Entire Intervention Research Articles

Towards more homogenous and rigorous methods in sham-controlled dry needling trials: two Delphi surveys

ObjectivesSham-controlled trials of dry needling, a popular treatment for pain, use a range of methods and theoretical frameworks and most have high risk of bias. Critically, patient blinding is often unsuccessful and therapist blinding has not been attempted. The specific effects of dry needling on pain therefore remain unclear. Our objectives were to identify (1) important elements of active dry needling; (2) important elements of shams for dry needling. Design and participantsTwo Delphi surveys (to quantify levels of consensus) were undertaken with three expert groups: experts in (1) dry needling, (2) research methodology, and (3) deceptive/hypnotic techniques including magic. Experts in dry needling participated in Delphi 1 and all three groups participated in Delphi 2. Each survey commenced with an open-ended question. Responses were converted to single ‘items’ suitable for rating on 9-point Likert scales [categorised as ‘Not important’ (0–3), Depends (4–6), and Essential (7–9)], which participants rated in the following two rounds. Consensus was pre-defined as ≥80% agreement within a 3-point category. ResultsIn Delphi 1 (n=20 experts), of 80 items, 35 reached consensus in the ‘Essential’ category, which related to explanations, therapist knowledge/skills, intervention rationale, the setting, and safety. In Delphi 2 (n=53 experts), of 97 items, 15 items reached consensus in the ‘Essential’ category in all three groups, which related to standardisation/indistinguishability, therapist attributes, expectations/beliefs, vision, protocol, and environment. ConclusionsExperts placed high importance on the entire intervention experience for active and sham protocols. Cognitive influences that extend beyond mimicking of tactile sensations should be used to create a believable simulation of active dry needling.

Efecto de una intervención nutricional intensiva en pacientes refractarios a la pérdida de peso

ObjectiveTo assess the effect of an intensive nutritional intervention on the body weight and waist circumference in adults refractory to weight loss, by applying a personalised low-calorie Mediterranean diet. Material and methodsA prospective study was conducted for 6 months on 100 participants with an age range between 55 and 75 years, a BMI ≥ 27 and < 40 kg/my, and fulfilled 3 or more criteria of metabolic syndrome. The intervention consisted of prescribing a low-calorie Mediterranean diet, exercise recommendations, and motivational talks. Anthropometric variables were recorded 11a month during the entire intervention. An analysis was made of the results using the Chi-squared and Student-t tests. The Odds Ratio of the variables associated with weight loss and their 95% confidence intervals was calculated using a non-conditional logistic regression. ResultsAfter the “rescue” intervention, the patients lost an average of 2.9% of the body weight and 2.1% of waist circumference, the target of the loss ≥ 3% of the weight and 26% of the sample the target of reduction ≥ 3% of waist circumference being achieved 38% of the sample. No statistically significant differences were observed in weight and waist circumference loss in any of the variables analysed. ConclusionsIntensive intervention, based on a low-calorie Mediterranean diet, with recommendations of physical activity and motivational talks, achieved a moderate weight loss in patients refractory to treatments for obesity.

A systematic map and in-depth review of European telehealth interventions efficacy for chronic obstructive pulmonary disease.

Evidence to support the implementation of telehealth (TH) interventions in the management of chronic obstructive pulmonary disease (COPD) varies throughout Europe. Despite more than ten years of TH research in COPD management, it is still not possible to define which TH interventions are beneficial to which patient group. Therefore, informing policymakers on TH implementation is complicated. We aimed to examine the provision and efficacy of TH for COPD management to guide future decision-making. A mapping study of twelve systematic reviews of TH interventions for COPD management was conducted. This was followed by an in-depth review of fourteen clinical trials performed in Europe extracted from the systematic reviews. Efficacy outcomes for COPD management were synthesized. The mapping study revealed that systematic reviews with a meta-analysis often report positive clinical outcomes. Despite this, we identified a lack of pragmatic trial design affecting the synthesis of reported outcomes. The in-depth review visualized outcomes for three TH categories, which revealed a plethora of heterogeneous outcomes. Suggestions for reporting within these three outcomes are synthesized as targets for future empirical research reporting. The present study indicates the need for more standardized and updated systematic reviews. Policymakers should advocate for improved TH trial designs, focusing on the entire intervention's adoption process evaluation. One of the policymakers' priorities should be the harmonization of the outcome sets, which would be considered suitable for deciding about subsequent reimbursement. We propose possible outcome sets in three TH categories which could be used for discussion with stakeholders.

