Early Sessions Research Articles

THE EFFECT OF IN-BED LEG CYCLING EXERCISES ON MUSCLE STRENGTH IN PATIENTS WITH INTENSIVE CARE UNIT-ACQUIRED WEAKNESS: A SINGLE-CENTER RETROSPECTIVE STUDY.

To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW). Single-center retrospective study. Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group. The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared. Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001). In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes

Dropout rates for treatments for adult posttraumatic stress disorder (PTSD) are high. Process research can reveal client factors during treatment that predict dropout. An observational coding system was used to code client processes in audio-recorded early sessions of cognitive processing therapy (CPT), a gold-standard treatment for PTSD. Data are from a randomized controlled noninferiority trial of CPT and written exposure therapy (WET), with higher rates of dropout in CPT than WET (39.7% vs. 6.4%). Participants in this study were 53 treatment-seeking adults with PTSD who were in the CPT arm of the trial and completed the CAPS-5 at pretreatment and at least one session. Of these, 15 (28.3%) dropped out of CPT early (completing ≤9 sessions) and 38 (71.7%) completed treatment. Sessions were coded with an observational coding system on a four-point scale (0 = absent to 3 = high) for maladaptive trauma-related responses (overgeneralized beliefs, ruminative processing, avoidance), affective engagement (negative emotions, physiological distress), and adaptive processing (cognitive emotional processing). Binary logistic regressions showed that more physiological distress and cognitive emotional processing predicted lower dropout, whereas more avoidance predicted higher dropout. Negative emotion, ruminative processing, and overgeneralization were not significant predictors. These findings highlight potential early indicators of treatment engagement that could be targeted to reduce dropout and perhaps facilitate further therapeutic change.

O031 The Inter-stimulus Interval Effect in the Psychomotor Vigilance Task

Abstract Introduction The Psychomotor Vigilance Task (PVT) is a widely used measure of the effects of sleep deprivation on vigilant attention. The test requires a rapid response to a stimulus occurring at random inter-stimulus intervals (ISIs) between 2 and 10 seconds following a previous response. A few studies have found an ISI effect where shorter ISIs (2-4s) have slower reaction times (RTs) than longer ISIs (8-10s). How this ISI effect is impacted by circadian timing has yet to be investigated. Method This study compared the ISI effect at 3 time points coinciding with 5, 23 (circadian trough), and 29 hours of wakefulness. Data were taken from 16 healthy participants during a 30 hour period of sleep deprivation. Results A repeated-measures (3 x 3) ANOVA (3 time points, 3 ISIs) found that RTs were slower and lapses (RT&amp;gt;500msec) more frequent in short ISIs compared with medium and long ISIs. RTs were also slower and lapses more frequent at the circadian trough compared to both the early testing session and after 29h of total sleep deprivation. Discussion Increased lapses in shorter ISIs could be explained by an involuntary mental “rest period” after responding, that gets longer and more frequent under sleep pressure from both circadian and homeostatic sleep pressure. These findings have implications for interpreting PVT results and their application to everyday tasks, such as driving. Further research could involve neuroimaging the brain’s responses during different ISIs to confirm the mental ‘rest period’ following a response in the PVT task.

Assessing Attendance Frequency and Duration at a Drop-In Animal Visitation Program Among First-Semester University Students Separated From Their Pets

ABSTRACT Anxiety and stress among incoming university students are associated with higher rates of mental health disorders and decreased academic success. One approach universities employ to prevent these problems is the implementation of Animal Visitation Programs (AVPs). While efficacy trials suggest positive effects, little is known about students’ program uptake (e.g., attendance frequency and duration) or students’ characteristics (e.g., current mood and past mental health, pet ownership, and pet separation anxiety) that shape program uptake. This study identified student characteristics that predicted AVP uptake in a subsample (n = 209) of randomly selected first-year university students (n = 2,000) who were screened for pet ownership and randomly assigned to attend a semester-long drop-in AVP program (i.e., seven 2-hour sessions) (n = 105) with registered therapy dogs or a waitlist control group (n = 104). Using logistic and multiple regression modeling, participants’ mental health history, current mood, and relationship with their childhood pet were modeled on students’ attendance frequency and duration. Students’ early session uptake was negatively associated with mental health history (B frequency = –0.876, p = 0.03, OR = 0.417) and perceived stress (B frequency = –0.177, p = 0.04, OR = 0.838; β duration = –0.433, p = 0.02, d = 0.61) and positively associated with current anxiety (B frequency = 0.179, p = 0.01, OR = 1.196; β duration = 0.513, p = 0.01, d = 0.66). Overall attendance was negatively associated with levels of pet separation anxiety (β frequency = –0.342, p = 0.004, d = 0.70; β duration = –0.286, p = 0.03, d = 0.53) and identifying as male (β frequency = –0.308, p = 0.003, d = 0.72; β duration = –0.321, p = 0.004, d = 0.68) and was positively associated with early uptake (β frequency = 0.627, p < 0.001, d = 1.40; β duration = 0.532, p < 0.001, d = 1.08). Findings suggest that program attendance may be enhanced by prioritizing access to students experiencing anxiety upon arrival to campus, rather than students experiencing stress, pet separation anxiety, or those reporting a history of mental health problems. Administrators should strongly promote attendance to the first session as this is significantly associated with greater program uptake.

