary recommends that lawmakers and military leaders expand their notion of intensive outpatient treatments to include both programs and stand-alone, massed treatments. By doing so, the MHS could have more options for service members and commands as they search for workable treatment options.

Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety.

Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.

Massed Training is Logistically Superior to Distributed Training in Acquiring Basic Endovascular Skills.

OBJECTIVE: A "PROficiency based StePwise Endovascular Curricular Training" (PROSPECT) has proven its superiority over traditional training in a randomised controlled trial to acquire basic endovascular skills outside theatre, but real life adherence is low. This study aimed to compare the original distributed training format, where trainees learn at their own pace, with a massed training format offering the same content within a limited time span while exempt from clinical duties. Secondly, long term skills retention was evaluated. METHODS: A multicentre, prospective study allocated participants to the distributed D-PROSPECT or to a massed, compact version (C-PROSPECT) based on logistics such as travel time, participant and instructor availability. A multiple choice question (MCQ) test (max. score 20) tested cognitive skills. Technical skills were assessed using a global rating scale (GRS) (max. score 55), examiner's checklist (max. score 85), and validated simulator metrics. Data were collected pre- and post-programme and at three, six, and 12 months after programme completion. RESULTS: Over four years and in two countries, D-PROSPECT was implemented in two centres and C-PROSPECT in three. A total of 22 participants completed D-PROSPECT with a 41% dropout rate, and 21 completed C-PROSPECT with 0% dropout rate. All participants showed significant improvement for all performance parameters after programme completion: MCQ test (median 14.5 vs. 18; p < .001), GRS (median 20 vs. 41; p < .001), examiner's checklist (median 49 vs. 78.5; p < .001), and simulation metrics (p < .001). Scores of C- or D-PROSPECT participants were not significantly different. No significant differences were seen between groups during the retention period. CONCLUSION: PROSPECT significantly improves the quality of simulated endovascular performances using a massed or distributed training format. A massed training format of PROSPECT may be preferred to decrease dropout during standardised training to obtain basic endovascular skills in existing surgical curricula.

'Undoing a knot': a qualitative study of massed 1-week Cognitive Processing Therapy.

Introduction: Intensive or massed Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) has been found to result in significant PTSD symptom reductions. However, few studies to date have used qualitative approaches to systematically evaluate client reflections about massed treatment approaches for PTSD. To address this gap, the present study aimed to improve our understanding of trauma survivors' reflections following the completion of 1-week CPT.Method: We conducted semi-structured interviews with seven trauma survivors within 3-months of the completion of 1-week CPT. We used the scissor-and-sort technique to identify themes and subthemes in the qualitative data.Results: Using the scissor-and-sort technique, we generated five main themes and associated subthemes from the data. The main themes were: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Conclusion: Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.

Scant research has examined client reflections about massed treatment approaches for PTSD.Among participants who completed a semi-structured interview about their experiences with 1-week CPT for PTSD, we generated five themes: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.

Massed v. standard prolonged exposure therapy for PTSD in military personnel and veterans: 12-month follow-up of a non-inferiority randomised controlled trial.

BACKGROUND: The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes. METHODS: A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63). RESULTS: Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months. CONCLUSIONS: The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.

Preservation of long-term memory in older adults using a spaced learning paradigm.

How much information we retain depends on type/schedule of training. It has been widely acknowledged that spaced learning is advantageous compared to massed learning for cognitively healthy young adults and should be considered an educational standard. Literature would suggest that the spacing effect is preserved with age, though it is unclear whether this effect translates to more ecologically valid concepts such as face-name associations, which are particularly susceptible to deterioration with age. Two experiments were conducted to investigate the effects of spacing across recent/remote retention intervals, and the effect of age on spacing in cognitively healthy older adults using the Face-Name Pairs task. Experiment 1 results suggest that the beneficial memory effects of spacing are particularly observed with long-term memory. Experiment 2 results suggest that older adults are impaired at learning compared to younger adults, that the spacing effect influences both older and younger adults at longer intervals, and that spaced-trained participants display similar forgetting patterns at longer intervals, irrespective of age. These results may have some implications regarding improving the conditions under which optimum retention occurs (namely, whether spacing is beneficial when learning ecologically valid concepts at longer intervals outside of laboratory settings), and may provide insight into the effect of age on our ability to learn and remember face-name associations.

