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• The activated clotting time values did not significantly differ between patients with and without hemorrhage or thrombosis. • Activated clotting time is a widely used heparin monitoring tool. • The evidence on the association of activated clotting time with hemorrhagic or thromboembolic events is controversial and limited. Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to reduce the risk of thromboembolic events. Despite its historic role, activated clotting time (ACT) remains a widely used heparin monitoring method. Systematic evidence on the association of ACT-guided monitoring with hemorrhagic or thromboembolic complications does not exist. Systematic literature review and meta-analysis (Scopus and PubMed, July 2023). All cohort studies. Patients receiving ECMO support. Anticoagulation monitoring with ACT. We identified 3,177 publications, with 8 studies reporting the average ACT values for patients with and without bleeding. Meta-analysis revealed no significant difference in the compared groups (SMD = 0.69; 95% CI −0.05 to 1.43, p = 0.069; I2 = 87.4%). Three studies (n = 117 patients) reported on the average ACT values for patients with thrombosis, without significant differences in ACT between patients with and without thrombosis (SMD = 0.47; 95% CI −0.50 to 1.44, p = 0.342; I2 = 81.1%). Even though ACT is a widely used heparin monitoring tool, the evidence on its association with hemorrhagic or thromboembolic events is still controversial and limited. Further studies are essential to elucidate the role of ACT in anticoagulation monitoring during ECMO support. [ABSTRACT FROM AUTHOR]

There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period. A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used. A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was d ppc2 = −0.81 (95% CI = −1.12 to −0.50), while it was d ppc2 = −1.04 (95% CI = −1.54 to −0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias. The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies. In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period. • Depression and anxiety in the perinatal period are prevalent and tend to coexist. • Contextual therapies seem appropriate to be applied to the perinatal period. • There are meta-analyses on contextual therapies in the perinatal period. • Contextual therapies are effective for perinatal anxiety and depression. [ABSTRACT FROM AUTHOR]

• Seventeen studies (n = 17) were evaluated to determine if ACT can be used to treat adult OCD. • Current evidence suggests that ACT can be used to reduce symptoms of OCD in adults. • Dismantling studies and RCTs directly comparing ACT to ERP are needed. The present review aims to critically evaluate available literature on the use of acceptance and commitment therapy (ACT) to treat adult obsessive-compulsive disorder (OCD) and to draw conclusions about using ACT to reduce OCD symptoms in adults with OCD. Databases (PsycINFO, PsycARTICLES, MEDLINE, and PubMed), Google Scholar, and article references were used to identify relevant studies through October 10, 2020. This review includes both peer-reviewed, published articles (n = 15) and unpublished theses and dissertations (n = 2) to increase the breadth of the review as suggested by PRISMA guidelines. Reviewed articles utilized ACT and at least one measure of OCD symptom severity. Information on methodological, measurement, statistical, and analytical characteristics of the included studies were extracted to determine the quality of the available studies and to inform the conclusions of this review. Seventeen studies (n = 17) with 336 participants from three countries were evaluated. The current evidence suggests that ACT can be used to reduce symptoms of OCD in adults. A conclusion supporting the use of ACT to reduce OCD symptoms can be made because of several strengths within this body of literature (e.g., use of validated OCD symptom measures, inclusion of treatment manuals, use of multiple assessment points, etc.). However, because a majority of the included studies are quasi-experimental and single-subject studies, more stringent research (i.e., randomized controlled trials) with large, diverse samples is needed to strengthen this conclusion. Additionally, dismantling studies exploring the components of ACT that lead to OCD symptom improvement are needed. [ABSTRACT FROM AUTHOR]

• Cognitive defusion is an outcome, not a procedure or a process. • Cognitive defusion can be achieved through different behavioral processes. • Possible processes include selective attention and spatial distancing. • Other relevant processes involve relational coherence, reinforcement and extinction. Cognitive defusion is among the main components of Acceptance and Commitment Therapy (ACT), a contextual behavioral approach to psychotherapy. Defusion serves as a middle-level term, and, as such, may be useful for applying and disseminating behavior science, despite its lower precision. However, some authors argue that for middle-level terms in psychotherapy to be useful to clinicians, they need to be clearly linked to basic behavioral concepts, with higher precision; and that this is not currently the case with defusion. Our objective is to increase the pragmatic utility of the concept of "cognitive defusion" by providing a more nuanced, multifaceted and process-based definition of the term. In order to do this, we surveyed the ACT literature regarding defusion and critically examined it through the lens of conceptual analysis. This culminated in a revised and updated conceptualization of defusion in terms of its relationship to basic behavioral concepts, in which defusion is an outcome that may be achieved through different processes. [ABSTRACT FROM AUTHOR]

Mobile phone apps have reached almost all sectors of everyday modern human life, including health promotion and patient education intervention. Regarding asthma self-management programs, apps are considered to be a potential learning medium for patients with asthma, especially young patients, due to their effectiveness in improving patients' knowledge and, consequently, the level of asthma control. The aim of this study was to evaluate the effectiveness of the AsmaDroid® mobile app, as compared with conventional educational methods, as a self-management educational intervention tool for improving asthma control among young patients. To determine the app's effectiveness, the study involved 140 participants from various backgrounds and applied a quasi-experimental method using a two-group pretest and posttest with a control group design. Specifically, the treatment groups received the AsmaDroid® app as a learning medium, while the control groups used conventional methods (e.g., books, posters, videos, and social media). Before and after a 4-week intervention period, all the participants of both groups were asked to complete the Asthma Control Test (ACT) questionnaire. The results of this study revealed a significant difference of +1.4 (p < 0.0001) in the pretest and posttest scores of the ACT questionnaire from the intervention group, while no difference was found in the control group. Therefore, this study concluded that mobile app-assisted self-management educational intervention significantly improved the scores of the ACT questionnaire among young asthmatic patients. [ABSTRACT FROM AUTHOR]

Self-care is aimed at achieving a balance between personal and professional life and supporting and promoting daily functioning. Though self-care is imperative for health and helping professional students given their caregiver responsibilities, training programs offer insufficient focus on self-care, and students' uptake of self-care is low. In the present study, we developed and evaluated a six-session group self-care intervention called Values-Based Self-Care (VBSC), based on Acceptance & Commitment Therapy (ACT) principles. Both within-group changes for the intervention group, and group differences between the intervention and waitlist groups, were measured. Significant changes were found for participants who received the intervention on self-care, emotional distress, valued living, and self-esteem occurred. However, when comparing the intervention and waitlist control groups, meaningful differences were only found for self-care, valued living, and depression. This study highlights the need for support and time dedicated to consolidating self-care behaviors into health and helping professional students' identities. • Short-term group-based self-care intervention helps reduce depression and stress. • A focus on only two of the six ACT components results in significant changes. • Brevity and efficiency are important as main obstacle to mental health care is time. • Students need support in learning self-care techniques. [ABSTRACT FROM AUTHOR]

Assessing the effects of Mindfulness-Based Stress Reduction (MBSR) on symptoms of OSA, especially on the primary outcome, excessive daytime sleepiness (EDS). Parallel randomized controlled trial. 16 OSA patients with residual EDS (rEDS) were randomized and assigned to either a standardized 8-week MBSR program or a time-matched program on Acceptance and Commitment Therapy (ACT). Both programs were conducted online. Participants answered questionnaires online at baseline (pre), post-intervention (post), three months after the intervention (follow-up) and were blinded to whether their group was the treatment or active control group but not to group allocation (partial blinding). Three participants dropped out early. Most analyses are based on the remaining 13 patients. There was a significant difference between the MBSR (n = 7) and ACT group (n = 6) in changes of EDS between pre and post (Cohen's d = 1.24, CI [0.01, 2.42]) and a significant reduction of EDS for patients in the ACT group at post (Cohen's d = 1.18 and [0.08, 2.22]). This EDS reduction averaging 2.17 points on the Epworth Sleepiness Scale reached the prespecified bar for clinical significance of two points on that scale. Insomnia symptoms, a secondary outcome, reduced significantly following ACT (Cohen's d = 1.43 [0.23, 2.58]). In MBSR, both participants and the MBSR-trainer judged movement-based exercises to be most efficacious. ACT shows potential as adjunctive therapy for OSA with rEDS, although further studies are needed. It seems promising to develop therapeutic approaches for OSA with rEDS using ACT, especially if they are tailored to the needs specific to this patient group. https://www.drks.de ; Identifier: DRKS00026812. • Acceptance and Commitment Therapy (ACT) reduces daytime sleepiness in OSA patients. • Lower daytime sleepiness may improve OSA patients' health-related quality of life. • ACT reduces insomnia symptoms. • Movement-based exercises in Mindfulness-Based Stress Reduction are most efficacious. • Behavioral treatments for obstructive sleep apnea (OSA) patients may be promising. [ABSTRACT FROM AUTHOR]