Feasibility, acceptability and lessons learned from an infant feeding intervention trial among women living with HIV in western Kenya

BackgroundThe World Health Organization recommends mothers breastfeed exclusively for the first six months of their infant’s life. However, women living with HIV in low resource settings face many barriers to recommended infant feeding practices such as fear of HIV transmission and perceived milk insufficiency. Moreover, current support for breastfeeding in this context is often insufficient to overcome these barriers. To support women’s infant feeding experience, we tested a personalized infant feeding support program among perinatal women living with HIV in Kenya.MethodsSupporting Healthy Mothers is a theory and evidence-based multilevel intervention designed to address the mental health burden associated with financial and food insecurity and provide personalized support for optimal infant feeding postpartum. As part of the Supporting Healthy Mothers intervention feasibility trial, between February 23, 2022 and November 9, 2022, twenty mothers received five personalized infant feeding support sessions delivered by a local professional lactation specialist from pregnancy until three months postpartum. Through detailed observations of these sessions, clinical notes and repeated team discussions, we aimed to describe and provide a limited evaluation of these sessions. We identified the strengths and limitations of the lactation support sessions as well as areas for future development.ResultsParticipation in the sessions was high and at three months postpartum all participants reported exclusive breastfeeding as recommended despite experiencing a myriad of challenges. Having face-to-face and frequent early postpartum sessions, being available to field participant concerns between sessions and measuring infant weights at each session were key strengths. Continuing sessions beyond three months postpartum and incorporating family planning and general maternal health counseling topics would enhance these supportive sessions.ConclusionsThe personalized professional infant feeding support sessions were highly acceptable and feasible to implement. In-person sessions, in a clinic setting provided opportunities to evaluate and adjust breastfeeding technique and led to successful exclusive breastfeeding practice. Future interventions should consider integrating with other perinatal care services and offering support on demand and immediately postpartum.Trial registrationSupporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, posted on February 2, 2022. Identifiers: NCT05219552 Unique Protocol ID: K23MH116807.

Retraction of Kivlighan et al. (2016).

Reports the retraction of "Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model" by Dennis M. Kivlighan Jr., Clara E. Hill, Charles J. Gelso and Ellen Baumann (Journal of Counseling Psychology, 2016[Mar], Vol 63[2], 149-161). The following article is being retracted (https://doi.org/10.1037/cou0000134). This retraction is at the request of coauthors Kivlighan, Hill, and Gelso after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Baumann was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2015-57048-001.) We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant's own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients' working alliance and real relationship independently predicting their therapists' evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists' real relationship ratings (partner effect) were a stronger predictor of clients' session quality ratings in later sessions than in earlier sessions. Therapists' working alliance ratings (partner effect) were a stronger predictor of clients' session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients' session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients' session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

On the participation of adenosinergic receptors in the reconsolidation of spatial long-term memory in male rats.

To date, there is insufficient evidence to explain the role of adenosinergic receptors in the reconsolidation of long-term spatial memory. In this work, the role of the adenosinergic receptor family (A1, A2A, A2B, and A3) in this process has been elucidated. It was demonstrated that when infused bilaterally into the hippocampal CA1 region immediately after an early nonreinforced test session performed 24 h posttraining in the Morris water maze task, adenosine can cause anterograde amnesia for recent and late long-term spatial memory. This effect on spatial memory reconsolidation was blocked by A1 or A3 receptor antagonists and mimicked by A1 plus A3 receptor agonists, showing that this effect occurs through A1 and A3 receptors simultaneously. The A3 receptor alone participates only in the reconsolidation of late long-term spatial memory. When the memory to be reconsolidated was delayed (reactivation 5 d posttraining), the amnesic effect of adenosine became transient and did not occur in a test performed 5 d after the reactivation of the mnemonic trace. Finally, it has been shown that the amnesic effect of adenosine on spatial memory reconsolidation depends on the occurrence of protein degradation and that the amnesic effect of inhibition of protein synthesis on spatial memory reconsolidation is dependent on the activation of A3 receptors.

