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ABSTRACTSelective mutism (SM) is a relatively rare, but highly interfering, child anxiety disorder characterized by a consistent failure to speak in certain situations, despite demonstrating fluent speech in other contexts. Exposure-based cognitive behavioral therapy and Parent-Child Interaction Therapy adapted for SM can be effective, but the broad availability and accessibility of such specialty care options remains limited. Stay-at-home guidelines to mitigate the spread of COVID-19 further limited the accessibility of office-based specialty care for SM. Building on separate lines of research supporting intensive treatments and telehealth service delivery models, this paper is the first to describe the development, preliminary feasibility, acceptability, and efficacy of a Remote Intensive Group Behavioral Treatment (IGBT) for families of young children with SM (N=9). Treatment leveraged videoconferencing technology to deliver caregiver training sessions, lead-in sessions, 5 consecutive daily IGBT sessions, and an individualized caregiver coaching session. Remote IGBT was found to be both feasible and acceptable. All families (100%) completed diagnostic assessments and caregiver-report questionnaires at four major study timepoints (i.e., intake, pre-treatment, post-treatment, 4-month follow-up) and participated in all treatment components. Caregivers reported high treatment satisfaction at post-treatment and 4-month follow-up and low levels of burden associated with treatment participation at post-treatment. Approximately half of participating children were classified as treatment responders by independent evaluators at post-treatment and 4-month follow-up. Although these pilot results should be interpreted with caution, the present work underscores the potential utility of using videoconferencing to remotely deliver IGBT to families in their natural environments.

Online courses and programs in higher education, including nursing education, continue to multiply exponentially in the United States. In order to meet accreditation standards and build internal standards of quality in online course delivery, nursing administrators and faculty must keep abreast of evidence and best practice in online course design. Awareness and adoption of online standards of excellence may be a departure from standard operating procedure with faculty adept at creating face-to-face courses and mavericks self-taught in online course development. The Plan-Do-Study-Act process for improvement is a viable and scalable method to achieve national certification of online course quality, improving ability to compete in a dynamic online education environment. Considerations of infrastructure and multiple stakeholder groups are critical to successful implementation. The case of one nursing program that used faculty development, team building, and continuous quality improvement to successfully reach national online quality benchmarks is presented.

AbstractBackground:Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods:The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results:Just over two thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about (a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); (b) setting characteristics (80%); (c) training methods (format = 96%, length = 92%); (d) coaching (76%); and (e) evaluation of MI skills (92%). Conclusion:Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainees’ skill, continue to limit knowledge of effective training methods.

Background:To improve the quality of patient care, the Institute of Medicine has called for eliminating barriers to academic progression for nurses. Despite this call, nurses who matriculate from institutions that lack national nursing-specific accreditation are denied admission to advanced degree programs.Method:Within an online RN-to-baccalaureate nursing (BSN) program, the performance of students who matriculated from institutions lacking discipline-specific accreditation was compared with student performance representative of programs holding discipline-specific accreditation. The bases for comparison were grade point average (GPA), on-time completion rate, and academic withdrawal.Results:Students admitted from institutions lacking national nursing accreditation had a higher on-time completion rate and a lower GPA than comparison groups. Differences in GPA were statistically insignificant (Students admitted from institutions lacking national nursing accreditation had a higher on-time completion rate and a lower GPA than comparison groups. Differences in GPA were statistically insignificant (p> .05). Evidence regarding withdrawals was insufficient for adequate comparisons.Conclusion:Admission policies that deny education opportunities to candidates from institutions lacking national nursing accreditation may create unwarranted barriers to educational advancement. [Admission policies that deny education opportunities to candidates from institutions lacking national nursing accreditation may create unwarranted barriers to educational advancement. [J Contin Educ Nurs.2019;50(1):15–19.]

The article discusses how physicians are affected by burnout and mentions that physicians and healthcare leaders need to understand signs of burnout and its causes and treatment. Topics discussed include how several physicians suffered from clinical and colloquial depression, symptoms of burnout such as reduced self-efficacy and depersonalization, and need of follow-up communication to identify coaching opportunities.

ABSTRACTAnxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Although the vast majority of supported programs for child anxiety focus on youth 7 years of age and older, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, that is, the Parent–Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6-year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient’s anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed.

Campylobacterspp. are among the most commonly reported bacterial causes of acute diarrheal disease in humans worldwide. Potential virulence factors include motility, chemotaxis, colonization ability, adhesion to intestinal cells, invasion and epithelial translocation, intracellular survival, and formation of toxins. Probiotic Lactobacillusand Bifidobacteriumstrains are known to have an inhibitory effect against the growth of various foodborne pathogens. The objective of this study was to investigate the effect of Lactobacillus acidophilusstrain La-5 and Bifidobacterium longumstrain NCC2705 cell-free spent media (CFSM) on the expression of virulence genes (cadF, cdtB, flaA, and ciaB)of Campylobacter jejunistrain 81-176 and a luxSmutant, using real-time PCR. Our results demonstrated that the CFSM of both probiotic strains were able to down-regulate the expression of ciaB(ratio of –2.80 and –5.51, respectively) and flaA(ratio of –7.00 and –5.13, respectively) in the wild-type Campylobacterstrain. In the luxSmutant, where the activated methyl cycle is disrupted, only the ciaBgene (ratio –7.21) was repressed in the presence of La-5 CFSM. A supplementation of homocysteine to restore the disrupted cycle was able to partially reestablish the probiotic effect of both strains. luxSand the activated methyl cycle might play an active role in the modulation of virulence of C. jejuniby probiotic extracts.