Providers working with families of autistic children have a shared responsibility to ensure access to culturally responsive and linguistically appropriate services for Latino caregivers. Acceptance and Commitment Therapy (ACT) is a promising intervention for Autism parents. However, research on ACT for Latino caregivers is absent. This small pilot study indicated that a brief, group-based, culturally adapted ACT protocol may enhance the wellbeing of Latino mothers. The 2-day intervention was associated with significant reductions in anxiety, depression and psychological inflexibility for all parents, with medium to large effect sizes. Methodological factors significantly limit conclusions, however, the study offers the foundation for a program of research centered on the promotion of thriving in Latino families with autistic children, and how to best integrate guidelines for culturally adapted practice with CBS approaches. The study also highlights the importance of centering social justice as a key component of what it means to be effective contextual behavioral scientists and the need for systemic action to address current barriers to care for Latino families. • A brief culturally adapted ACT intervention was associated with reduced psychological distress. • The ACT protocol was culturally adapted according to guidelines provided by Bernal et al. (1995). • Recommendations regarding future research and culturally responsive clinical practice with are provided. • Study highlights issues of diversity, equity and inclusion within CBS research and service delivery. [ABSTRACT FROM AUTHOR]

Although some adolescents managed to cope well with the challenges brought on by the COVID-19 pandemic, the well-being of many was adversely affected due to school closures, distance education, restrictions on gathering with friends, and limited access to mental health services. Many adolescents reported increased anxiety and depression as well as decreased psychological wellbeing due to the pandemic. Consequently, there is a need for psychological support that exceeds the strained resources available to schools to support young people during times of crisis and societal pressure. The present study aimed to explore the effects of an online-delivered ACT intervention to promote adolescent psychological flexibility and self-compassion and decrease psychological distress during the second wave of COVID-19 in the fall of 2020. A total of 348 adolescents aged 15–16 were randomly divided into three equal groups: 1) the iACT student coach + virtual coach group, n = 116; 2) the iACT virtual coach group, n = 116; and 3) the control group with no intervention, n = 116). Among these adolescents, 234 participated in a pre-measurement (iACT, n = 154; control, n = 80; intent-to-treat) and completed measures of psychological flexibility, self-compassion, anxiety, and depression. An investigation of all the adolescents who participated in the pre-measurement (intent-to-treat analysis, n = 234) revealed no significant differences between the three groups with regard to psychological flexibility, self-compassion, and symptoms of anxiety and depression. However, upon combining the two intervention groups and examining the adolescents who completed at least 30% of the Youth Compass program (per-protocol analysis, n = 137), small but significant differences between the iACT intervention and control groups were found regarding the psychological flexibility subscale valued action, self-compassion, and anxiety in favor of the intervention group. Active use of an ACT-based online intervention under adverse circumstances may decrease symptoms of anxiety and increase psychological flexibility skills in adolescents. • iACT program Youth Compass was offered to adolescents during COVID-19. • Adolescents completed measures of symptoms and psychological flexibility. • Adolescents who actively used the Youth Compass , benefitted from the intervention. • Openness to experiences increased among those who used at least 80% of the program. • Benefits were related to the amount of exposure of the program. [ABSTRACT FROM AUTHOR]

Acceptance and commitment therapy (ACT) has recently received much attention from therapists working in the field of sleep disorders. However, less attention has been paid to the role of ACT components in sleep problems. To this end, the present study aimed to investigate the role of ACT components in predicting sleep quality and insomnia severity. This cross-sectional study was conducted on the survivors of a major earthquake (7.3 on the Richter scale in 2017) in urban and rural areas of Kermanshah province (western Iran) 4 years after the earthquake. The data were collected using a questionnaire and data analysis was performed for 1094 people. The results showed that all six components of ACT are related to sleep quality and insomnia severity. The findings also revealed that ACT processes can account for 19% of sleep quality and 27% of insomnia severity. Moreover, about 35% of the variances in the sleep quality subscales were predicted by the six components of ACT. The results showed the important role of experiential avoidance (i.e., acceptance) in predicting sleep quality and insomnia severity compared to other ACT processes. Based on the results of the present study, it can be suggested all six processes of ACT are correlated with and predictive of sleep quality and insomnia severity. Further, sleep disorder therapists should take special account of acceptance when working with sleep problems because of the importance of acceptance in predicting sleep problems in the present study. • All six components of ACT are related to sleep quality and insomnia severity. • Components of ACT can predict 19% of sleep quality and 27% of insomnia severity. • Acceptance is a stronger predictor of insomnia intensity compared to the other components ACT model. • ACT model can provide useful solutions to reduce sleep problems and improve sleep quality in all cognitive, emotional, and behavioral contexts. [ABSTRACT FROM AUTHOR]

Chronic pain management is complex and often a challenge to manage. Patients' expectations are frequently at odds with the treatment outcomes which can be a significant source of distress. This is been further compounded by the significant impact of the coronavirus disease (COVID-19) pandemic with patients' access to pain clinic services reduced in many areas. Clinical psychologists work as part of the multidisciplinary pain team to draw together information and develop a biopsychosocial understanding of how to support patients to live well while experiencing ongoing pain in the context of the COVID-19 pandemic. This article presents two alternative models for formulating and providing therapy for individuals experiencing chronic pain including consideration of the impact of the COVID-19 pandemic: cognitive behavioural therapy and acceptance and commitment therapy. Psychologically informed strategies to support healthcare professionals in their interactions with people with chronic pain are presented. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial. Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, M age = 29.15 years; M BMI = 33.13 kg/m2; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined. The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ2/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life. Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change. • The CompACT is a three-factor measure of psychological flexibility. • Psychometric properties were examined in a unique sample of active-duty military seeking weight loss. • Factor structure of the original and refined versions were tested using CFA. • Internal reliability and convergent validity were established. • Refined 18-item version of the CompACT can be used as a three-factor measure of psychological flexibility. [ABSTRACT FROM AUTHOR]