The experience of motivation and adherence to group-based exercise of Norwegians aged 80 and more: a qualitative study

BackgroundPhysical activity is crucial for public health; worldwide, across all age groups, exercise has been recognised as a factor that leads to improved health. However, many people do not engage in regular physical activity and hence miss the opportunity to achieve these significant physical and mental health benefits. With the benefits of exercise in mind, the aim of the present study is to describe the experiences of older people’s motivation for participating in and adhering to a group-based exercise intervention in a local community setting.MethodsA qualitative design was used in which semistructured interviews of three men and four women of an advanced age (81–92) were conducted; the participants described their experiences with their participation in and adherence to a long-term group exercise intervention programme in a community setting. Data were analysed using systematic text condensation and discussed in light of the salutogenetic theory.ResultsFour main themes emerged from the data collection: (1) Experience of health challenges: A meaningful starting point; (2) Adherence motivated by increased life-manageability; (3) Comprehensibility through skilled instruction and (4) Social and professional support enhancing motivation. The participants; who had experienced negative changes to their health and function, as well as to their life situation, chose to sign up for the exercise groups and continued to participate throughout the entire intervention. Attending group exercise sessions meant positive changes to physical, mental and social functions enhancing the participants’ motivation to sustain their attendance and leading to positive behavioural changes that were important to their everyday lives.ConclusionEssential factors for these participants’ decision to sign up for the exercise groups were the following: having important life areas connected to physical activity in their history and having belief in exercise as an effective way to restore function and coping; as well as having current experience of health challenges. Adherence to the group exercise was associated with better coping and the ability to fulfil roles and keep up with important life areas. Support from family, friends and professionals also contributed, both to the process of signing up, and adhering to this long-term intervention. The professionals’ skills and the way the instructor tailored group instruction were emphasized as very important to the participants’ adherence. Understanding of motivational factors for participation in and adherence to, exercise programmes is of great importance to older people, health professionals and society.

A Novel Approach to Improve the Estimation of a Diet Adherence Considering Seasonality and Short Term Variability - The NU-AGE Mediterranean Diet Experience.

In this work we present a novel statistical approach to improve the assessment of the adherence to a 1-year nutritional intervention within the framework of the NU-AGE project. This was measured with a single adherence score based on 7-days food records, under limitations on the number of observations per subject and time frame of intervention. The results of the NU-AGE dietary intervention were summarized by variations of the NU-AGE index as described in the NU-AGE protocol. Food and nutrient intake of all participants was assessed by means of 7-days food records at recruitment and after 10 to 14 months of intervention (depending on the subject availability). Sixteen food groups and supplementations covering the dietary goals of the NU-AGE diet have been used to estimate the NU-AGE index before and after the intervention. The 7-days food record is a reliable tool to register food intakes, however, as with other tools used to assess lifestyle dietary compliance, it is affected by uncertainty in this estimation due to the possibility that the observed week is not fully representative of the entire intervention period. Also, due to logistic limitations, the effects of seasonality can never be completely removed. These variabilities, if not accounted for in the index estimation, will reduce the statistical power of the analyses. In this work we discuss a method to assess these uncertainties and thus improve the resulting NU-AGE index. The proposed method is based on Hierarchical Bayesian Models. This model explicitly includes country-specific averages of the NU-AGE index, index variation induced by the dietary intervention, and country based seasonality. This information is used to evaluate the NU-AGE index uncertainty and thus to estimate the “real” NU-AGE index for each subject, both before and after the intervention. These corrections reduce the possibility of misinterpreting measurement variability as real information, improving the power of the statistical tests that are performed with the resulting index. The results suggest that this method is able to reduce the short term and seasonal variability of the measured index in the context of multicenter dietary intervention trials. Using this method to estimate seasonality and variability would allow one to obtain better measurements from the subjects of a study, and be able to simplify the scheduling of diet assessments.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01754012.

