Quality Of Sessions Research Articles

The Application of Trauma-Informed Care to Health Care for Military-Connected Individuals.

Military families face unique stressors beyond civilian life, such as deployments, frequent relocations, and the potential for combat, all of which can significantly impact well-being. A trauma-informed care (TIC) approach to military medicine is paramount; however, a critical gap exists, with no published curricula to guide practitioners in employing TIC in the care of military-connected individuals. We delivered a 50-minute interactive and virtual session to second-year medical students at the Uniformed Services University (USU) that reviewed the neurobiology of adversity and the relevance of TIC in caring for military-connected populations. Participants completed a 14-question pre- and posttest on perceived knowledge, attitudes, practice, and confidence, as well as posttest questions evaluating session quality. The USU Institutional Review Board approved this evaluation. One hundred sixty medical students participated in the session, with 78 matched pre- and posttest responses. We observed a statistically significant pre-post improvement (p ≤ .05) in all category scores, with the largest changes in knowledge (1.33) and confidence (1.33). On a 5-point Likert scale, with 5 being best, mean scores for overall quality of the session and relevance of the material to participants' learning and future practice were 3.95 and 4.20, respectively. By equipping health care providers with knowledge and confidence to apply TIC in military medicine, we can improve the well-being of service members and their families across both military and civilian health care settings. Broader implementation of this program has potential to improve patient outcomes and overall health care delivery for this population.

Barriers and challenges to telemedicine usage among the elderly population in Israel

Abstract Background Despite the challenges to its adoption, telemedicine is becoming more and more popular for helping elderly people preserve their independence and continue to live in their own homes. Aims We investigated the challenges and barriers experienced by the elderly population when using telemedicine services in Israel. Methods Fourteen elderly people were recruited for the study and interviewed in person using a semi structured interview protocol, using a qualitative technique. Participants’ replies were evaluated and analyzed thematically. The participants were questioned regarding their usage of telehealth services, the benefits they perceive in them, any potential difficulties to use, and suggestions they had for making these services more readily available and simpler to use for the elderly. Results Most participants recognized the advantages of telehealth services, particularly for the elderly population during pandemics and normal times. However, most of them also expressed various challenges that face the elderly population in using these services. Many participants were concerned that the quality of telemedicine sessions may not be good enough compared to in-person sessions, and expressed a lack of confidence in telemedicine services, and frustration from the absence of in person interaction. Many participants highlighted the technological challenges in the use of computers and applications in general and in the context of healthcare, in particular, in addition to physiological and literacy difficulties. Finally, the participants suggested several ways to increase the accessibility and usage of telemedicine solutions by elderly people. Conclusions A proactive approach to identifying and resolving telehealth barriers can maximize virtual interactions for the older population and alleviate care inequities. There is a need to increase awareness of the availability, benefits, and uses of each telehealth service in comparison to in-person consultations. Key messages • A proactive approach to identifying and resolving telehealth barriers can maximize virtual interactions for the older population and alleviate care inequities. • There is a need to increase awareness of the availability, benefits, and uses of each telehealth service in comparison to in-person consultations.