Acceptance is an important construct in various psychological models seeking to describe psychological distress and emotion regulation. Existing measures either focus on broader constructs like psychological flexibility or lack proper validation. There are no established tools which measure acceptance as a general process, as defined within Acceptance and Commitment Therapy (ACT). The absence of valid and reliable measures impedes research on acceptance processes in clinical change. To address this, we developed the Southampton Experiential Avoidance and Acceptance Scale (SEAAS). Across four studies an item pool was generated, evaluated, and refined into an 18-item scale with a theoretically coherent two-factor structure. The SEASS demonstrates strong psychometric properties, including excellent internal consistency, convergent, concurrent, and discriminant validity, and test-retest reliability. This scale is a promising new tool for assessing acceptance and experiential avoidance. • The SEAAS two-factor structure replicates findings that acceptance and avoidance are distinct but related constructs. • The SEEAS evidenced convergent, divergent and incremental validity, as well as excellent internal consistency. • The SEAAS temporal stability was demonstrated over a two-week period. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT) is a promising approach in psycho-oncology that has led to an increasing number of studies and reviews. This systematic umbrella review provides a comprehensive overview of the results of existing systematic reviews and meta-analyses to investigate the trans-symptomatic (i.e., psychological and physical symptoms) efficacy of ACT in the context of cancer. The study addresses both physical and psychological outcomes, aiming to identify existing research gaps and delineate potential focal points for future studies exploring the application of ACT in psycho-oncological settings. A systematic literature search was conducted in Pubmed, Ebsco Host Academic Search Complete (incl. APA PsycInfo), Web of Science, Cochrane Library, website of the Association of Contextual Behavioral Science (ACBS), and Prospero. To be included, studies had to meet the following criteria: 1) be a systematic review and/or meta-analysis focusing on ACT and its impact on psychological and physical outcomes in cancer patients or survivors; 2) include only patients with oncological conditions; 3) be published in English. The quality of the reviews and meta-analyses was assessed using the AMSTAR 2 criteria. We included eight systematic reviews and meta-analyses in our synthesis. Results of the reviews and meta-analyses indicate that ACT interventions increase the health-related quality of life (HRQoL) and psychological flexibility, and reduce depression, anxiety, and psychological distress in cancer patients and survivors. The best evidence exists regarding psychological distress and HRQoL. The efficacy of these interventions concerning other psychological outcome measures (e.g., fear of progression/recurrence, hope) and biological parameters has not yet been well investigated. Moderator analyses revealed larger effects for younger patients, individuals from Eastern countries (Iran, China), and after longer intervention durations. Results suggest potential differential effects based on the cancer stage. According to the AMSTAR 2 criteria, the quality of the included reviews was low or critically low. Recent meta-analyses and reviews suggests that ACT interventions are an effective and evidence-based treatment for increasing HRQoL and reducing psychological distress in patients with cancer. However, the results should be interpreted with caution, as the quality of the included reviews was generally low. Our synthesis highlights the need for more high-quality randomized controlled trials, reviews, meta-analyses, and mediator analyses in this research area. [ABSTRACT FROM AUTHOR]

Family caregivers of people with neurodevelopmental disabilities (NDDs) experience high levels of stress, anxiety, and depression, yet few interventions target their wellbeing. Moreover, most evidence-based interventions fail to include caregivers in their design and delivery despite evidence that caregivers can play a vital role in enhancing the success of interventions to other caregivers. The present study explored the experiences of caregivers and clinicians who worked in partnership to co-deliver an Acceptance and Commitment Training (ACT) intervention to caregivers of people with NDDs in the community. Caregiver and clinician facilitators completed an open-ended survey asking about their experiences co-facilitating an evidence-based, group ACT intervention. Thematic analysis was used to analyze the data. Elements of successful partnerships, the benefits and challenges co-leading the intervention, and considerations for future implementation efforts were explored. Findings revealed the complementary contributions of facilitators' diverse perspectives, experiences and skills, as well as how regular communication, trust, and flexibility supported successful partnerships. Benefits of co-facilitating included connection with others and personal growth, while challenges included emotional costs, capacity and compensation. Taken together, results highlight ways to support the successful implementation of an ACT intervention co-led by caregivers and clinicians, as well as other partnered interventions. • Family caregivers can play an important role in supporting each other. • A group-based ACT intervention was co-delivered with clinicians and family caregivers. • Caregivers and clinicians reflected on their experiences co-facilitating. • Findings highlight ways to support and sustain caregiver-clinician partnerships. [ABSTRACT FROM AUTHOR]

Artemisinin resistance (AR) emerged in South East Asia 13 years ago and the identification of the resistance conferring molecular marker, Plasmodium falciparum Kelch 13 (Pfk13) , 7 years ago has provided an invaluable tool for monitoring AR in malaria endemic countries. Molecular Pfk13 surveillance revealed the resistance foci in the Greater Mekong Subregion, an independent emergence in Guyana, South America, and a low frequency of mutations in Africa. The recent identification of the R561H Pfk1 3 AR associated mutation in Tanzania, Uganda and in Rwanda, where it has been associated with delayed parasite clearance, should be a concern for the continent. In this review, we provide a summary of Pfk13 resistance associated propeller domain mutation frequencies across Africa from 2012 to 2020, to examine how many other countries have identified these mutations. Only four African countries reported a recent identification of the M476I, P553L, R561H, P574L, C580Y and A675V Pfk13 mutations at low frequencies and with no reports of clinical treatment failure, except for Rwanda. These mutations present a threat to malaria control across the continent, since the greatest burden of malaria remains in Africa. A rise in the frequency of these mutations and their spread would reverse the gains made in the reduction of malaria over the last 20 years, given the lack of new antimalarial treatments in the event artemisinin-based combination therapies fail. The review highlights the frequency of Pfk13 propeller domain mutations across Africa, providing an up-to-date perspective of Pfk13 mutations, and appeals for an urgent and concerted effort to monitoring antimalarial resistance markers in Africa and the efficacy of antimalarials by re-establishing sentinel surveillance systems. [Display omitted] • Indigenous Pfk13 resistance associated mutations have been identified in Africa • Currently, only 4 African countries have reported 6 (M476I, P553L, R561H, P574L, C580Y and A675V) of the 10 validated artemisinin resistance associated mutations • The 6 mutations though identified at low frequencies are an early warning signal for Africa, since a rise in frequency and their spread to other countries could be catastrophic for malaria control • Africa needs a concerted and systematic approach to monitoring Pfk13 mutations (beyond the few research studies published across Africa) and antimalarial efficacy through a re-establishment of sentinel surveillance platforms [ABSTRACT FROM AUTHOR]

Veterans of the United States military represent a large sample of the population and a distinctive culture. Veterans have a high prevalence rate of a variety of psychological disorders and disabilities. Research on treatments that meet the needs of this culturally unique group is essential. Acceptance and Commitment Therapy (ACT) may meet this need with its unified treatment approach and its focus on functioning rather than diagnosis. In this study we examine the current state of the literature of ACT for U.S. Veterans. A systematic review of 249 papers found 34 unique relevant studies involving 21 single arm studies, eight randomized clinical trials, two non-randomized controlled trials, and three case studies that met inclusion criteria. Overall, results suggest ACT is a promising intervention for Veterans across multiple conditions (e.g., anxiety disorders, depression, chronic pain) as well as intervention delivery (in-person and telehealth) and type (group and individual therapy). Limitations highlighted include recruitment methods of studies included, lack of active control conditions, and the limited number of randomized trials. Future researchers should continue to examine which presentations respond to ACT and seek to understand what types of adaptations may be necessary to increase the effectiveness of ACT for U.S. Veterans. • Systematic review of the current evidence for ACT among U.S. Veterans. • 34 unique studies with 4324 participants were included, but only 8 of those being RCTs. • ACT shows promise in treating common disorders in the Veteran population when compared to other effective treatments. • Future RCTs should consider methodology that aims to improve the risk of performance bias and detection bias. • Recommendations are provided to improve the evidence base of ACT for Veterans. [ABSTRACT FROM AUTHOR]

• Six-month outcomes from an RCT of acceptance-enhanced behavior therapy (AEBT) for TTM. • AEBT was compared to psychoeducation and supportive therapy (PST). • AEBT treatment gains were maintained from post-treatment to six-month follow-up. • At follow-up, symptom severity did not differ between AEBT and PST. • Higher TTM severity at baseline predicted higher TTM severity at follow-up for PST Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N =85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance. [ABSTRACT FROM AUTHOR]

Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods. PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes. Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g : −0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect. Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided. • ACT is used to improve functioning in chronic health condition populations. • Single-session ACT may be more feasible and acceptable than multi-session ACT. • Single-session ACT appears feasible and beneficial across several chronic health conditions. • Meta-analysis found a medium-sized, non-significant effect on general functioning. • Larger, randomized controlled trials are warranted to test efficacy. [ABSTRACT FROM AUTHOR]