Acute Effects of Fitlight Training on Cognitive-Motor Processes in Young Basketball Players.

Cognitive-motor training could be used to improve open-skill sport performances, increasing cognitive demands to stimulate executive function (EF) development. Nevertheless, a distributed training proposal for the improvement of EFs is increasingly difficult to combine with seasonal sport commitments. This study aimed to investigate whether a massed basketball training program enriched with Fitlight training can improve EFs and motor performance. Forty-nine players (age = 15.0 ± 1.5 yrs) were assigned to the control and Fitlight-trained (FITL) groups, which performed 3 weeks of massed basketball practice, including 25 min per day of shooting sessions or Fitlight training, respectively. All athletes were tested in cognitive tasks (Flanker/Reverse Flanker; Digit Span) and fitness tests (Agility T-test; Yo-Yo IR1). During the intervention, exercise/session perceived effort (eRPE/sRPE) and enjoyment were collected. RM-ANOVA showed significant EFs scores increased in both groups over time, without differences between the groups. Moreover, an increased sRPE and eRPE appeared in the FITL group (p = 0.0001; p = 0.01), with no group differences in activity enjoyment and fitness tests. Three weeks of massed basketball training improved EFs and motor performance in young players. The additional Fitlight training increased the perceived cognitive effort without decreasing enjoyment, even if it seems unable to induce additional improvements in EFs.

Help is on its Way: Exploring the Mental Health and Wellbeing Outcomes of a Massed Community Choir Program.

BACKGROUND: This paper explores the mental health and wellbeing outcomes of a massed community choir program in Australia. METHODS: This study employed a mixed methods approach. Data were collected via a survey of choir participants (N = 305), four qualitative interviews and focus groups with facilitators and participants (N = 22), and two workshops with organising staff (N = 5). Questions were derived from a co-designed program logic, and data were triangulated and analysed thematically. RESULTS: Participants reported feeling a sense of connectedness (psychological), but also experiencing connection (social) with their fellow singers. Psychological outcomes included the sensations of affect, arousal, and affirmation. Social outcomes included experiencing belonging, inclusion, and sharing. These positive psycho-social experiences promoted positive mental health and wellbeing outcomes in the large group of participating singers. CONCLUSIONS: This paper addresses gaps in our understanding about the mental health and wellbeing outcomes fostered by community choirs at scale.

Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group.

OBJECTIVES: To investigate the noninferiority of intensive voice therapy and compare its effects with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction, and attendance in people with muscle tension dysphonia (MTD). The study further aimed to explore clinician's perceptions of barriers and enablers to implementation of intensive therapy. STUDY DESIGN: Noninferiority randomised controlled trial with nested focus group. METHODS: Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks). Participants were assessed by a blinded assessor twice before treatment, once post treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction) and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech Language Pathologists also participated in a focus group to explore barriers and enablers to implementing intensive therapy, with questions and analyses guided by the Theoretical Domains Framework. RESULTS: While noninferiority for the primary outcome measure VHI was not confirmed, secondary outcome measures revealed comparable within group clinically important improvements for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures for both groups. A trend of more improvements being maintained in the intensive group was identified. Comparably high satisfaction and attendance was also found between groups. Clinicians reported more enablers than barriers to providing intensive therapy which included beliefs that it led to greater progression and consolidation of patient learning, was supported by the local context and was associated with positive emotions. Barriers related to difficulties with booking and scheduling and the belief that intensive therapy was not for all patients. CONCLUSIONS: While the current study was likely underpowered to establish non-inferiority of intensive therapy, secondary outcomes suggested that intensive therapy may produce comparable benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy and may be a viable therapy option for individuals with MTD. When implementing intensive therapy, clinicians should consider patient's preferences and availability, as well as systems which allow for flexible booking and therapy provision for patients. Clear recommendations for future research including the use of a larger sample and telehealth are also provided.

Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity.