Abstract B032: Advancing the science of cancer in Latinos conference

Abstract Cancer is the leading cause of mortality within the Latino population. Projections suggest a 142% increase in cancer incidence among Latinos over the next two decades. This trend is concerning given that Latinos, the largest minority group in the United States, are expected to constitute at least 28% of the nation's populace by 2060. To address the need for enhanced comprehension of these trends and to identify equitable interventions targeting Latino health disparities, the Institute of Health Promotion Research and the Mays Cancer Center jointly established the biennial Advancing the Science of Cancer in Latinos (ASCL) Conference. The fourth ASCL Conference convened in San Antonio, TX from February 21-23, 2024. The conference objectives were twofold: 1) Examine the intersection of health equity and biological underpinnings in cancer control, prevention, and treatment; and 2) Foster collaborative initiatives among attendees aimed at addressing cancer-related health disparities within the Latino community. The 2024 conference attracted 286 participants compared to 251 attendees in 2022, encompassing guest speakers, researchers, physicians, healthcare professionals, patient advocates, researchers, and students. It comprised 23 sessions (3 keynotes, 6 plenaries, 6 breakouts, 3 general sessions, 1 special session, 1 lunch panel session) featuring insights from 51 speakers, alongside a poster session highlighting 80 research abstracts and a rapid-fire session tailored for early-career investigators. Sessions encompassed multiple topics relevant to Latino cancer research, spanning health disparities, clinical trials, survivorship, patient advocacy, climate change impacts on cancer, precision medicine, health policy and social determinants of health. A post-conference survey from a cohort of 48 respondents underscored high levels of satisfaction, with 90% expressing pronounced contentment regarding the conference experience, compared to 85% in 2022. Moreover, nearly all respondents (98%) rated the relevance of conference content to Latino cancer science as excellent, with 93% regarding the conference as an exceptional platform for information exchange, compared to 79% in 2022. Impressions regarding session quality were overwhelmingly positive, with 90% of respondents indicating a high level of satisfaction, and all survey respondents acknowledging the objectivity, balance, and absence of commercial bias in the session content. Our results showed that the resounding positivity in attendee feedback reflects the conference's success in fostering meaningful engagement among researchers committed to alleviating Latino cancer health disparities. The ASCL conference facilitated an understanding of cultural nuances and barriers specific to the Latino community, stimulating collaborative efforts aimed at enhancing Latino health outcomes. Overall, this retrospective analysis affirms the conference's success in achieving its stipulated objectives and underscores the need of having consistently coordinated research endeavors to reduce Latino health disparities. Citation Format: Amelie G. Ramirez, Rebecca T. Jones, Matthew P. Banegas, Maria C Camargo, Gerardo Colon-Otero, Cliff Despres, Laura Fejerman, Filipa Lynce, Martin Mendoza, Patricia I. Moreno, Alejandro Recio-Boiles, Barbara Segarra-Vazquez, Sandi Stanford, Mariana Stern, Katherine Y. Tossas, Edward J. Trapido, Nicolette M Orozco. Advancing the science of cancer in Latinos conference [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B032.

Patients' perspective on the therapeutic relationship and session quality: the central role of alliance.

In this study, we examined how four components of the therapeutic relationship-working alliance, real relationship, and positive and negative affective reactions of the patient toward their therapist-relate to each other and to the psychotherapy session outcome, from the patient's point of view. Our simple comprised 700 adult patients in individual psychotherapy who were recruited and participated online. They underwent a baseline evaluation of their most recent therapy session, which encompassed a series of validated self-report measures focused on specific elements of the therapeutic relationship. The results revealed that, from the patient's perspective, working alliance, real relationship, and positive affective reactions toward the therapist were positively correlated with session outcome, while negative affective reactions were negatively correlated. All components predicted session outcome when simultaneously included in a regression model. Collectively, these four components accounted for 30% of the variance in session outcome. Factor analysis revealed four distinct factors, underlying perceptions of the therapeutic relationship. Notably, the bond dimension of the alliance was sufficiently different from the task and goal dimensions, warranting consideration as a distinct construct. These findings, although cross-sectional, lay the groundwork for a more nuanced investigation of multiple dimensions of the therapeutic relationship.

Therapeutic Communication in Mental Health Telemedicine Services Through the Halodoc Application

This qualitative study explores the communication dynamics between psychologists and clients within the framework of utilising mental health services provided by Halodoc. Telemedicine has emerged as a popular alternative for individuals seeking mental health support in the digital age. Using a case study methodology, in-depth interviews were conducted with psychologists and clients who availed themselves of Halodoc’s mental health features. The findings reveal both advantages and challenges associated with communication via Halodoc. Advantages include enhanced accessibility, convenience, and privacy for clients, while challenges encompass the absence of non-verbal cues, difficulties in building rapport, and occasional technical constraints affecting session quality. This research offers valuable insights into the communication dynamics of digital mental health services, laying the groundwork for enhancing service efficacy and user experience. In conclusion, the study emphasises the need to address challenges within telemedicine platforms and continuously improve them to optimise mental health service delivery in the digital realm. Ultimately, the study contributes to advancing our understanding of communication in digital mental health services and underscores the importance of ongoing refinement in telemedicine platforms to meet the evolving needs of clients and psychologists alike.

Correlation Between ECT Quality Measures and Likelihood to Transition From Acute to Continuation and Maintenance ECT.