Recent gains in the fight against malaria are threatened by the emergence and spread of artemisinin and partner drug resistance in Plasmodium falciparum in the Greater Mekong Subregion (GMS). When artemisinins are combined with a single partner drug, all recommended artemisinin-based combination therapies have shown reduced efficacy in some countries in the GMS at some point. Novel drugs are not available for the near future. Triple artemisinin-based combination therapies, combining artemisinins with two currently available partner drugs, will provide one of the last remaining safe and effective treatments for falciparum malaria that can be deployed rapidly in the GMS, whereas their deployment beyond the GMS could delay or prevent the global emergence and spread of resistance to currently available drugs. Artemisinin and partner drug resistance have resulted in high failure rates of artemisinin-based combination therapies (ACTs) in the GMS. Spread or emergence of resistance beyond the GMS are threats to malaria control. Triple ACTs (TACTs), combining an artemisinin and two existing partner drugs, could be a stop-gap therapy for treating multidrug-resistant malaria until new antimalarials are available. Where resistance is not established, deployment of TACTs could delay or prevent emergence of resistance and could prolong the longevity of antimalarial compounds used in any triple-drug combination. TACTs must be safe, well-tolerated, effective, and affordable. Fixed-dose combinations of three drugs in the same tablet will likely improve adherence. Barriers that hinder deployment and adherence must be identified and addressed early in the development of TACTs. [ABSTRACT FROM AUTHOR]

One of the core processes of acceptance and commitment therapy (ACT) is "self-as-context" (SAC). SAC is conventionally taught as an extension of mindfulness, which enables individuals to focus on a stable, grounded, and enduring sense of self that is able to have a flexible perspective. There has been a growing number of studies that have evaluated the effects of the SAC component in improving emotional well-being in various samples. The objective of this systematic review was twofold: (a) to evaluate whether SAC can be effectively taught and assessed in component analyses, and (b) to evaluate whether SAC improves emotional well-being. The electronic databases of PsycInfo and Medline were searched to identify relevant studies with the final search completed in August 2019. All studies that examined SAC as a stand-alone construct were considered. A total of 20 studies (published in 14 papers) met inclusion criteria for this review. Seven studies were based on a single-session lab trial, two studies were based on intervention trials, and 11 studies utilized cross-sectional assessment designs. On the basis of four identified studies, there is only provisional but very limited evidence to suggest that SAC can be effectively taught and implemented as a stand-alone process to manage emotional well-being. Mixed findings emerged in relation to SAC improving emotional well-being. The methodological quality of the studies was variable, which contributed to the mixed outcomes. There is limited evidence to support the use of the SAC component as a stand-alone process in ACT-based interventions, and research recommendations are discussed. [ABSTRACT FROM AUTHOR]

This paper details the Flourishing Footballers programme, a practical innovation which was designed to enhance resilience by explicitly integrating ACT into a male Academy football context (Youth Development Phase). The intervention was carried out by implementing a season-long psycho-education programme, which is the culmination of ten years work. Core components of the programme are presented and evaluated. The programme was deemed to be successful based on player engagement with the programme, and utilisation of the taught ACT-based skills. Thus, support is offered for ACT as an efficacious method of intervention within an elite sport context. Consideration is given to the practical implications of this novel programme. • UK Academy footballers participated in a resilience intervention based on ACT. • The programme is presented illustrating a unique application of ACT in sport. • ACT was versatile and had currency within an elite football environment. • The Flourishing Footballers programme was effective in enhancing performance. [ABSTRACT FROM AUTHOR]

The Acceptance and Action Questionnaire (AAQ-II) is a self-report measure proposed to assess psychological inflexibility and experiential avoidance. Empirical evidence for the measurement invariance of the scale across ethnically diverse populations as well as associations with the theoretically relevant construct of distress tolerance are scarce. This study examined factorial invariance of the AAQ-II across sex and racial/ethnic groups of university students (N = 538). It also examined the relationships between psychological inflexibility/experiential avoidance and distress tolerance, as measured by the AAQ-II and the Distress Tolerance Scale, respectively. The AAQ-II demonstrated strong factorial invariance across sex and race/ethnicity, and it displayed significant associations with distress tolerance. Findings support the unidimensional nature of AAQ-II and suggest that this self-report instrument functions equivalently across subgroups based on sex and race/ethnicity. • AAQ-II showed factorial invariance across sex groups • AAQ-II showed factorial invariance across diverse race/ethnicity groups • Psychological inflexibility/experiential avoidance was higher among Asians than Hispanics • High AAQ-II scores were negatively correlated with DTS and its subscales [ABSTRACT FROM AUTHOR]

Cognitive defusion may enhance healthy coping with negative self-referential thoughts amongst college students. However, research is needed to examine how to effectively introduce and teach defusion to this population. The current pilot study tested the usability of and satisfaction with the D-FUSE program, a single-session, web-based program for a mixed sample of undergraduates and its effectiveness in producing improvements in cognitive defusion and self-criticism. In an undergraduate sample (N = 141), the D-FUSE program was found to be usable and satisfactory. Program engagement rendered significant reductions in the believability of and emotional discomfort produced by negative self-referential thoughts. Further improvements to program development and administration are considered. • Development of a satisfactory and usable web-based cognitive defusion program. • Effective defusion web program targeting college students' self-critical thoughts. • Reductions in believability and emotional discomfort of self-critical thoughts. [ABSTRACT FROM AUTHOR]

Treatment of youth in residential care may be a challenging task for most providers because comorbid problems are common and general psychosocial functioning is low. Cognitive behavioral therapy (CBT) is found to be the most effective treatment but results in only rather small improvements. Hence, there is potential to improve treatment approaches. Acceptance and Commitment Therapy (ACT) could be one such approach. The purpose of this study was to test the effectiveness and feasibility of a brief trans diagnostic ACT group intervention for youth with comorbid problems in residential care. We also wanted to see whether increased psychological flexibility (PF) mediated potential positive outcomes, and to test the intervention under real-world conditions in residential care when delivered by less-specialized staff. With a quasi-experimental design, 69 youth (mean age 17.3 years) received Treatment-As-Usual (TAU), and 91 youth received TAU with an additional 12 h of ACT in a group setting (TAU + ACT). Follow-ups were conducted two weeks, 1 month, 6 months and 18 months after baseline. Intention-to-Treat (ITT) analyses showed statistically significant improvements 18 months after baseline, measured by the interaction of treatment and time for the primary outcomes of, anxiety [ACT * Months = −0.885 (0.445), p < 0.05, d = 0.34], depression [ACT * Months = −1.058 (0.526), p < 0.05, d = 0.39] and psychological flexibility [ACT * Months = −0.970 (0.413), p < 0.05; ACT * Months2 = 0.053 (0.023), p < 0.05; d = 0.44] in TAU + ACT youth compared to TAU alone. Regarding secondary outcomes 6 months after baseline, the TAU + ACT group showed a significant decrease in anger, disruptive behavior, and increased self-concept, with small to medium effect sizes. We also observed that psychological flexibility mediated the decrease in the primary outcome of decreased anxiety. ACT in group format may be of help in promoting various positive outcomes for youth in residential care when added to treatment as usual. Increasing PF is a promising process variable that can be targeted to increase the effectiveness of interventions for this population. • A preliminary test of a brief, transdiagnostic, ACT group intervention for youth. • The study included 160 youth in residential care. • ACT in group format was associated with various positive outcomes for youth. • Psychological flexibility mediated decreased anxiety. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) has gained evidence as an efficacious treatment for adolescent anxiety. The primary aim of this review was to evaluate research evidence about the efficacy of ACT when delivered in group-format for adolescent anxiety. The secondary aim was to undertake a subgroup analysis to assess the effect of group ACT on adolescent anxiety as a function of symptom severity. Finally, we aimed to assess the effect of group ACT on adolescent psychological inflexibility. Electronic databases PsycInfo (EBSCO); PubMed (NCBI); Scopus (Elsevier); Cochran Library; Embase (Ovid); MEDLINE (Ovid); Web of Science Core Collection (Thomson Reuters); and ProQuest Dissertation & Theses were searched for prospective longitudinal research involving 10–20-year-olds. No restrictions were placed on publication date. A systematic review and Meta-Analysis was conducted on studies that met inclusion criteria. Results indicated that group ACT had significant, positive, between group's effects on anxiety symptoms in adolescents post treatment. Within group's analysis revealed reductions in anxiety symptoms in adolescents at follow up that were greater than those observed post treatment. Subgroup analysis indicated differences in efficacy depending on symptom severity, suggesting that ACT may be most effective for adolescents with clinically significant symptoms of anxiety. Finally, group ACT had significant, positive, between group's effects on psychological inflexibility post treatment. Within group's analysis also revealed reductions in psychological inflexibility in adolescents at follow up. Limited publication bias was evident across the included studies. These findings indicate that group ACT may be effective in reducing anxiety symptoms in adolescents, particularly in cases involving clinically significant symptoms characterised by psychological inflexibility. • Group ACT reduces anxiety symptoms in adolescents. • Treatment effects following group ACT increased over time to follow-up. • Group ACT may be most effective for adolescents with clinically significant levels of anxiety. • Group ACT may function to reduce psychological inflexibility by reducing experiential avoidance and cognitive fusion. [ABSTRACT FROM AUTHOR]