Unconjugated and secondary bile acid profiles in response to higher-fat, lower-carbohydrate diet and associated with related gut microbiota: A 6-month randomized controlled-feeding trial

Observational studies have shown that diets high in fat and low in dietary fiber, might have an unfavorable impact on bile acid (BA) profiles, which might further affect host cardiometabolic health. In the current study, we aimed to evaluate the effects of dietary fat content on BA profiles and associated gut microbiota, and their correlates with cardiometabolic risk factors. In a randomized controlled-feeding trial, healthy young adults were assigned to one of the three diets: a lower-fat diet (fat 20%, carbohydrate 66% and protein 14%), a moderate-fat diet (fat 30%, carbohydrate 56% and protein 14%) and a higher-fat diet (fat 40%, carbohydrate 46% and protein 14%) for 6 months. All the foods were provided during the entire intervention period. The BA profiles, associated gut microbiota and markers of cardiometabolic risk factors were determined before and after intervention. The higher-fat diet resulted in an elevated concentration of total BAs (p<0.001), and unconjugated BAs (p=0.03) compared with lower-fat diet. Secondary BAs, such as deoxycholic acid (DCA), taurodeoxycholic acid (TDCA), 12ketolithocholic acid (12keto-LCA), 3β-DCA and taurolithocholic acid (TLCA) (p<0.05 after FDR correction) were significantly increased in the higher-fat diet group after the 6-month intervention. Consistently, the abundances of gut bacteria (Bacteroides, Clostridium, Bifidobacterium and Lactobacillus) which affect bile salt hydrolase gene expression were significantly increased after higher-fat consumption. The change of DCA was positively associated with the relative abundance of Bacteroides (r=0.31, p=0.08 after FDR correction). In addition, the changes of fecal concentrations of DCA and 12keto-LCA were positively associated with serum total cholesterol (r>0.3, p=0.02 and p=0.008 after FDR correction, respectively). In line with these findings, serum fibroblast growth factor 19 (FGF19) was marginally significantly elevated in the higher-fat group after intervention (p=0.05). The higher-fat diet resulted in an alteration of BAs, especially unconjugated BAs and secondary BAs, most likely through actions of gut microbiota. These alterations might confer potentially unfavorable impacts on colonic and host cardiometabolic health in healthy young adults. Clinical trial registry number: NCT02355795 listed on NIH website: ClinicalTrials.gov.

Voluntary Elbow Extension-Flexion Using Single Joint Hybrid Assistive Limb (HAL) for Patients of Spastic Cerebral Palsy: Two Cases Report.

Cerebral palsy (CP) patients with spastic diplegia struggle to perform activities of daily life (ADL) using their upper arms. The single-joint-type Hybrid Assistive limb (HAL) for upper limbs is a new portable robot that can provide elbow motion support in accordance with bioelectric activation of patient's biceps and triceps brachii muscles. The purpose of this study is to assess the feasibility and efficacy of the use of HAL for CP patients. Two patients were enrolled in this study. (Case 1: a 19-years-old male, at the Gross Motor Function Classification System (GMFCS) level IV, Case 2: a 17-years-old male at GMFCS level III). Both these patients experienced difficulty in voluntary elbow extension in ADLs. The HAL intervention (eight sessions; voluntary extension-flexion training of the elbow with HAL and clinical evaluation) was conducted for both sides in Case 1 and for the right side in Case 2. Clinical assessments were conducted as follows: Surface electromyography was used to evaluate the muscle activities of the biceps, triceps brachii, trapezius, and pectoralis major during elbow extension-flexion. The voluntary extension-flexion angles of the elbow, the coactivation index of the biceps and triceps brachii muscles, synergy analysis, and the Action Research Arm Test (ARAT) scores were assessed before and after the HAL sessions; the FIM score was evaluated before and after the entire intervention. In Case 1, the voluntary extension angle tended to increase after the HAL sessions. In both cases, the ARAT scores improved after the sessions. The FIM scores improved after HAL intervention. The voluntary extension-flexion of the elbow using the HAL may be a feasible option for rehabilitation of CP patients.