To evaluate the association between 3 ECT quality measures (seizure duration, Postictal Suppression Index [PSI], and heart rate response) and therapeutic compliance as indicated by transitioning from acute to continuation to maintenance phases of ECT. This was a retrospective chart review of patients who received ECT between July 2016 and July 2019. ECT quality measures were lagged by 1 ECT session to examine the effect of the prior session's quality measure on progressing to a higher ECT phase at the subsequent ECT session. Associations with therapeutic compliance were analyzed using mixed-effects ordinal regression and mixed-effects partial proportional odds models. Seizure duration was associated with 8% higher adjusted odds of progressing to out of the acute phase (95% confidence interval [CI]: 2% to 15%, P = 0.007) and 18% higher adjusted odds of progressing to the maintenance phase (95% CI: 10% to 28%, P < 0.001); PSI was associated with 9% higher adjusted odds of progressing out of the acute phase (95% CI: 3% to 16%, P = 0.005), whereas heart rate response was not statistically associated with therapeutic compliance. Greater therapeutic compliance was also associated with bilateral electrode placement and older age. Longer seizure duration was associated with greater therapeutic compliance across all ECT phases, PSI was associated with progressing out of the acute phase, and heart rate response was not associated with therapeutic compliance. Our findings assist ECT psychiatrists in optimizing ECT quality measures to promote better compliance with ECT.

AI-Generated Art in Art Therapy: Insights from Art Therapists Using a Mixed Methods Approach.

With the increasing integration of Artificial Intelligence (AI) into various aspects of daily life, there is a growing interest among designers and practitioners in incorporating AI into their fields. In healthcare domains like art therapy, AI is also becoming a subject of exploration. However, the use of AI in art therapy is still undergoing investigation, with its benefits and challenges being actively explored. This study aims to investigate the integration of AI into art therapy practices to comprehend its potential impact on therapeutic processes and outcomes. Specifically, the focus is on understanding the perspectives of art therapists regarding the utilization of AI-assisted tools in their practice with clients, as demonstrated through the presentation of our prototype consisting of a deck of cards with words covering various categories alongside an AI-generated image. Employing a co-design approach, ten art therapists affiliated with the American Art Therapy Association participated in this study. They engaged in individual interviews where they discussed their professional perspectives on integrating AI into their therapeutic approaches, evaluating the prototype. Qualitative analysis was conducted to derive themes and insights from these sessions. The study began in August 2023, with data collection involving 10 participants taking place in October 2023. Our qualitative findings provide a comprehensive evaluation of the impact of AI on facilitating therapeutic processes. The combination of a deck of cards and the utilization of an AI-generated tool demonstrated an enhancement in the quality and accessibility of therapy sessions. However, challenges such as credibility and privacy concerns were also identified. The integration of AI into art therapy presents promising avenues for innovation and progress within the field. By gaining insights into the perspectives and experiences of art therapists, this study contributes knowledge for both practical application and further research.

Therapist contribution, client reflective functioning, and alliance rupture-repair: A microprocess case study of psychodynamic therapy for pregnancy after loss.

Meta-analysis has found a significant relation between rupture-repair and client outcome (Eubanks et al., 2018). Rupture-repair processes may be particularly important in psychotherapy for pregnancy loss wherein ruptures related to client feelings of shame and inadequacy, the societal invalidation of perinatal grief, and reenactments in the therapy relationship of early attachment experiences have been theorized to be common and important events (Markin, 2024). Thus, it is important to understand what occurs on a microlevel during the process of therapy to ultimately explain the rupture resolution (RR) and treatment outcome association. In particular, while both the therapist and client are believed to contribute to ruptures and to their repair (Safran & Muran, 2000), little is known about how therapist contributions impact rupture events, rupture resolution, and treatment progress. Further, client reflective functioning (RF) may represent a set of capacities that contribute to and are increased by rupture resolution yet vary depending on the role of the therapist in the rupture. The current investigation examined how observer-rated therapist contribution to ruptures and client RF were related to rupture events, rupture resolution, and client-reported symptom change and session quality over 22 sessions of psychodynamic therapy for pregnancy after loss. Therapist contribution to ruptures predicted rupture significance, high and steady within-session client RF scores, and symptom change. Client RF and rupture resolution predicted symptom change differently, often depending on type of symptom. Importantly, client RF and rupture resolution may predict successful outcomes through ameliorating commonly reported symptoms during pregnancies after loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptions of Relief Workers in Iran Regarding the Quality of Emergency Group Therapy Sessions for Post-traumatic Stress Disorder and the Related Factors

Perceptions of Relief Workers in Iran Regarding the Quality of Emergency Group Therapy Sessions for Post-traumatic Stress Disorder and the Related Factors

Improving measurement of functional status among older adults in primary care: A pilot study.

Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.

Surgical Residency Training in Nigeria: An Audit Through the Lenses of the Trainee and Trainer

IntroductionResident doctors constitute an important workforce of the Nigerian healthcare system wherein they undergo structured training to become competent specialists in different fields of medicine. The aim of this survey was to audit the surgical residency training process, incorporating both the trainer's and the trainee's perspectives, with a view to improving both residency training and overall patient care. MethodsThis was a multicenter descriptive cross-sectional study involving consultant surgeons and surgical trainees in selected tertiary healthcare institutions in Nigeria. A link to an online semi-structured and pretested questionnaire was sent to study participants whose agreement to fill out the questionnaire was taken as implied consent for the study. The perception of respondents on key areas of surgical residency training like the quality of training, skill acquisition, mentorship, supervision, operative exposures, research, funding, didactic sessions, and work schedule was assessed using a Likert scale. Their perceived challenges to training and measures to improve the quality of training were recorded. Data were analysed using version 23 of the SPSS. ResultsA total of 127 participants (25 trainers and 102 trainees) were recruited with a mean age of 34.8 ± 3.5 y for the trainees and 47.5 ± 6.9 y for the trainers. The majority of both the trainers and trainees (72%, n = 18 and 93%, n = 96, respectively) were dissatisfied with the quality of surgical residency training in Nigeria with the trainers (88%, n = 22) and trainees (97.1%, n = 99) mostly agreeing that surgical training should be standardized across training centres in Nigeria. The trainees and trainers rated mentorship, research, funding, and overall quality of surgical residency training as inadequate, while most of the trainees and trainers rated supervision of trainees as adequate. The trainees predominantly identified poor training facilities as the most important challenge to surgical residency, followed by high clinical workload, while the majority of the trainers identified workplace bullying and high clinical workload as being the predominant factors. The nine-pronged recommendations by both the trainers and trainees to improve surgical training in Nigeria include mentorship program for trainees, funding of surgical residency training, provision of facilities and equipment for training, adequate supervision of trainees by trainers, job description and defined work schedule for trainees, health insurance of patients, overseas training of trainees during the residency program, improved remuneration of trainees, and adequate motivation of trainers. ConclusionsThe quality of surgical residency training in Nigeria is perceived as suboptimal by trainees and trainers. Perceived common challenges to surgical residency training include poor training facilities, workplace bullying, and high clinical workload. Adequate funding of surgical residency program, standardized mentorship, and training of trainees with improved remuneration of trainees and motivation of their trainers would enhance the overall quality of surgical residency training in Nigeria.

The Transition from Face-to-Face Counseling to Videoconferencing Following the Onset of the COVID-19 Pandemic in Taiwan: The Client's Perspective