This preregistered review sought to appraise what interventions have been developed and trialled applying acceptance and commitment therapy (ACT) for weight management in adolescents with regard to the acceptability, feasibility of and benefit that such interventions offer to participants. The impact of ACT on eating behaviour, weight management and wellbeing were of particular interest. Studies based on ACT interventions as a treatment for adolescents (age 11–18 years) with overweight or obesity were included in this review. No limits to language or search date were implemented. Systematic searches of the literature were conducted using the following databases – Medline, Scopus, Embase, Web of Science and PsycInfo. International Standard Randomised Controlled Trial Number, Clinical-Trials.gov , Cochrane Central Register of Controlled Trials, National Institute for Health and Care Excellence and OpenGrey were also searched. The studies were collated, data was extracted, and a narrative analysis was conducted. Cincinnati Children's Hospital Medical Centre's Let Evidence Guide Every New Decision evidence evaluation tools and resources were used for assessing studies' quality. Searches identified 267 texts that were retrieved for screening. Following review by two independent authors, 13 texts detailing the work of six ACT interventions were included. The quality assessment showed that there is currently a low body of evidence for recommending ACT for the treatment of adolescents with overweight or obesity. Yet, the acceptability of ACT based interventions was high, with strong attendance and high retention rates. Participation in ACT-based interventions demonstrated some evidence that key ACT processes may yield support for weight change. For example, improvements in outcomes such as psychological flexibility and weight-related experiential avoidance indicate improved aspects of self-regulation. These findings in adolescents align with similar research in adults. While only six ACT-based interventions for weight management in adolescents have been developed to date, evaluating the related findings generated thus far offers opportunities to optimise the delivery and measurement of ACT approaches in future intervention designs. High quality, fully powered trials are now needed to increase the evidence for the beneficial effects of ACT for weight management. • Only six ACT-based interventions are reported for weight management in adolescents. • ACT for weight management showed high acceptability among adolescents. • Studies demonstrate some evidence that ACT may yield support for weight management. • ACT shows promise for the wellbeing promotion of adolescents with obesity. • Fully powered RCTs examining ACT for adolescents with obesity are needed. [ABSTRACT FROM AUTHOR]

Insomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBT I) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined. Data consisted of a secondary analysis from a randomized comparative effectiveness trial of CBT-I and ABC-I among women veterans with insomnia and comorbid pain. Pain outcomes, beliefs about sleep, and psychological flexibility were assessed at baseline, post-treatment, and at three-months follow-up. At baseline, 93 women veterans reported comorbid insomnia and pain (mean age = 46.7; 33.3% Black, 24.7% Hispanic/Latina). Both CBT-I (n = 48) and ABC-I (n = 45) were associated with decreased pain intensity (p <.001, Cohen's d = 0.41–0.67) and pain interference (p <.001, Cohen's d = 0.71–0.77) at post-treatment and three-months follow-up, with results indicating that ABC-I was non-inferior to CBT-I for pain improvement. Both conditions were associated with greater psychological flexibility post-treatment, and CBT-I resulted in larger reductions in dysfunctional beliefs about sleep (p =.01, Cohen's d = 0.59). CBT-I and ABC-I both had positive secondary effects on pain with ABC-I being non-inferior to CBT-I with respect to its impact on pain. The mechanisms of change associated with these treatments may differ with CBT-I leading to greater reductions in dysfunctional beliefs. Hybrid treatments which incorporate an acceptance and commitment approach to both insomnia and pain warrant further examination. • Women veterans are prone to both insomnia and pain. • Cognitive behavioral therapy for insomnia (CBT I) can improve pain. • CBT-I was compared to Acceptance and Behavioral Changes for Insomnia (ABC-I). • ABC-I combines behavioral sleep strategies with Acceptance and Commitment Therapy. • ABC-I was non-inferior to CBT-I with respect to its effect on pain outcomes. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic and its extensive effects, the incidence of posttraumatic stress disorder (PTSD) symptoms is rapidly increasing in China. This research aimed to assess the efficacy and acceptability of a mobile application delivering Acceptance and Commitment Therapy (ACT) in reducing PTSD symptoms. 221 Chinese individuals with elevated PTSD symptoms were randomly assigned to app-delivered ACT (ACT condition), app-delivered mindfulness (MI condition), or a waitlist (WL condition). Assessments were performed pre- and post-intervention. The results showed that participants in both the ACT and MI groups had significantly greater improvements across mental health outcomes compared to the WL group. No significant differences were observed between the ACT and MI groups except for psychological flexibility, which improved more in ACT than MI (d = −0.37). Compared to WL, the ACT group showed a greater improvement in PTSD symptoms (d = −0.79), anxiety (d = −0.62), depression (d = -0.51), posttraumatic growth (d = 0.46), and psychological flexibility (d = 0.76). The drop-out rates in the ACT and MI were 25.76% and 39.71%, respectively. Participants in the ACT condition reported medium program satisfaction. The study suggests app-delivered ACT is efficacious in reducing PTSD symptoms and improving overall mental health among Chinese adults. • App-delivered ACT is effective in reducing PTSD symptoms and improving overall mental health among Chinese adults. • Mindfulness was also shown to be an effective brief treatment for alleviating psychological symptoms when used on its own. • Participants in the ACT condition reported high program satisfaction. [ABSTRACT FROM AUTHOR]

Asthma is a common disease that has a significant influence on patients' quality of life. Although Arabic tools for assessing symptom control and quality of life in individuals with asthma are available, no sufficient studies have evaluated the validity of these tools. Therefore, the aim of the current study was to validate the Arabic version of these tools. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on the Arabic versions of the Asthma Control Test (ACT) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ). A total of 314 participants (70.1 % females) were enrolled in the current study. The mean age of the participants was 51.47 (±16.37). EFA suggested a three-factor model for Mini AQLQ and a one-factor model for ACT, which was confirmed by CFA analyses. High correlations were found between spirometric values and ACT and Mini AQLQ scores, indicating good concurrent validity. The area under the curve produced by the Roc curve was 0.861 (p < 0.001), and the most suitable cut-off point was 4.741. All analyses conducted showed that the Arabic versions of both Mini AQLQ and ACT are reliable and valid and can be administered to adults with asthma. The application of these validated instruments will improve the management and diagnosis of asthma in Arab countries. [ABSTRACT FROM AUTHOR]

Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population. • Routine screening for distress and provision of self-help may be useful for those with visible difference. • ACT self-help interventions may lower social anxiety associated with visible difference. • This ACT-self-help intervention reduced functional impairment. • Seventy-seven percent of those who used this self-help intervention reported finding it helpful. [ABSTRACT FROM AUTHOR]