Piloting a Financial Counseling Intervention for Patients With Cancer Receiving Chemotherapy

National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, -0.13379 to -0.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (β = -1.916; 95% CI, -3.358 to -0.475; P = .0092). Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.

Effectiveness of the Chronic Care Model in Type 2 Diabetes Management in a Community Health Service Center in China: A Group Randomized Experimental Study.

Objective The Chronic Care Model, based on core elements of team-centered care in chronic diseases, has widely been accepted. This study was aimed at evaluating the effectiveness of the Chronic Care Model in type 2 diabetes management. Methods A group randomized experimental study was conducted. Twelve communities of the Zhaohui Community Health Service Center in Hangzhou, China, were randomly assigned into an intervention group (n = 6) receiving the Chronic Care Model-based intervention and a control group (n = 6) receiving conventional care. A total of three hundred patients, twenty-five for each community, aged ≥18 years with type 2 diabetes for at least 1-year duration, were recruited. Data of health behaviors, clinical outcomes, and health-related quality of life (Short-Form 36-item questionnaire) were collected before and after a 9-month intervention and analyzed using descriptive statistics, t-test, chi-square test, binary logistic regression, and linear mixed regression. A total of 258 patients (134 in intervention and 124 in control) who completed the baseline and follow-up evaluations and the entire intervention were included in the final analyses. Results Health behaviors such as drinking habit (OR = 0.07, 95% CI: 0.01, 0.75), physical activity (OR = 2.92, 95% CI: 1.18, 7.25), and diet habit (OR = 4.30, 95% CI: 1.49, 12.43) were improved. The intervention group had a remarkable reduction in glycated hemoglobin (from 7.17% to 6.60%, P < 0.001). The quality of life score changes of the role limitation due to physical problems (mean = 9.97, 95% CI: 3.33, 16.60), social functioning (mean = 6.50, 95% CI: 2.37, 10.64), role limitation due to emotional problems (mean = 8.06, 95% CI: 2.15, 13.96), and physical component summary score (mean = 3.31, 95% CI: 1.22, 5.39) were improved in the intervention group compared to the control group. Conclusion The Chronic Care Model-based intervention helped improve some health behaviors, clinical outcomes, and quality of life of type 2 diabetes patients in China in a short term.

The Line Manager's Role in Implementing Successful Organizational Interventions.

The aim of the paper is to discuss the role of the line manager in implementing to plan, implement and evaluate successful organizational interventions using our experiences from the ARK-program. Earlier literature has shown that line managers have a major influence on an intervention's outcomes (Nielsen, 2017; Saksvik, Nytrø, Dahl-Jørgensen, &amp; Mikkelsen, 2002), however, there is a lack of knowledge about the managements' role throughout the entire intervention process and how line managers are influenced by the context at different levels. We therefore discuss the line managers' role within the five phase cycle of an organizational intervention, including preparation, screening, action planning, implementation and evaluation. We also introduce a more in-depth understanding of the context by using of the IGLO-model (Individual, Group, Leadership and Organizational level). Based on our knowledge and experience from the ARK-program we make some recommendations for (a) what the line managers need throughout the five phases in order to contribute to a successful intervention, and (b) on what the line manager has to provide in order to develop and implement a successful intervention process.

Characterization of the geological and geotechnical conditions at the village of Monsanto

The stability of slopes and hillsides involving rock or soil masses depends crucially on the occurring geological and geotechnical conditions. The village of Monsanto, municipality of Idanha-a-Nova, is located on a granitic inselberg. The tourist interest of the village lies largely in the fusion of the granitic rock mass with the man-made constructions and in the aesthetics of several granitic boulders scattered throughout the village. In the present work the geological and geotechnical characterization of the rock mass has been carried out, namely by the field survey of the entire intervention area and by a set of laboratory tests on samples collected in the field (ultrasound propagation velocity and the uniaxial compression test). Based on this information, the shear strength of the discontinuities was estimated and a kinematic analysis was performed using the Dips 7.0 commercial software, with the objective of defining the predominant sets of joints and identifying the most probable failure mechanisms in each hillside.