Evaluation of a rapport‐building intervention for early interventionists working with children on the autism spectrum

AbstractRapport, or the therapeutic relationship between a therapist and client, is essential for successful intervention. In behavior analytic interventions for autistic children, practitioners commonly use pairing to establish rapport. A limited body of research has evaluated how to train interventionists to pair with their child clients. Furthermore, fewer studies have examined the effects of pairing on client behavior. Therefore, we implemented behavioral skills training to teach interventionists pairing skills and assessed the effects of presession pairing on child interfering behavior using a concurrent multiple probe design (with replication). We implemented a pairing protocol before early intensive behavioral intervention sessions with four children (3–5 years old) on the autism spectrum. Interventionists mastered pairing skills during training sessions, which were generally maintained when working with child clients. When interventionists implemented presession pairing, child participants demonstrated fewer interfering behaviors. We discuss implications of our preliminary findings and future directions.

Development of a novel observed structured clinical exam to assess clinical ultrasound proficiency in undergraduate medical education

ObjectivesA pilot study was performed to develop and test an observed structured clinical exam (OSCE) for clinical ultrasound in second-year medical students. The goal was to assess a longitudinal clinical ultrasound curriculum for medical students and to help determine readiness to perform ultrasound during clinical clerkships.MethodsThe OSCE contained 40 tasks over 30 min in a one-to-one examiner to examinee environment using standardized patients covering cardiac, pulmonary, and inferior vena cava (IVC) ultrasound exams along with 6 critical diagnoses. Examinees were assessed using a binary checklist approach. A two-way ANOVA analysis was performed to determine if there were differences between the day and session the OSCE was administered. Results are presented as mean ± standard deviation.ResultsOne hundred fifty-two students were tested with an overall mean score of 64.9 ± 17.6%. Scores between the cardiac, IVC, and lung sections varied—67.8% ± 18.8%, 62.4% ± 26.2%, and 57.1% ± 20.6%, respectively. One hundred twenty-six (82.9%) answered at least one critical diagnosis incorrectly. Students in the late session performed better than the early session (1: 60% vs 2: 69%, p = .001).ConclusionsStudents performed better in later sessions. Additionally, the number of questions left blank at the end of the exam suggests that the length of the OSCE should be evaluated. Incorporating critical diagnoses was challenging for examinees. The proposed OSCE is a valuable assessment tool that could be adapted to assess student’s readiness to use clinical ultrasound prior to clerkships.

Developing Cosmopolitanism Through Intercultural Mediation Activities: An After-School Digital Storytelling Project in Catalonia

This article analyzes interaction taking place in an after-school digital storytelling project, involving a group of teenagers in Catalonia, Spain, with different lingua-cultural backgrounds. It focuses on intercultural mediation activities carried out in one of the early project sessions in which a young girl of Ghanaian origin mobilizes her previous life experience to mediate, for her local peers in Catalonia, understanding of a video produced by Ugandan youth. The data is transcribed and analyzed using a multimodal conversation analytic perspective. Drawing on the theoretical concepts of intercultural mediation, cosmopolitanism, and funds of knowledge, this article investigates the following: (a) how the girl mobilizes her funds of knowledge to mediate the content of the video and the other audience members and, (b) how cosmopolitanism is developed in intercultural mediation. The article also touches on how intercultural mediation is collaboratively constructed across modes, languages, and material objects. The findings indicate that the young participants’ cosmopolitan stances are enacted and enabled in intercultural mediation, as the youngsters can make sense of cultural concepts that they can not tackle as well on their own. The findings further help to reconceptualize the competences, knowledge, and resources of youth in the superdiverse and interconnected world.

Do People Want the 'New Normal'? A Mixed Method Investigation of Young Person, Parent, and Clinician Experience and Preferences for Eating Disorder Treatment Delivery in the Post-COVID-19 World.