Background: Intensive outpatient treatment could be a promising option for patients with post-traumatic stress disorder (PTSD). Objective: The aim of the study was to test the effectiveness of an eight-day (two-week) intensive treatment for PTSD within a public health care setting (open trial design). Method: Eighty-nine patients were offered the choice between intensive treatment and spaced individual treatment, of which 34 (38.2%) chose the intensive format. Patients were assessed with self-report batteries and interviews at pre-treatment, start of treatment, post-treatment and three-month follow-up. Each day consisted of individual Prolonged Exposure therapy, Eye Movement Desensitization and Reprocessing therapy, group psychoeducation, and physical activity. Therapists rotated between patients. Results: Between 55 and 62% of the patients showed a clinically significant change (recovery) in symptoms of PTSD, and the effect sizes were large (d = 1.38-1.52). Patients also showed reduction in symptoms of depression and anxiety, along with improved well-being and interpersonal functioning. Changes in social and work functioning were more ambiguous. There were no dropouts, attendance was high, and patients were highly satisfied with the treatment. Conclusions: The intensive programme was an attractive and effective treatment option for patients with PTSD.

Antecedentes: El tratamiento ambulatorio intensivo podría ser una opción prometedora para los pacientes con trastorno de estrés postraumático (TEPT).Objetivo: El objetivo del estudio fue probar la efectividad de un tratamiento intensivo de 8 días (2 semanas) para el TEPT dentro de un entorno de atención de salud pública (diseño de ensayo abierto).Método: Se ofreció a 89 pacientes elegir entre tratamiento intensivo y tratamiento individual espaciado, de los cuales 34 (38,2%) eligieron el formato intensivo. Los pacientes fueron evaluados con baterías de autoinforme y entrevistas antes del tratamiento, al inicio del tratamiento, después del tratamiento y a los 3 meses de seguimiento. Cada día consistió en terapia de exposición prolongada individual, terapia de reprocesamiento y desensibilización por movimientos oculares, psicoeducación grupal y actividad física. Los terapeutas rotaron entre los pacientes.Resultados: Entre el 55-62% de los pacientes mostraron un cambio clínicamente significativo (recuperación) en los síntomas del TEPT, y los tamaños del efecto fueron grandes (d = 1,38­1,52). Los pacientes también mostraron una reducción en los síntomas de depresión y ansiedad, junto con mejoría en bienestar y funcionamiento interpersonal. Los cambios en el funcionamiento social y laboral fueron más ambiguos. No hubo abandonos, la asistencia fue alta y los pacientes estaban altamente satisfechos con el tratamiento.Conclusiones: El programa intensivo fue una opción de tratamiento atractiva y efectiva para pacientes con TEPT.

Anesthesia Resistant Memories in Drosophila, a Working Perspective.

Memories are lasting representations over time of associations between stimuli or events. In general, the relatively slow consolidation of memories requires protein synthesis with a known exception being the so-called Anesthesia Resistant Memory (ARM) in Drosophila. This protein synthesis-independent memory type survives amnestic shocks after a short, sensitive window post training, and can also emerge after repeated cycles of training in a negatively reinforced olfactory conditioning task, without rest between cycles (massed conditioning-MC). We discussed operational and molecular mechanisms that mediate ARM and differentiate it from protein synthesis-dependent long-term memory (LTM) in Drosophila. Based on the notion that ARM is unlikely to specifically characterize Drosophila, we examined protein synthesis and MC-elicited memories in other species and based on intraspecies shared molecular components and proposed potential relationships of ARM with established memory types in Drosophila and vertebrates.

Prospective comparison of single encounter versus distributed laparoscopic training in novice learners: A controlled trial.

BACKGROUND: The traditional model of teaching surgical skills on "real" patients using graded responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. The purpose of our study was to determine if the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest that distributed training programs might have better outcomes, but the results are inconclusive. We designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained using the distributed method may have enhanced learning outcomes. MATERIALS AND METHODS: 100 medical students were assigned in a 1:1 ratio to one of two groups. Group A underwent a single orientation and supervised practice session of 3 h duration. Group B underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive weeks. Participant scores were analyzed before and after the intervention and at 3- and 6-month intervals using repeat measures of ANOVA. RESULTS: Pretest and immediate posttest scores were comparable between the two groups. The 3-month interval test showed significantly higher scores in Group B (difference = -2.90, P < 0.001). The 6-month interval test showed no differences in scores between the two groups (P = 0.178). CONCLUSIONS: Distributed teaching resulted in significantly enhanced scores at 3-month assessment. However, similar scores at 6 months suggest the need for repeated intervention.