6.5 The Good Behavior Game: How It Works and What It Does for Psychiatric Disorders

Pediatric psychiatric disorders are increasing every 2 years. Can a fun, well-tested classroom game invented in 1969 reduce these disorders? The answer is “yes.” In this session, participants will learn the following: 1) how the game works; 2) the breadth of longitudinal outcomes; and 3) how to scale up the game. The game is played during regular school instruction. Teachers divide children into 2 to 5 teams per classroom, balancing teams with high-achieving, shy, and disruptive students. The teams work to increase PAX (“peace, productivity, health, and happiness”). If the teacher counts 3 or fewer “spleems” (disruptive behaviors that reduce PAX) per team, the team wins. Rewards vary from written notes praising an individual child to permission for the team to engage in activities not usually allowed during class (eg, tapping a pencil on a desk or throwing paper balls). These activities use peer reinforcement to socialize children. The entire intervention uses positive and playful language. Notes praising a child are called“tootles,” and the rewards for good behavior (pencil tapping, ball throwing) are called “Granny’s wacky prizes.” PAX language directed at teachers and parents is positive and aspirational. PAX materials refer to 4 of the following miracles that happen when children go to school: 1) learning to read; 2) learning to write; 3) learning mathematics; and 4) “acquiring the mental ability to sustain attention, self-regulate or self-manage, and cooperate with others intentionally.” The breadth of longitudinal outcomes was based on multiple RCTs by colleagues at Johns Hopkins and real-world implementations. Population-level implementation of the game shows that it is possible for public or private entities to cost-effectively prevent or treat DSM-5-classified multiple disorders.

Exploring Efficacy of a Serious Game (TOBBSTOP) for Smoking Cessation in Pregnant Women: Pilot Case-Control Study

Background: Tobacco use entails, during pregnancy, a serious risk to the mother and harmful effects on the development of the child. Europa has the highest tobacco smoking prevalence (19.3%) as compared to a worldwide mean of 6.8%. Twenty to thirty percent of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on risks associated to tobacco use during pregnancy. Objective: This study aims to investigate the possibility to address this problem through a serious game (TOBBSTOP), something that has proven efficient as a tool for learning in many situations. By using a game for smoke cessation during pregnancy, we aim to maintain cessation and interest pregnant smokers in learning about health care and effects of tobacco by playing a game that helps them to achieve their challenge. Methods: A pilot case-control study enrolls 44 women who were visited in two primary care centers in Spain between March 2015 and November 2016. All participants were pregnant smokers over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy who expressed their desire to stop smoking. We recruited the intervention group (n=22) among the attended on the centers and instructed them to install the game on their smartphone or tablet and use it for 3 months. Until the delivery, all participants had to respond to a questionnaire, assessing their stage on smoke cessation during their follow-up midwife consultations. The selected control group participants (n=22), matched for age, level of tobacco-dependence and number of smoking attempts. We tested the amount of CO at each visit with a carboxymeter during the entire intervention period to assess the abstinence. Results: Pregnant women from the intervention group, with 80.0% (12/15), had significant higher rates of cessation until delivery than control group (χ2=8.4; P=.004). Logistic regression analyses revealed that game’s use was associated with an increased likelihood to maintain smoking cessation during the intervention period compared with those not using the game (odds ratio 4.0; 95% CI 1.3-12.2). Additionally, a Mantel-Cox means’ analysis revealed that the use of the game was associated with an increased number of days without smoking, with an average of 139.7 days (95% CI 97.1-182.4) in the intervention group (χ2=13.912; P<.001). Conclusions: Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games is an emerging technology, growing in importance, which is shown as a good tool to assist in maintaining women without smoking and help behavior change during pregnancy. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.