Eating disorder treatment was predominantly provided online during the COVID-19 pandemic, which has continued into the post-pandemic world. This mixed method study explored young person, parent/caregiver, and clinician experiences of child and adolescent eating disorder treatment. In total, 90 participants (25 young people, 49 parents/caregivers, and 16 clinicians) completed online surveys about the experience of online working. Data were compared to similar data collected by the same service earlier in the pandemic. The results show that preferences are largely unchanged since 2020; online treatment is considered helpful and acceptable by all groups. Nevertheless, face-to-face assessment sessions (young people: 52.2%; and parents/caregivers: 68.9%) and final sessions (young people: 82.6%; and parents/caregivers: 82.2%) were preferred compared to online. There was also a preference for early treatment sessions to either be always or mostly face-to-face (young people: 65.2%; and parents/caregivers: 73.3%). The middle and latter parts of treatment were a time when preferences shifted slightly to a more hybrid mode of delivery. Participants reported finding engagement with the therapist (young people: 70.6%; and parents/caregivers: 52.5%) easier during face-to-face treatment. Stepping away from the binary of online or face-to-face, the current data suggest that a hybrid and flexible model is a way forward with current findings providing insights into how to structure this.

Methodological choices for an economic evaluation of a combined psychosocial and nutrition treatment intervention for children with severe acute malnutrition: The FUSAM trial in Nepal

As a public health burden, severe acute malnutrition (SAM) among children has been increasingly studied to determine the optimal combination of treatment approaches. Among the new approaches is the addition of early childhood development sessions to standard nutrition-based treatment for SAM which can enhance both nutrition and development outcomes among young children. However, few studies demonstrate the relationship between the costs of such combined programs and the benefits accrued to the children and their caregivers. This article describes our experience of designing and conducting an economic evaluation alongside a cluster randomized controlled trial assessing a combined nutrition and psychosocial intervention for the treatment of SAM in children aged 6–24 months in Nepal. We present key lessons learned regarding methodological choices, the challenges of field data collection, as well as study adjustment when data analysis did not unfold as anticipated. With the view to transparency, this manuscript provides some clarifications on the evaluation processes for funders and policy makers on what economic evaluations entail and what information they convey for the purpose of supporting policy decision-making around limited resource allocation.

Acquired alterations in nucleus accumbens responsiveness to a cocaine-paired discriminative stimulus preceding rats’ daily cocaine consumption

Resumption of drug taking is a primary focus for substance use disorder research and can be triggered by drug-associated environmental stimuli. The Nucleus Accumbens (NAc) is a key brain region which guides motivated behavior and is implicated in resumption. Yet, there remains a pressing need to characterize NAc neurons’ responsiveness to drug associated stimuli during withdrawal and abstinence. We recorded discriminative stimulus (DS) induced NAc activity via in vivo single-unit electrophysiology in rats that self-administered cocaine. Male and female rats implanted with a jugular catheter and a microwire array in NAc Core and Shell self-administered cocaine under control of a 30s auditory DS for 6 hours per session across 14 consecutive days. Rats acquired tone discrimination within 4 sessions. To exclude pharmacological effects of circulating cocaine from all neuronal analyses, we studied changes in DS-induced firing only for trials preceding the first infusion of cocaine in each of the 14 sessions, which were defined as “pre-drug trials.” NAc neuron responses were assessed prior to tone-evoked movement onset. Responsiveness to the DS tone was exhibited throughout all sessions by the NAc Core population, but only during Early sessions by the NAc Shell population. Both Core and Shell responded selectively to the DS, i.e., more strongly on drug taking trials, or Hits, than on Missed opportunities. These findings suggest that NAc Core and Shell play distinct roles in initiating cocaine seeking prior to daily cocaine consumption, and align with reports suggesting that as drug use becomes chronic, cue-evoked activity shifts from NAc Shell to NAc Core.

1767-P: “Leader” ß-Cells within the Pancreatic Islet Are a Functionally Stable Subpopulation In Vitro and In Vivo