&lt;p&gt;COVID-19疫情嚴重威脅人們的身心健康，也加速通訊諮商的發展。原進行實體諮商的當事人，面對突發疫情須轉為視訊晤談，這轉換過程的經驗、對諮商關係的知覺，是本研究探究焦點。本研究以發現式研究取向，針對九位大學生當事人，透過半結構式深度訪談蒐集資料，並採紮根理論研究的資料分析方法。研究結果發現，當事人在轉換過程的經驗有四個主題，一是對視訊晤談的預想，正面期待與擔憂參半；二是視訊晤談過程實際困境，包含溝通品質不佳影響投入、虛擬空間療癒氛圍難以營造、情緒表達與覺察受限等，此一主題也是敘說最豐富的；三是有助持續視訊晤談的因素，包含當事人務實的考量、視訊困境的應對與調適；四是視訊晤談的正向經驗，包含省時便利、降低社交接觸的負擔。當事人對於轉換過程諮商關係的知覺有兩個主題，一是轉換對諮商關係的影響，包含情感連結的減損、諮商關係更親近；二是有助諮商關係維繫的因素，包含原有實體諮商基礎的加持、心理師即時的支持與回應。本研究認為在視訊晤談前準備度不足，是導致當事人衝擊經驗的主因之一，而當事人與心理師因應視訊形式的雙向調整有助於當事人調適視訊困境，此外，當事人在轉換過程普遍經歷情感連結的弱化，然原有實體諮商關係的基礎有助於調節轉換過程的不適。最後，依研究結果，提供相關實務與未來研究之建議。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The global COVID-19 pandemic was a serious threat to the physical and mental health of individuals. Due to social distancing measures, psychological counseling sessions that were previously held face-to-face had to be conducted through videoconferencing. In Taiwan, the two COVID-19 outbreaks in early 2020 and May 2021 necessitated the imposition of social restrictions. This study focuses on the experiences and views of college student clients who initially received counseling for mental health issues through face-to-face sessions but had to transition to online video counseling due to the epidemic.&lt;/p&gt; &lt;p&gt;In this study, a qualitative research method with discovery orientation was adopted. The recruitment of study participants was carried out in two phases. The first phase targeted two universities in central Taiwan, while the second phase was expanded to include universities in northern and southern Taiwan. Both recruitments were promoted online on the school pages of several universities. Over 20 college students signed up in the two stages. After screening by the researchers through telephone and email, only 9 college students (female = 6), all sophomores or juniors, met the study criteria. Data collection was conducted through semi-structured, in-depth interviews conducted through videoconferencing due to social distancing constraints. Open coding, axial coding, and selective coding based on grounded theory research were used for data analysis.&lt;/p&gt; &lt;p&gt;The analysis extracted four themes in the participants&amp;rsquo; experiences of transition to videoconferencing. The first theme is the anticipation of the videoconference, which includes three sub-themes: feeling a sense of similarity to previous experiences of online social communication or distance learning, having positive expectations due to novelty and convenience, and worrying about the possible limitations of the videoconference or interfering distractions. The second theme addresses the challenges of videoconferences, encompassing three sub-themes: the adverse effects of poor dialogue quality on engagement, difficulties in establishing a comforting atmosphere in virtual spaces, and limitations on emotional expression and awareness. The participants discussed this theme frequently in the interviews. The third theme is related to the elements that enable the success of continuous videoconference interviews, including two sub-themes: pragmatic considerations of the client and coping with and adjusting to videoconferencing difficulties. Fourth, the positive experience of videoconferencing includes two sub-themes: time-saving and convenience, which reduce the burden of social contact. Two themes were identified in the participants&amp;rsquo; perception of the counseling relationship during the transition process. One aspect to consider is the impact of transition on the counseling relationship, which includes two sub-themes: loss of emotional connection and a strengthened counseling relationship. The second theme pertains to the factors that contribute to maintaining the consultation relationship, encompassing two sub-themes: the support of an existing face-to-face counseling relationship and the immediate support and response from the counseling psychologist.&lt;/p&gt; &lt;p&gt;This study suggests that the absence of proper informed consent by psychological counseling professionals before the videoconference is one of the main factors affecting the client’s experience. The quality of the videoconference session is significantly influenced by communication equipment and the environment. In addition, participants typically spoke of a weakening of the emotional connection in the counseling relationship during the transition process. The original face-to-face counseling relationship foundation helped to alleviate the discomfort of the transition process. Finally, based on the study results, recommendations for practice related to telecounseling and suggestions for future research directions are provided.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Качество сессии в психотерапии и консультировании: литературный обзор методов оценивания и основных характеристик

&lt;p style="text-align: justify;"&gt;Defining a high-quality psychotherapy or counseling session is important but challenging due to the lack of consensus in the scientific community. Presently, there is no clear definition or universally accepted criteria for determining session quality. This article presents a narrative review of contemporary literature on universal methods for evaluating the quality of individual psychotherapy and psychological counseling sessions. This review aims to identify prevalent and valid instruments for assessing session quality and to define the main characteristics of a high-quality session. The Session Evaluation Questionnaire, Session Evaluation Scale, Session Impacts Scale, and Individual Therapy Process Questionnaire encompass the predominant methods found. This study explores the structure, applications, psychometric properties, strengths, and weaknesses of each tool and provides recommendations for their utilization in examining session quality. The article also comprehensively examines the characteristics of high-quality sessions embedded within these methods. High-quality sessions are based on a trusting relationship in which the specialist respects the client's self-sufficiency and avoids imposing his/her beliefs or actions. To improve the quality of sessions, the therapist or counselor should emotionally support the client, encourage hope, actualize strengths, develop inner resources, help reframe and overcome difficulties, explore new perspectives and meanings, and increase overall awareness of motivations for behavior.&lt;/p&gt;