How much does community-based targeting of the ultra-poor in the health sector cost? Novel evidence from Burkina Faso

BackgroundTargeting efforts aimed at increasing access to care for the poorest by reducing to a minimum or completely eliminating payments at point of use are increasingly being adopted across low and middle income countries, within the framework of Universal Health Coverage policies. No evidence, however, is available on the real cost of designing and implementing these efforts. Our study aimed to fill this gap in knowledge through the systematic assessment of both the financial and economic costs associated with designing and implementing a pro-poor community-based targeting intervention across eight districts in rural Burkina Faso.MethodsWe conducted a partial retrospective economic evaluation (i.e. estimating costs, but not benefits) associated with the abovementioned targeting intervention. We adopted a health system perspective, including all costs incurred by the government and its development partners as well as costs incurred by the community when working as volunteers on behalf of government structures. To trace both financial and economic costs, we combined Activity-Based Costing with Resource Consumption Accounting. To this purpose, we consulted and extracted information from all relevant design/implementation documents and conducted additional key informant structured interviews to assess the resource consumption that was not valued in the documents.ResultsFor the entire community-based targeting intervention, we estimated a financial cost of USD 587,510 and an economic cost of USD 1,213,447. The difference was driven primarily by the value of the time contributed by the community. Communities carried the main economic burden. With a total of 102,609 ultra-poor identified, the financial cost and the economic cost per ultra-poor person were respectively USD 5,73 and USD 11,83.ConclusionThe study is first of its kind to accurately trace the financial and economic costs of a community-based targeting intervention aiming to identify the ultra-poor. The financial costs amounted to USD 5,73 and the economic costs to USD 11,83 per ultra-poor person identified. The financial costs of almost USD 6 represents 21% of the per capita government expenditure on health.

Feasibility of a Smartphone-enabled Cardiac Rehabilitation Program in Male Veterans With Previous Clinical Evidence of Coronary Heart Disease

Cardiac rehabilitation (CR) is recommended for patients with coronary heart disease, however, participation among veterans remains poor. Smartphones may facilitate data transfer and communication between patients and providers, among other benefits. We evaluated the feasibility of a smartphone-enabled CR program in a population of veterans. Qualifying veterans were prospectively enrolled in a single-arm, nonrandomized feasibility study of a smartphone-enabled, home-based CR program, featuring an app with daily reminders to exercise, log vitals, and review educational materials. A coach remotely monitored patients through an online dashboard and scheduled telephone visits. Clinical end points were assessed as an exploratory aim. After 21 veterans provided informed consent, 18 were enrolled and successfully completed at least 30days of the program; 13 completed the entire 12-week intervention. Mean (standard deviation) age was 62 (7) years and 96% were male. Program completers logged a mean (standard deviation) of 3.5 (1.4) exercise sessions and 150 (86) exercise minutes per week. The majority (84%) of program completers reported being satisfied overall with the program. Mean functional capacity improved by 1.0 metabolic equivalents (5.3 to 6.3, 95% confidence interval 0.3 to 1.7; p = 0.008) and mean systolic blood pressure at rest improved by 9.6mm Hg (mean difference 9.6, 95% confidence interval -19.0 to -0.7; p = 0.049) among completers. Smartphone-enabled, home-based CR is feasible in veterans with heart disease and is associated with moderate to high levels of engagement and patient satisfaction.

Robust and semantic needle detection in 3D ultrasound using orthogonal-plane convolutional neural networks

PurposeDuring needle interventions, successful automated detection of the needle immediately after insertion is necessary to allow the physician identify and correct any misalignment of the needle and the target at early stages, which reduces needle passes and improves health outcomes.MethodsWe present a novel approach to localize partially inserted needles in 3D ultrasound volume with high precision using convolutional neural networks. We propose two methods based on patch classification and semantic segmentation of the needle from orthogonal 2D cross-sections extracted from the volume. For patch classification, each voxel is classified from locally extracted raw data of three orthogonal planes centered on it. We propose a bootstrap resampling approach to enhance the training in our highly imbalanced data. For semantic segmentation, parts of a needle are detected in cross-sections perpendicular to the lateral and elevational axes. We propose to exploit the structural information in the data with a novel thick-slice processing approach for efficient modeling of the context.ResultsOur introduced methods successfully detect 17 and 22 G needles with a single trained network, showing a robust generalized approach. Extensive ex-vivo evaluations on datasets of chicken breast and porcine leg show 80 and 84% F1-scores, respectively. Furthermore, very short needles are detected with tip localization errors of less than 0.7 mm for lengths of only 5 and 10 mm at 0.2 and 0.36 mm voxel sizes, respectively.ConclusionOur method is able to accurately detect even very short needles, ensuring that the needle and its tip are maximally visible in the visualized plane during the entire intervention, thereby eliminating the need for advanced bi-manual coordination of the needle and transducer.