Nurses are at high risk of chronic stress. Tailored, evidence-based stress-management interventions may minimise absenteeism and staff turnover, whilst at the same time promoting good quality patient care. Current literature for nurse-focused stress-management interventions is varied in quality, with little focus on data-driven intervention development. This study explores how process measures related to Acceptance and Commitment Training (ACT) are associated with perceived stress and professional quality of life in nurses, in order to guide intervention development. A cross-sectional, online psychometric survey was implemented using LimeSurvey software. One-hundred and forty-two nurses were recruited from various specialties across four English National Health Service (NHS) Trusts. Questionnaires assessed demographic and work-related sample characteristics, ACT processes (mindfulness, acceptance, cognitive defusion, self-as-context, values and committed action), and four work-related wellbeing outcomes (perceived stress, burnout, compassion fatigue and compassion satisfaction). Correlation and regression models were used to analyse data. All six ACT processes negatively correlated with perceived stress, burnout and compassion fatigue, and positively correlated with compassion satisfaction (all p <.05). In regression models, these same processes explained significant variance for all outcomes (R 2 range = 0.36-0.61), above and beyond that explained by socio-demographic and work-related factors. Acceptance (β range: -.25 to -.55), mindfulness (β range: -.25 to -.39), and values-based processes (β range: -.21 to -.36) were frequent independent contributors to work-related wellbeing. This study demonstrates that the ACT framework provides a promising platform from which to develop nurse-focused stress-management interventions. Interventions focusing on acceptance, mindfulness, and values-linked processes may be most effective. • High perceived stress was associated with poorer professional quality of life. • ACT processes are associated with improved work-related wellbeing. • Acceptance, mindfulness and values are important in intervention development. [ABSTRACT FROM AUTHOR]

Background: Individuals with visible differences can experience appearance anxiety that is distressing and disruptive to daily functioning. Understanding psychological factors that maintain appearance anxiety related to scarring is important in developing theoretical understanding of adjustment to injury, and in identifying targets for psychological therapies. This study aimed to investigate whether psychological flexibility, a key element underpinning acceptance and commitment therapy (ACT), was associated with appearance anxiety. It was hypothesised that reduced psychological flexibility (lower acceptance, cognitive defusion, mindfulness, and committed action) would be related to increased appearance anxiety. The role of psychological flexibility in the maintenance of appearance anxiety was investigated using a cross-sectional quantitative questionnaire study.Method: Seventy-eight burns patients (47 female, 31 male; M age=45.2years) completed the Derriford Appearance Scale (DAS-24), the Acceptance and Action Questionnaire (AAQ-II), the Cognitive Fusion Questionnaire (CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Committed Action Questionnaire (CAQ-8).Results: As hypothesised, increased appearance anxiety was related to reduced acceptance (rs(76)=0.80, p<0.001, one-tailed) and cognitive defusion (rs(76)=0.76, p<0.001). Reduced levels of mindfully describing (r(72)=-0.39, p<0.001), acting with awareness (r(72)=-0.57, p<0.001), non-judging (r(72)=-0.61, p<0.001) and non-reactivity (r(72)=-0.28, p<0.01) as well as reduced committed action (r(72)=-0.57, p<0.001) were also related to increased appearance anxiety.Conclusions: Individuals experiencing appearance anxiety associated with a burn injury may struggle with accepting difficult emotions, stepping back from distressing thoughts, being mindful and engaging in valued action. These findings suggest that ACT may be useful in treating appearance related anxiety and concerns associated with conditions causing a visible difference. [ABSTRACT FROM AUTHOR]

Abstract Background/aims Prostate specific antigen (PSA) is regulated by steroid hormones, such as testosterone, the serum levels of which are altered in patients with Alzheimer's disease (AD).This pilot study compared serum levels of the free (f) PSA between AD, mild cognitive impairment (MCI), and control subjects, and evaluated the relationship between fPSA serum levels and cognitive assessment tests and neuroimaging data. In addition, in a subgroup of AD patients, we correlated fPSA serum levels with the existing data on serum levels of amyloid-beta (Aβ), and iron-related proteins, including hepcidin and ferritin. Methods Frozen serum samples from the Oregon Tissue Bank were used to measure serum levels of fPSA using enzyme-linked immunosorbent assay. Results fPSA serum levels calculated as median ± SD were higher in AD males (663.6 ± 821.0 pg/ml) compared to control males (152.0 ± 207.0 pg/ml), p = 0.003. A similar Pattern emerged when comparing MCI males (310.7 ± 367.0 pg/ml) to control males (P = 0.02). Correlation studies showed a significant association between fPSA and CDR (r = 0.56, P = 0.006) and CDR-SOB (r = 0.54, P = 0.009) in AD males. Conclusion Additional studies in a larger cohort are required for determining whether fPSA can be used as biomarker of AD disease progression and whether it has the potential to identify male subjects at risk of AD dementia. Highlights • We compared free prostate specific antigen (fPSA) between AD, MCI, and controls. • fPSA serum levels were significantly higher in male AD and MCI compared to their control counterparts. • fPSA serum levels correlated significantly with indicators of AD disease severity, including CDR and CDR-SOB. • Our data show the possible involvement of fPSA in AD pathology. • Future studies involving larger cohorts are warranted. [ABSTRACT FROM AUTHOR]

Objective To compare the incidence of bleeding and thrombosis between adult venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients managed with an activated clotting time (ACT)-guided heparin anticoagulation protocol and activated partial thromboplastin time (aPTT) protocol. Design Retrospective cohort study. Setting Tertiary care, academic medical center. Participants Consecutive adult VA ECMO patients during a 6-year period. Interventions None. Measurements and Main Results Demographic, medical, transfusion, and ECMO data were collected for all patients. Primary study outcomes were bleeding and thrombosis. Secondary outcomes were stroke and in-hospital mortality. One hundred twenty-one patients were included in the cohort. Fifty patients had ACT monitoring, and 71 had aPTT monitoring. There was no difference in the incidence of bleeding or thrombosis between the 2 groups (78.0% v 67.6% for bleeding [p = 0.21] and 16.0% v 19.7% for thrombosis [p = 1.0]). After adjusting for age and total ECMO days, patients managed with ACT received approximately 30% more red blood cell, fresh frozen plasma, and platelet transfusion (all p < 0.05). Conclusion There is no apparent difference in the incidence rate of bleeding or thrombosis between VA ECMO patients managed with an ACT- or aPTT-guided heparin anticoagulation protocol. Patients managed with an ACT-guided protocol received more blood transfusion, which could reflect greater total bleeding. Future randomized controlled trials would help to elucidate optimal anticoagulation strategies for VA ECMO patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Prior small-scale clinical trials showed that Artemisia annua and Artemisia afra infusions, decoctions, capsules, or tablets were low cost, easy to use, and efficient in curing malaria infections. In a larger-scale trial in Kalima district, Democratic Republic of Congo, we aimed to show A. annua and/or A. afra infusions were superior or at least equivalent to artesunate-amodiaquine (ASAQ) against malaria.Methods: A double blind, randomized clinical trial with 957 malaria-infected patients had two treatment arms: 472 patients for ASAQ and 471 for Artemisia (248 A. annua, 223 A. afra) remained at end of the trial. ASAQ-treated patients were treated per manufacturer posology, and Artemisia-treated patients received 1 l/d of dry leaf/twig infusions for 7 d; both arms had 28 d follow-up. Parasitemia and gametocytes were measured microscopically with results statistically compared among arms for age and gender.Results: Artemisinin content of A. afra was negligible, but therapeutic responses of patients were similar to A. annua-treated patients; trophozoites cleared after 24  h, but took up to 14 d to clear in ASAQ-treated patients. D28 cure rates defined as absence of parasitemia were for pediatrics 82, 91, and 50% for A. afra, A. annua and ASAQ; while for adults cure rates were 91, 100, and 30%, respectively. Fever clearance took 48  h for ASAQ, but 24  h for Artemisia. From D14-28 no Artemisia-treated patients had microscopically detectable gametocytes, while 10 ASAQ-treated patients remained gametocyte carriers at D28. More females than males were gametocyte carriers in the ASAQ arm but were unaffected in the Artemisia arms. Hemoglobin remained constant at 11 g/dl for A. afra after D1, while for A. annua and ASAQ it decreased to 9-9.5  g/dl. Only 5.0% of Artemisia-treated patients reported adverse effects, vs. 42.8% for ASAQ.Conclusion: A. annua and A. afra infusions are polytherapies with better outcomes than ASAQ against malaria. In contrast to ASAQ, both Artemisias appeared to break the cycle of malaria by eliminating gametocytes. This study merits further investigation for possible inclusion of Artemisia tea infusions as an alternative for fighting and eradicating malaria. [ABSTRACT FROM AUTHOR]