The Effect of Augmented Feedback on the Hit Accuracy of Foil Fencers

The study aims to investigate the effect of augmented feedback on the hit accuracy of foil fencers. A total of 10 fencing players, juniors and cadets registered at the XX fencing federation were divided into control and experimental groups. The ‘Fencing Scouting Sheet / Foil’ instrument was developed to collect the required data divided into ‘Touches scored’, ‘Touches received’, ‘Touches scored out of target’ and ‘Touches received out of target’. Each player of the experimental and control group played 20 bouts; each bout was scouted and calculated by the coach using a scouting sheet. The total of each group member (experimental and control) was calculated (100 games for each group). Coaches provided the experimental group players with the proper augmented feedback based on each player’s performance. Individually or in group before, during, or after the bouts. The results of the study indicated that the experimental group was 37.4 % higher than the control group in ‘Touches scored’, but less by 36.7%, 59.3% and 19.3% in ‘Touches received’, ‘Touches scored out of target’ and ‘Touches received out of target’ respectively. We encourage future studies to implement the scouting sheet developed to enhance the quality of training sessions and the players' performance.

Assessing the viability of virtual structured democratic dialogue

AbstractThe paper examines the impact of virtual rendering of the Structured Democratic Dialogue (SDD) process. The authors discuss the implications of implementing each process stage virtually and suggest necessary adaptations to the relevant practices. They provide recommendations for improving the overall quality of online sessions and propose qualitative and quantitative indicators that can be used to compare and evaluate face‐to‐face and hybrid or virtual implementations. Pertinent indicators include financial cost, completion time, cost of required resources, number of factors generated, Spreadthink, extent, depth and quality of discussions during clustering and mapping stages, number of dimensions identified, number of factors included in the influence map, number of connections in the influence tree, situational complexity indices and degree of agreement on how to move forward. The authors propose that further research and additional case studies can help systems scientists and practitioners converge on reliable and validated criteria and metrics to allow solid assessment of possible quality loss associated with rendering each stage of the SDD process virtual.

Statement of Retraction: Therapist Immediacy: The association with Working Alliance, Real Relationship, Session Quality and Time in Psychotherapy

Statement of Retraction: Therapist Immediacy: The association with Working Alliance, Real Relationship, Session Quality and Time in Psychotherapy

TABDeep: A two-level action branch architecture-based deep reinforcement learning for distributed sub-tree scheduling of online multicast sessions in EON

The surge in demand for multimedia applications has brought a great pressure on network bandwidth resources. In order to improve the efficiency of bandwidth resource usage and ensure the transmission quality of multicast sessions, it is very urgent to effectively schedule online multicast sessions. To do so, in this paper, we study the distributed sub-tree scheduling problem of online multicast sessions in elastic optical network (EON). First, we model the problem as a Markov Decision Process (MDP) by defining state, action and reward. Second, a two-level action branch architecture-based deep reinforcement learning (TABDeep) algorithm is proposed to realize the destination node grouping, source node selection, route establishment and spectrum assignment of multicast sessions. Finally, to test the superiority of TABDeep, we construct a series of simulation experiments to compare TABDeep with a link-aware distributed steiner sub-tree benchmark algorithm (LA-DSST). The experimental results confirm that TABDeep performs better than LA-DSST in reducing the blocking probability of the session.