A Study on Validity of the Integrated Intervention Program Model for At-Risk Children from Multicultural Families

- 게재 철회 논문: 황은진, 이신동 (2018). 다문화 가정 장애위험 유아를 위한 통합적 중재프로그램 모형의 타당도 검증 연구, 유아특수교육연구, 18(2), 75-102. - 게재 철회 사유: 연구윤리 위반(부당한 저자표시) 본 연구는 다문화 가정 장애위험 유아(만 4∼5세)를 위한 통합적 중재프로그램 모형의 타당도 검증을 목적으로 하고 있다. 먼저 중재프로그램 모형을 개발하기 위해 전체 개발 절차를 비롯하여 단계별 내용 및 현장 타당도 검증을 3회 실시하였으며, 자료수집, 개발 참여자, 방법론의 삼각화(triangulation)를 통해 모형 개발 전 과정의 신뢰도를 확보하고자 하였다. 연구결과, 중재프로그램 모형의 신뢰도와 타당도를 검증하였다. 첫째, 전체 중재프로그램 모형의 타당도 검증은 세 가지 방법으로 실행되었다. 즉, 설문조사를 통한 양적(통계)분석, 2차는 전화면담을 통한 질적 자료 분석, 3차는 파일럿 실행(중재충실도)을 통한 질적 자료 분석 등을 사용하여 내용 및 현장 타당도 검증을 실시하였으며, 그 결과 통합적 중재프로그램 모형 및 중재활동시안 12회기를 개발하였다. 둘째, 타당도 검증을 통해 제시한 중재활동에 대한 유아교사들의 인식을 정리해 보면, 유아교사들은 대체로 다문화 가정 장애위험 유아에 관한 낮은 이해와 정보 부족으로 인해 중재 계획 및 실행에 있어서 많은 어려움을 경험하고 있다.또한 중재활동의 실용화를 위해 국내 다문화 가정 장애유아에게 적합한 중재프로그램 개발과 교육지원이 매우 중요하다고 인식하였다. 셋째, 유아교사들이 인식한 효율적인 중재프로그램의 특징은 대상 유아에게 친근한 생활주제, 장애위험 요소와 발달 정도에 따른 대그룹 및 개별화 활동의 적용이라고 제시하였다. 이 연구결과를 토대로 중재서비스의 활성화 방안을 제언하였다.The purpose of this study was to examine the validity of an integrated intervention program model for at-risk children (four to five years old) from multicultural families. In order to develop the intervention program model, tests for contents and field validity were taken in three steps including whole development procedure. The reliability of the whole model development process was secured through the triangulation of data collection, development participants, and methodology. Findings from the results showed reliability and validity of the intervention program developed in this study. First, the validity tests of the entire intervention program model were implemented by three different ways: the quantitative data analysis from the surveys, qualitative data analysis from telephone interviews, and qualitative data analysis form pilot tests(interventional fidelity). As a result, an integrated intervention program model and twelve intervention activity plans were developed in this study. Second, the early childhood teachers perceptions of intervention activities presented by the validity tests shows that the teachers were experiencing many difficulties in planning and implementing intervention programs due to low understanding and lack of information about at-risk children from multicultural families. In addition, for the practical uses of intervention, the teachers recognized that it is important to develop appropriate intervention programs and educational supports for the children. Finally, the participants in this study explained that the effective integrated intervention program is characterized as friendly subjects to the target children and the application of both groups and individualized activities regarding the children s different developmental levels and risk factors of developmental delay and disabilities. Based on the results, this study suggested ways for activation of intervention services for at-risk children from multicultural families.