β-cell coordination within the islet is critical for normal glucose-stimulated insulin secretion. Recently, we and others have identified a subpopulation of β-cells termed “leaders” which are the first cells to show an increase intracellular Ca2+ during glucose-induced Ca2+ waves. In the Zebrafish, photo ablation of leader cells disrupts pan-islet coordination identifying these as likely pacemakers alongside connected “hub” cells. Our earlier studies were conducted over relatively short time windows (~1hr), leaving open the possibility that leader cells may simply reflect the emergence of a transient functional state rather than a stable subpopulation. To address this question, we used islets from Ins1Cre:GCaMP6ffl/fl transgenic mice which express the Ca2+ sensor GCaMP6f selectively in β-cells. Fast (3-6 Hz) confocal imaging and cell-tracking were used to record calcium dynamics with cellular resolution during stimulation in vitro at 11 mM glucose. Adenoviral delivery of photo-activable PA-mCherry, and excitation with UV light, allowed the identification and labelling of leader cells. Re-imaged 24 h later, 80% (8/10; 4 mice in 2 separate experiments) of islets had the same leader cell as in the earlier session. Correspondingly, after islet engraftment into the anterior chamber (ACE) of the mouse eye, and revascularization, multi-photon imaging revealed calcium waves that were initiated from the same region of the islet in vivo in imaging sessions 24 h apart. These findings establish leader β-cells as a stable subpopulation in vitro and in vivo whose dysfunction may contribute to defective insulin secretion in some forms of diabetes. Disclosure L.F.Delgadillo silva: None. G.A.Rutter: Consultant; Sun Pharmaceutical Industries Ltd. P.L.Chabosseau: None. A.Provencher-girard: None. A.Prat: None. L.Lopez noriega: None.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%,P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%,P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%,P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%,P = 0.019). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB;P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

Transcranial Random Noise Stimulation Boosts Early Motion Perception Learning Rather than the Later Performance Plateau.

The effect of transcranial random noise stimulation (tRNS) on visual perceptual learning has only been investigated during early training sessions, and the influence of tRNS on later performance is unclear. We engaged participants first in 8 days of training to reach a plateau (Stage 1) and then in continued training for 3 days (Stage 2). In the first group, tRNS was applied to visual areas of the brain while participants were trained on a coherent motion direction identification task over a period of 11 days (Stage 1 + Stage 2). In the second group, participants completed an 8-day training period without any stimulation to reach a plateau (Stage 1); after that, they continued training for 3 days, during which tRNS was administered (Stage 2). In the third group, participants completed the same training as the second group, but during Stage 2, tRNS was replaced by sham stimulation. Coherence thresholds were measured three times: before training, after Stage 1, and after Stage 2. Compared with sham simulation, tRNS did not improve coherence thresholds during the plateau period. The comparison of learning curves between the first and third groups showed that tRNS decreased thresholds in the early training stage, but it failed to improve plateau thresholds. For the second and third groups, tRNS did not further enhance plateau thresholds after the continued 3-day training period. In conclusion, tRNS facilitated visual perceptual learning in the early stage, but its effect disappeared as the training continued.

Early post-operative walking bouts are associated with improved gait speed and symmetry at 90 days

IntroductionThere is a paucity of literature on optimal patterns of daily walking following joint arthroplasty, which are now evaluated with consumer technologies like smartphones, and can enhance our understanding of post-operative mobility. When smartphone-recorded, daily walking patterns are captured, qualities of gait-recovery such as gait speed or symmetry can be analyzed in real-world environments. Research questionAre the daily distribution of walking bouts in the early post-operative period associated with 90-day gait quality measures following hip and knee arthroplasty? MethodsGait data was collected passively using a smartphone-based care management platform in patients undergoing hip and knee arthroplasty. As recorded via subjects’ free-living smartphone-collected gait bouts, data were investigated as a function of the walking session length and were used to create a ratio to the total time logging bouts, representing the fraction of walking performed during a single session per day (aggregation score). Quantile regression was performed to evaluate the association between early walking session lengths or aggregation score at 30 days post-operatively and the gait-sampled speed and asymmetry of walking at 90 days. ResultsIn total, 2255 patients provided evaluable data. The walking session length at 30 days was positively associated with 90-day mean gait speed across procedure types where quantile regression coefficients ranged from 0.11 to 0.17. In contrast, aggregation score was negatively associated with gait speed at 90 days, with coefficients ranging from −0.18 to −0.12. SignificanceThe duration and frequency of walking bouts was associated with recovery of gait speed and symmetry following lower limb arthroplasty. The findings may help clinicians design walking protocols that are associated with improved gait metrics at 3 months.