Abstract TP118: Development and Integration of a Dedicated Neurorehabilitation Space Within a Hospital-Based Stroke Unit

Background: It is well documented that rehabilitation post-stroke is associated with better functional outcomes, however, in the United States access to post-acute care rehabilitation is becoming increasingly limited. The Office of the Inspector General recently reported that 13% of Medicare beneficiaries were denied access by some Medicare Advantage Organizations to medically necessary care, including admission to inpatient rehabilitation facilities (IRF). Further, the Centers for Medicare and Medicaid Services have initiated the Review Choice Demonstration (RCD) for IRF Services in several states which is anticipated to further reduce access to post-acute care rehabilitation. In response, when our institution began planning for a new neuroscience unit, the decision was made to build a dedicated neurorehabilitation space. The purpose of this project was to design a space that would increase patient access to high quality, intensive neurorehabilitation in the hospital setting. Methods: To maximize utilization and effectiveness of the space, the neurorehabilitation staff were involved in the design of the layout and the selection of appropriate equipment, and participated in several training sessions. One year after opening, the neurorehabilitation staff were surveyed about their access to necessary equipment, and their perception of the effects different features of the space had on the quality of their treatment sessions. Results: Of the 20 surveys completed, the percentage of staff who reported they had the necessary equipment increased from 35% to 100%, and 90% of the space’s features had a favorable effect on the quality of the treatment sessions. Additionally, 95% of staff reported that the overall time spent with each patient increased and overall job satisfaction improved from 60% to 85%. Conclusion: A dedicated rehabilitation space was developed to better meet the needs of the neurorehabilitation staff, and to improve patient access to neurorehabilitation in the hospital setting. Survey results suggested that job satisfaction and staff’s perception of therapy quality improved after opening the new space.

Analysis of the Influencing Factors and Improvement Measures of Morning Study Quality in High School

Morning study is an important component of high school learning, and how to promote the quality of morning study remains a focal point in high school teaching. Previous studies mostly focused on subjects such as Chinese and English, but few studies on History and Biology. There is no deeper exploration of the commonality of the problems, which is difficult to reveal the influencing factors of the quality of morning study accurately. This paper takes the morning study of the second grade of Dangyang No. 1 High School in Yichang City as an example, analyzing the differences between groups by calculating the 50-day quality score of morning study (target number of students/total number of students), taking the quality score of morning study as the dependent variable, and using the t-test to calculate the significance, so as to deeply explore the potential factors affecting the quality of morning study in high school. Our results found significant differences in the quality of morning study sessions across different disciplines, with Chinese morning study sessions having the highest quality and English morning study sessions having the lowest quality, these may be related to positive relationship between students and parents.

Use of Inter-Effort Recovery Hypoxia as a New Approach to Improve Anaerobic Capacity and Time to Exhaustion.

Putti, Germano Marcolino, Gabriel Peinado Costa, Matheus Silva Norberto, Carlos Dellavechia de Carvalho, Rômulo Cássio de Moraes Bertuzzi, and Marcelo Papoti. Use of inter-effort recovery hypoxia as a new approach to improve anaerobic capacity and time to exhaustion. High Alt Med Biol. 25:68-76, 2024. Background: Although adding hypoxia to high-intensity training may offer some benefits, a significant problem of this training model is the diminished quality of the training session when performing efforts in hypoxia. The purpose of this study was to investigate the effects of training and tapering combined with inter-effort recovery hypoxia (IEH) on anaerobic capacity, as estimated by alternative maximum accumulated oxygen deficit (MAODALT) and time to exhaustion (TTE). Methods: Twenty-four amateur runners performed, for 5 weeks, 3 sessions per week of training consisted of ten 1-minute bouts at 120% (weeks 1-3) and 130% (weeks 4 and 5) of maximum velocity (VMAX) obtained in graded exercise test, separated by a 2-minute interval in IEH (IEH, n = 11, FIO2 = 0.136) or normoxia (NOR, n = 13, fraction of inspired oxygen = 0.209). Before training, after training, and after 1 week of tapering, a graded exercise test and a maximal effort to exhaustion at 120% of VMAX were performed to determine TTE and MAODALT. The results were analyzed using generalized linear mixed models, and a clinical analysis was also realized by the smallest worthwhile change. Results: MAODALT increased only in IEH after training (0.8 ± 0.5 eq.lO2) and tapering (0.8 ± 0.5 eq.lO2), with time x group interaction. TTE increased for the pooled groups after taper (23 ± 11 seconds) and only for IEH alone (29 ± 16 seconds). Clinical analysis revealed a small size increase for NOR and a moderate size increase for IEH. Conclusions: Although the effects should be investigated in other populations, it can be concluded that IEH is a promising model for improving anaerobic performance and capacity. World Health Organization Universal Trial Number: U1111-1295-9954. University's ethics committee registration number: CAAE: 32220020.0.0000.5659.