Sleep disturbances are a common health problem. New and more accessible alternatives are needed to improve the availability of psychological treatments for insomnia. The aim of the present study was to investigate the effects of a self-help Acceptance and Commitment Therapy-based web-intervention for sleep disturbances. Participants (N = 86) reporting symptoms of insomnia were randomly assigned to an Internet-delivered ACT (iACT, n = 43) or a control condition (WLC, n = 40) and assessed with standardized self-report measures related to sleep (ISI, BNSQ, ESS, DBAS), psychological symptoms (BDI-II, SCL-90), life satisfaction, and ACT-related processes (AAQ-2, FFMQ, and WBSI) at pre- and post-measurement, and at 6-month follow-up (iACT group only). Participants in the study condition received a 6-week Internet intervention based on the processes of ACT, enhanced with weekly automated email-based reminders. No therapist support was offered during the intervention. Hierarchical linear modeling analysis showed significant differences between the treatment and the control group in sleep quality and duration (BNSQ), sleep-related dysfunctional cognitions (DBAS), and severity of depressive symptoms (BDI-II) from Pre to Post-measurement in favor of the intervention group. The intervention showed also significant positive impact on thought suppression (WBSI), but no effect on general psychological flexibility and mindfulness. The between group effect sizes at Post were moderate or small (d = 0.21–0.53). In the iACT group, changes achieved in sleep quality and duration, symptom measures and suppression of thoughts during the intervention were maintained during the 6-month follow-up period. We conclude that unguided Internet-delivered Acceptance and Commitment Therapy can be effective in treating symptoms of insomnia and offers a useful addition to existing treatment options. • Internet-delivered self-help ACT improved quality and duration of sleep. • Positive impact was observed in dysfunctional beliefs and attitudes about sleep. • At 6-month follow-up, results were maintained. • Internet-delivered self-help ACT may be effective for sleep disturbances. [ABSTRACT FROM AUTHOR]

Acceptance is an important construct across models for understanding psychological distress. Several measures have been designed to capture this, however, there is a lack of evidence regarding the most suitable tool. The objective of this review was to systematically evaluate measurement properties of tools designed to measure self-reported acceptance. A systematic review of the literature on psychometric properties of acceptance measures was performed. Articles were selected if the primary aim was to develop or evaluate measurement properties (validity, reliability, responsiveness) of a self-report acceptance scale (or subscale). The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of measurement properties were evaluated using criteria suggested by Terwee et al. (2007). All studies were independently reviewed by two raters, and inter-rater reliability was assessed. The search strategy identified 3097 unique articles. Twenty articles, reporting 32 studies, met inclusion criteria. Nine instruments were identified; two unidimensional scales of acceptance, four mindfulness tools with an acceptance subscale, and three emotion regulation scales with an acceptance-based subscale. None of the instruments were assessed across all domains of psychometric properties. No studies investigated measurement error or cross-cultural validity. Internal consistency was the most widely assessed property, and was generally acceptable across all scales. Lack of target population involvement resulted in poor content validity for most scales. Inter-rater reliability of study selection and evaluation was excellent. There are important conceptual differences across current acceptance measures, which might result from differences in theoretical models on which these are based. None of the measures evaluated can be recommended as having superior psychometric properties. Important limitations in content validity need to be addressed, with greater involvement of target populations. Further research is required to demonstrate the psychometric properties of existing measures, given their significant role in evaluating acceptance-based interventions across clinical and research settings. • Acceptance is defined differently across theoretical models. • Acceptance and experiential avoidance may not be polarities of a single construct. • Poor content validity might result from lack of target population involvement. • Weaknesses in psychometric properties of tools may impede intervention evaluations. • There is insufficient evidence to recommend a superior tool to measure acceptance. [ABSTRACT FROM AUTHOR]

Acceptance and Commitment Therapy has not been evaluated for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) to date. However, recent studies indicate the importance of psychological flexibility for well-being in this condition. The present study is a preliminary evaluation of the feasibility of an ACT-based behavior medicine treatment protocol for ME/CFS. 40 adult individuals, fulfilling the 1994 Centers for Disease Control and Prevention and the 2003 clinical case criteria for ME/CFS, consecutively started an individual 13-session ACT-treatment. Data were collected pre-treatment, mid-treatment, post-treatment, and at 3- and 6-month follow-ups. Linear mixed effects modeling was used to analyze treatment effects on ME/CFS-related disability, psychological flexibility, ME/CFS symptoms, anxiety, depression and health-related quality of life. 80% (32) of the participants completed the treatment. ME/CFS-related disability (d = 0.80, p <.001) and psychological flexibility (d =1.07, p <.001) improved between pre- and post-treatment and remained stable between follow-ups. Similar results were found for secondary outcomes. Results indicate that the treatment was accepted by the participants, with a small drop-out rate and was safe with no harmful effects during or after treatment and also efficient with stable improvements in numerous outcomes. • First trial of ACT for patients diagnosed with ME/CFS. • ACT can be considered safe and preliminary effective. • Changes in psychological flexibility are related to improvements. [ABSTRACT FROM AUTHOR]

We examined the effect of a brief Acceptance and Commitment Therapy (ACT) based intervention for eighteen parents of children with autism compared to a matched randomized control group. The treatment group demonstrated statistically significant improvements (p < 0.05) and large effect sizes on six of eight self-report measures following treatment, including the Acceptance and Action Questionnaire-II (p = 0.0318, d= 0.94), Beck Depression Inventory-II (p = 0.0239, d= −1.01), Cognitive Fusion Questionnaire-13 (p = 0.0485, d= 0.83), Mindful Attention Awareness Scale (p = 0.007, d= 1.29), Internalized Shame Scale (p = 0.0052, d= −1.37), Personal Values Questionnaire-II (p = 0.0159, d= 1.11), White Bear Suppression Inventory (p = 0.1732, d= 0.46), and Frieburg Mindfulness Inventory (p = 0.2506, d= 0.32). These results suggest that a brief ACT-based intervention may be efficacious in treating the psychological challenges of parents of children with autism. • Interventions for parents= of a child with autism often focus on parent-child interactionshealth. • Parents of children with autism benefitted from an ACT intervention. • Brief ACT interventions that require fewer resources may be efficacious. [ABSTRACT FROM AUTHOR]

Abstract Feed-in tariffs offer renewable energy developers investor certainty but often at the cost of overly generous subsidisation. Reverse feed-in tariff auctions can overcome this problem but can be adversely affected by non-delivery risks, high auction costs and locational concentration. Between 2012 and 2016, the Australian Capital Territory Government in Australia conducted reverse auctions for the feed-in tariff rights to 640 MW of large-scale solar or wind generating capacity, the first such reverse auction program undertaken in the country. The auctions were used to meet a 100% by 2020 renewable electricity target. The auctions came to be assessed on a number of criteria, including local engagement and economic returns, rather than being narrowly focused on delivery risk and feed-in tariff price. Although the auction's successful projects were relatively concentrated, the auctions were successful in delivering significant local economic benefits as well as decreasing average feed-in tariff prices that declined by 23% for wind and 58% for solar over the period of the auctions driven, in part, by lower internal rates of return and lower interest rates. The delivery of projects and project commitments, and potential locational concentration, are key challenges that other reverse auction users may face. Highlights • Evolution of the reverse auction process in the Australian Capital Territory. • Feed-in tariff reverse auction design options. • Analysis of the outcomes of the first Australian feed-in tariff reverse auction program. • Identification of internal rates of return and debt costs as main drivers of reduced auction wind feed-in tariff prices. • Identification of capital costs and capacity factors as the main drivers of reduced auction solar feed-in tariff prices. [ABSTRACT FROM AUTHOR]