Dissociable effects of transcranial direct current stimulation (tDCS) on early and later stages of visual motion perceptual learning

Transcranial direct current stimulation (tDCS) has the potential to benefit visual perceptual learning (VPL). However, previous studies investigated the effect of tDCS on VPL within early sessions, and the influence of tDCS on learning effects at later stages (plateau level) is unclear. Here, participants completed 9 days of training on coherent motion direction identification to reach a plateau (stage 1) and then continued training for 3 days (stage 2). The coherent thresholds were measured before training, after stage 1 and after stage 2. In the first group, anodal tDCS was applied when participants trained over a period of 12 days (stage 1 + stage 2). In the second group, participants completed a 9-day training period without any stimulation to reach a plateau (stage 1); after that, participants completed a 3-day training period while anodal tDCS was administered (stage 2). The third group was treated the same as the second group except that anodal tDCS was replaced by sham tDCS. The results showed that anodal tDCS did not improve posttest performance after the plateau was reached. The comparison of learning curves between the first and third groups showed that anodal tDCS decreased the threshold at the early stage, but it did not improve the plateau level. For the second and third groups, anodal tDCS did not further enhance the plateau level after a continued 3-day training period. These results suggest that anodal tDCS boosts VLP during the early period of training sessions, but it fails to facilitate later learning effects. This study contributed to a deep understanding of the dissociable tDCS effects at distinct temporal stages, which may be due to the dynamic change in brain regions during the time course of VPL.

Dynamics of Depressive and Psychomotor Symptoms During Electroconvulsive Therapy in Older Depressive Patients: A Case Series.

Electroconvulsive therapy (ECT) is an effective treatment for patients experiencing a major depressive episode, especially older ones. Identification of specific responses within early ECT sessions remains an issue of debate, however. Hence, this pilot study prospectively examined the outcome in terms of depressive signs, symptom by symptom, throughout a course of ECT, concentrating particularly on psychomotor retardation symptoms. Nine patients were clinically evaluated several times during the ECT course, before the first session and then weekly (over 3-6 weeks, according to their evolution), by completing the Montgomery-Åsberg Depression Rating Scale (MADRS), the Mini-Mental State Examination test, and the French Retardation Rating Scale for Depression for assessing the severity of psychomotor retardation. Nonparametric Friedman tests showed significant positive changes in mood disorders during ECT in older depressive patients (mean, -27.3% of initial MADRS total score). Fast improvement in French Retardation Rating Scale for Depression score was observed at t1 (ie, after 3-4 ECT sessions), whereas a slightly delayed improvement in the MADRS scores was found at t2 (ie, after 5-6 ECT sessions). Moreover, the scores for items linked to the motor component of psychomotor retardation (eg, gait, postural control, fatigability) were the first to significantly decrease during the first 2 weeks of the ECT course compared with the cognitive component. Interestingly, participants' concentration on daily functional activities, their interest and fatigability, and their reported state of sadness were the first to progress, representing possible precursor signs of positive patient outcomes after ECT.

Effectiveness of a Dietitian-led Healthy Lifestyle Education Package in Improving Health Behaviours of Stroke Survivors in Malaysia: A Pilot Study

INTRODUCTION: Despite a higher risk of a recurrent cerebrovascular event, many stroke survivors failed to achieve their targeted treatment goals. This study aimed to examine the effectiveness of a dietitian-led healthy lifestyle educational package targeted at improving stroke risk factors and lifestyle practices among stroke survivors. MATERIALS AND METHODS: A quasi-experimental pilot study was undertaken in general medical wards of two public hospitals in Malaysia. Patients were allocated into either intervention or control groups based on the week of screening. Adults aged more than 18 years old, with first-ever stroke, and the willingness of caregivers to participate were included. The intervention group (patient-caregiver dyad) received three dietitian-led healthy lifestyle education sessions underpinned with Health Belief Model and Reflection and Refractive theories and was followed up for three months. The control group received the usual stroke care. Outcome variables included blood pressure, body mass index, waist circumference, dietary intake, physical activity levels, smoking status, alcohol consumption, malnutrition risk, and health-related quality of life. McNemar, Chi-square, and repeated measures Analysis of Covariance tests were conducted to examine the within - and between-group differences. RESULTS: A total of 54 participants (27 in each group) were included in this study. The intervention group had a significantly lower intake of sugar (P=0.002, effect size=0.50) and sodium (P=0.044, effect size=0.31), a lower proportion of active smokers (7% versus 33%, P=0.039), lesser sitting time (P=0.012, effect size=0.37), and lower proportion having pain/discomfort issues (22% versus 63%, P=0.005) than the control group. CONCLUSION: Early dietitian-led lifestyle modification sessions underpinned with behavioural change theories paired with the involvement of family members appear to be beneficial among stroke survivors.