To establish the relationship between HIV-induced cardiac diastolic dysfunction, immune responses, and virus replication in the heart using the simian immunodeficiency virus (SIV)macaque model.

The molecular mechanisms underlying learning and memory impairment in patients with HIV-associated neurological disease have remained unclear. Calcium/calmodulin-dependent kinase II (CaMKII) has key roles in synaptic potentiation and memory storage in neurons and also may have immunomodulatory functions. To determine whether HIV and simian immunodeficiency virus (SIV) induce alterations in CaMKII expression and/or activation (autophosphorylation) in the brain, we measured CaMKII alterations by quantitative immunoblotting in both an in vitroHIV/neuronal culture model and in vivoin an SIV-infected macaque model of HIV-associated neurological damage. Using primary rat hippocampal neuronal cultures treated with culture supernatants harvested from HIV-1–infected human monocyte-derived macrophages (HIV/MDM), we found that CaMKII activation declined after exposure of neurons to HIV/MDM. Consistent with our in vitromeasurements, a significant decrease in CaMKII activation was present in both the hippocampus and frontal cortex of SIV-infected macaques compared with uninfected animals. In SIV-infected animals, total CaMKII expression in the hippocampus correlated well with levels of synaptophysin. Furthermore, CaMKII expression in both the hippocampus and frontal cortex was inversely correlated with viral load in the brain. These findings suggest that alterations in CaMKII may compromise synaptic function in the early phases of chronic neurodegenerative processes induced by HIV.

Abstract: The Kuh-e-Surmeh carbonate-hosted zinc-lead deposit, located within the Simply Folded Belt of the Zagros Mountains in southwestern Iran, is an orogen-related Mississippi Valley type deposit originally formed in the foreland Thrust Belt of the Zagros Mountains. Structural and textural observations indicate that ore deposition took place as open-space fillings in brecciated carbonate rock and as internal sediments consisting of fine-grained ore minerals interlayered with carbonates. The preferred genetic model for the concentration of the ore metals is that of dewatering of the Zard-Kuh basin due to regional tectonic compaction tectonism and expulsion of basin-derived fluids into the highly porous and brecciated dolomitized rocks of the Dalan Formation. The metals precipitated from dense basinal brine (15 wt% equiv. NaCl) at low temperatures (less than 200 °C), typically within strata of a Late Paleozoic carbonate platform.

Electrocoagulation (EC) is a sustainable wastewater treatment alternative that is widely studied because of its environmentally friendly nature, versatility, and simplicity in setup and operation. However, EC alone cannot treat wastewater up to reusable standards and requires integration with other processes, mostly by adding highly hazardous oxidants. This work aims to investigate the combination of powdered activated carbon (AC) with biotreated palm oil mill effluent (BPOME) as wastewater sample, in the EC reactor, and to optimize its concentration for maximum pollutant removal efficiency. Ranging from 0.5-1.5 wt. % concentration of AC mixed with EC reactor, EC was carried out with its critical parameters set to a current of 1.75 A (i.e., 160 mA/cm2current density) and initial pH 6 and 10 mm interelectrode distance with aluminum electrodes. The EC treated wastewater was sampled from 5 minutes to 60 minutes and the parameters monitored were total suspended solids (TSS), turbidity, color and chemical oxygen demand (COD). Turbidity, TSS and color were removed nearly to completion within 5 to 15 minutes of EC, whereas maximum COD removal was determined to be 84.6 % with 1 wt. % powdered AC combined with EC, which is an increase of about 14.6% compared to EC with no AC addition. The optimum concentration of AC for maximum removal efficiency on BPOME was 1 wt. % (2 g per 200 ml). Addition of AC in EC resulted in a faster pollutant removal rate, with enhanced process efficiency.

BURGESS, M. L., R. J. ROBERTSON, J. M. DAVIS, and J. M. NORRIS. RPE, blood glucose, and carbohydrate oxidation during exercise: effects of glucose feedings. Med. Sci. Sports Exerc., Vol. 23, No. 3, pp. 353–359, 1991. This study examined the effects of glucose ingestion on differentiated and undifferentiated ratings of perceived exertion (RPE) during prolonged cycling exercise. On two occasions, seven trained males cycled for 180 min on a Monark cycle ergometer at 70 peak VO2(VO2peak). Subjects consumed an 8 glucose/electrolyte drink (G) or a flavored water placebo (P) every 15 min throughout exercise. Measurement of RPE, ventilation (VE), oxygen uptake (VO2), respiration rate (RR), respiratory exchange ratio (RER), heart rate (HR), and venous blood sample collection preceded ingestion of the drink. Subjects were homogenous with respect to height, weight, and VO2peak. RPE for the legs and overall body were significantly attenuated (P< 0.05) during the last 45 min of exercise. Plasma glucose and insulin were higher (P< 0.05) in G than in P at virtually all time points. CHO oxidation and work rate were maintained throughout exercise in G but not during the last 30 min of exercise in P (P< 0.05). Percent changes in plasma volume, plasma lactate, HR, VE, RR, and RPE for the chest were not different between conditions (P> 0.05). The data suggest that ingestion of carbohydrate beverages during endurance cycling can maintain plasma glucose and CHO oxidation during the latter stages of prolonged exercise. As a result, it appears that a relationship exists between attenuation of ratings of perceived exertion (especially in the legs), blood glucose, and CHO oxidation late in prolonged exercise. The mechanism for this probably involves the increased availability of blood-borne glucose to serve as substrate for brain and/or muscle energy metabolism during a time when endogenous stores of carbohydrate are low.