Abstract Disasters, whether natural or man-made, remain a major challenge to achieving global sustainability. Findings show that Nigeria is prone to disasters such as destructive storms, desertification, drought and flood. It is generally recognized that there is the need to advance policies and practices to reduce the risk of disasters, and one way to reduce such risks is to ensure that laws are put in place to ensure effective integration of DRR (Disaster Risk Reduction) policies in disaster management processes. Many nations have accordingly formulated disaster management laws and are using same in their countries. As nations search for solutions to challenges facing sustainability, such laws need to be subjected to critical appraisals from time to time. It is against this background that this study carried out an appraisal of Nigeria's NEMA (National Emergency Management Agency) Act with a view to ascertaining its effectiveness and efficiency in dealing with disasters in the country. It was observed that the Act focuses more on establishment and functioning of the nodal agency (NEMA) for disaster management rather than on development of action plans for mitigating or preventing or minimizing the risks of disasters in the country. It was further discovered that the Act lacks a clear-cut direction on resource mobilization for disaster management by the stakeholders and also does not confer on the nodal Agency the power to compel other government and private agencies to integrate disaster risk reduction in their operations. The Act, therefore, should be reviewed to ensure centrality in the coordination of disaster management by stakeholders, empower the nodal agency to be more proactive than reactive in its operations and also to guarantee that funding of disaster management operations becomes the responsibility of all stakeholders in the country. [ABSTRACT FROM AUTHOR]

In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures. [ABSTRACT FROM AUTHOR]

Abstract Delay discounting describes the tendency to select smaller-sooner rewards over larger-later rewards, which has been proposed as a behavior analytic model of impulsivity. Framed in this way, impulsivity is problematic because it results in the sub-optimization of rewards and is related to several addictive behaviors. The present study evaluated the efficacy of a brief, 5-min mindfulness exercise on participants' momentary state impulsivity using a monetary delay discounting questionnaire. Twenty-three participants were randomly assigned to either an experimental (n = 11) or control group (n = 12). Both groups completed delay discounting surveys before and after their respective interventions, where the experimental group watched a brief mindful breathing video and the control group watched a contemporary music video of approximately the same duration. Decreases in impulsive responding were seen in the experimental group and no significant changes were observed in the randomized control group. These results have implications for applying brief mindfulness-based strategies that can reduce the probability of impulsive choice behavior. Highlights • A contextual model of delay discounting is proposed. • Impulsivity is altered when exposed to mindfulness training. • State theories of impulsivity are supported. [ABSTRACT FROM AUTHOR]

Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis extracorporeal circuit and optimize hemodialysis adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated partial thromboplastin time, activated clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis. [ABSTRACT FROM AUTHOR]

Violence against women with disabilities is a difficult situation to detect and requires a multidisciplinary approach. The objective is to identify the needs and deficiencies in the care and treatment of cases of violence against women with disabilities in order to develop strategies for improvement. 295 professionals participated in the Women and Disability Conference, organised by the Spanish CERMI in 2019, in three locations in the Castilla-León Community. This is a qualitative study with focus groups. The information was analysed and coded, creating four categories: identification, detection, action and prevention. All types of violence are found. There is little information about this situation. The participants propose to guarantee help based on trust, listening and individuality. Professionals show a good knowledge of the problem. There is a lack of preventive programmes, coordination between the bodies involved, a mediator to accompany the process and comprehensive support to achieve social inclusion. [ABSTRACT FROM AUTHOR]

Like most countries in sub-Saharan African countries, Benin continues to bear a heavy malaria burden. In 2014, the National Malaria Control Programme (NMCP) changed its treatment policy, and recommended the use of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated Plasmodium falciparum cases. The study presented here was conducted to investigate the impact of current antimalarial drug resistance on the country. Molecular surveillance targeting the Pfcrt , Pfmdr1, Pfkelch13 , dhfr , and dhps genes was carried out on samples from patients positive for P. falciparum malaria by microscopy, LAMP and PCR diagnostic test. Molecular analysis was performed using targeted amplicon deep sequencing (TADS). In addition, the frequency of parasites with dual deletion of the histidine-rich protein 2 and 3 genes (pfhrp2 and pfhrp3), known to be responsible of the performance of HRP-based malaria rapid diagnostic tests (HRP-RDT), was estimated. Fifty-three falciparum samples collected at the Saint Jean de Dieu hospital in Tanguiéta, Benin, were tested. No Pfkelch13 validated or candidate artemisinin partial resistant variants were identified. A marked prevalence of Asn51Ile (N51I), Cys59Arg (C59R), and Ser108Asn (S108N) mutant alleles was found in the dhfr gene, representing the most frequent genotype (64%). Five-point mutations were detected in dhps , Ile431Val (I431V), Ser436Ala (S436A), Ala437Gly (A437G), Ala581Gly (A581G), Ala613Ser (A613S) of which the third was the most common (92%). No mutation was identified in dhps Lys540Glu (K540E). The quintuple mutant genotype resulting from the combination of the dhfr triple mutant (51I/59R/108N) with the dhps double mutant 436A/437G was detected at a frequency of 30%. Low levels of mutations in Pfcrt and no mutation at codon 86 in the Pfmdr1 DNA fragment were observed, whereas a high level of Tyr184Phe (Y184F) polymorphism in the Pfmdr1 gene was found. These results could be indicative, over a decade after the implementation of ACT therapy, of the return of chloroquine-sensitive but artemether-lumefantrine resistant falciparum genotypes in Benin. There was no evidence of HRP2 and HRP3 deletions. Data from the present study support the need for routine monitoring of molecular markers of antimalarial drug resistance as part of surveillance activities aimed to make informed treatment policy decisions at the national level. [ABSTRACT FROM AUTHOR]

Abstract This study is the first to examine relations between general intelligence (g), non- g factors, and theory of mind (ToM) using structural equation modeling with multiple indicators of g and ToM. g was based on the subtests of the ACT, a college admissions test that is strongly g loaded, and ToM was based on the Reading the Mind in the Eyes Test and the Short Story Test (SST). g correlated strongly with a latent ToM factor (β =.65) and moderately with the two ToM tests (β ≈.34), which correlated modestly with each other (β =.27). The modest correlation between the ToM tests indicates that g predicted a small amount of variance among the ToM tests (7%) and suggests that the ToM tests had little in common. In addition, non- g residuals of the ACT subtests, obtained after removing g , correlated negligibly with the ToM factor and the ToM tests (|β| < 0.06). Similar results were obtained for the ToM residuals, which correlated trivially with the ACT subtests. The trivial non- g effects suggest that g -ToM relations were attributable to "not much more than g." The results replicated with different combinations of ACT subtests, controls for possible confounds (reading comprehension on the SST), and another college admissions test (the SAT). The use of a convenience sample (college students) and the limited measures of g and ToM are discussed as limitations. Future research should examine the robustness of effects using different measures of g and ToM and also examine possible mediators of g -ToM relations (e.g., executive functions). Highlights • The study examined relations among g , non- g factors, and theory of mind (ToM). • A g based on the ACT correlated strongly with a ToM factor (β = 0.65). • However, the shared variance among ToM tests was small (7%). • Non- g residuals of the ACT and ToM tests had negligible effects (|β| < 0.06). • The results suggest that g -ToM relations are attributable to "not much more than g." [ABSTRACT FROM AUTHOR]