The Influence Of Non-exercise Physical Activity During Aerobic Exercise On Cardiometabolic Risk Factors

PURPOSE: To determine the impact of changes in non-exercise physical activity on changes in cardiometabolic risk factors in participants performing aerobic exercise training. METHODS: Obese adults (N=25) were randomized to an aerobic training group or an aerobic training and increasing non-exercise physical activity group. Both groups performed supervised aerobic training (50%-75% VO2 max) for 24 weeks at a dose of 12 kcals per kg per week. Non-exercise physical activity (total steps, minutes in low, moderate to vigorous [MVPA] physical activity) was quantified during the entire intervention using Fitbit One accelerometers (removed during supervised exercise sessions). Cardiometabolic assessments included lipids, glucose, insulin, 2-hour glucose/insulin from an oral glucose tolerance test, fitness, and body composition measures (% body fat, weight, and waist circumference). Linear regression models were run with change in the cardiometabolic variable as the dependent variable and baseline value, age, race, sex, supervised exercise time, adherence to exercise dose, change in non-exercise physical activity variables (change in total steps, minutes in light intensity and minutes in MVPA) as predictor variables. RESULTS: Change in total steps was a significant predictor for change in weight (r2= 0.17, p=0.04), percent weight loss (r2= 0.18, p=0.03, waist circumference (r2=0.31, p=0.004), triglycerides (r2= 0.30, p=0.01) and relative fitness (r2= 0.19, p=0.03). Change in total steps approached significance as a predictor for absolute fitness (p=0.052) and body fat (p=0.059). Change in minutes in low intensity was a significant predictor of the change in 2-hour glucose (r2= 0.20, p=0.03). Change in MVPA was not associated with change in any cardiometabolic variables (all ps>0.05). Change in non-exercise physical activity did not predict changes in glucose, insulin, 2-hour insulin, low density lipoprotein, high density lipoprotein, total cholesterol, or lean mass levels (all ps>0.05). CONCLUSIONS: Change in non-exercise physical activity outside of aerobic training was associated with changes in several cardiometabolic variables. Increasing total steps or minutes in low intensity may represent a clinical target to maximize the health benefits of aerobic exercise training in obese adults.

Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave

Objectives: Feasibility testing of a psychoeducational method -The Affect School and Script Analyses (ASSA) – in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS).Design: Pilot study.Setting: Three Swedish primary care centers serving 20,000 people.Intervention: 8 weekly 2-hour sessions with a 5–7 participant group led by two instructors - followed by 10 individual hour-long sessions.Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia.Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS.Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p < .05 after correction for multiple testing for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); 18 months post intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate).Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had >80% participation rates, and clear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.Key Points A pilot study of a psychoeducational intervention – The Affect School and Script Analyses (ASSA) – was performed in primary care • The intervention showed feasibility for patients on sick-leave due to depression, anxiety, or fibromyalgia • 92% completed the 8 weeks/16 hours Affect School and 83% completed the entire 26-hour ASSA intervention • 9 of 11 self-reported measures improved significantly one-week post intervention • 7 of 11 self-reported measures improved significantly 18 months post-intervention

THE EXERCISE GROUP TECHNIQUE ON ACADEMIC HARDINESS IN SENIOR HIGH SCHOOL STUDENTS

Academic stress related Hardiness (Benishek & Lopez, 2007). Academic hardiness provide positive framework for students to react toward academic challenges. Academic hardiness is the individual state of resilience toward academic failure: Individual who have academic hardiness display a willingness to engage in academic challenges, commit to follow all academic activities, and have control over academic performance for maximum results (Kobasa, Maddi, & Kahn, 1982). The purpose of this study is to determine the increasing of academic hardiness from senior high school student in Indonesia. Group exercise technique provides an exercise program to increase the commitment, control and challenge of each student. A quasi-experimental non-equivalent control group with pre-test and post-test was used with a convenience sample of students. Results of statistical analysis by paired t-tests revealed that the exercise group technique intervention have a statistically significant effect on increasing academic hardiness scores. Further academic hardiness research in senior high school, utilizing the entire academic hardiness intervention, was recommended .