Post-exercise pulse pressure is a better predictor of executive function than pre-exercise pulse pressure in cognitively normal older adults

Exercise “stress tests” are widely used to assess cardiovascular function and to detect abnormalities. In line with the view of exercise as a stressor, the present study examined the relationship between cognitive function and cardiovascular activity before and after light physical exercise in a sample of 84 non-demented community-dwelling older adults. Based on known relationships between hypertension, executive function and cerebral white matter changes, we hypothesized that greater post-exercise reactivity, as indexed by higher pulse pressure, would be more related to worse performance on frontal-executive tasks than pre-exercise physiologic measures. All participants were administered a comprehensive neuropsychological battery and underwent a Six Minute Walk Test (6MWT), with blood pressure (BP) measures obtained immediately before and after the walk. Pulse pressure (PP) was derived from BP as an indicator of vascular auto-regulation and composite scores were computed for each cognitive domain assessed. As predicted, worse executive function scores exhibited a stronger relationship with post-exercise PP than pre-exercise PP. Results suggest that PP following system stress in the form of walking may be more reflective of the state of vascular integrity and associated executive dysfunction in older adults than baseline physiologic measures.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.     

Developing skills in counselling and psychotherapy: a scoping review of Interpersonal Process Recall and Reflecting Team methods in initial therapist training

The authors conducted a scoping review of the peer-reviewed literature associated with Interpersonal Process Recall (IPR) and Reflecting Team (RT) methods in order to find evidence for their use within skills development in therapist trainings. Inclusion criteria were: empirical research, reviews of empirical research, and responses to these; RT or IPR for skills development in counsellors/psychotherapists undertaking initial training. Six papers were identified (four IPR, two RT), all from the USA. Of the four IPR papers, three were themselves reviews, the fourth empirical paper being of poor methodological quality. There was some evidence that IPR is more valuable in developing reflective practice than in initial skills training. The small number of RT studies, of varying methodological quality, made it difficult to draw any conclusions about the appropriateness of this method for initial skills training. However, the method appeared to have been broadly welcomed by students for its potential to be inclusive and collaborative. The limitations of this current review are acknowledged, and research recommendations made.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

先天易的数学基础初探——试论先天卦序与二进位制

本文从自然数及其记数法的基本慨念出发。辨析了与二进位制相关的几个容易混淆的概念,指出序数概念的引入在近代数学发展中有重要意义。作为邵雍数学学派的数学基础,先天易是数学史上第一个专门定义的序数体系,该序数体系在数学史上率先采用了二进位制记数法。先天易作为二进制序数体系这一事实在明清时期引起不同的反响,反对者认为它使易道沦落,大数学家汪莱则从P进制的角度论证它的优越性。本文最后还对近年来反对先天易与二进制有关的两种典型观点进行了剖析．指出其谬误所在。     

Ethical and Professional Challenges Posed by Patients with Genetic Concerns: A Report of Focus Group Discussions with Genetic Counselors, Physicians, and Nurses

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517–522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts; directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.     

Who Is Referred to Mental Health Services in the Juvenile Justice System?

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth's sociodemographic, criminal history, and clinical characteristics.     

The value of forgetting suicidal thoughts and behavior

This is a prospective longitudinal study examining recollections of suicidal content and correlates of accurate and inaccurate recollection. A primarily at-risk group of young adults (N = 78) who were initially assessed for suicidal ideation and behavior in adolescence, were asked to recall whether they had reported sui- cidal ideation or behavior about six years earlier. In recalling the previous inter- view, the majority of the participants provided consistent reports. However, with regard to those who had previously reported suicidal ideation or behavior, 38% failed to recall prior adolescent suicidal reports. Those who provided accurate reports of prior suicidal content were more symptomatic and were functioning more poorly than those who failed to recall past suicidal content. The implications for clinical assessment practices, research, and theory development are discussed.     

Establishing and Evaluating the Substantive Adequacy of Positive Behavioral Support Plans

The Individuals with Disabilities Education Improvement Act (2004) renewed the commitment to provide positive behavioral support (PBS) for students that engage in persistent problem behavior. Behavior intervention plans (also known as PBS plans) serve as legal documents that help guide the implementation of intervention strategies to encourage more positive forms of behavior. The purpose of this study was to evaluate the substantive adequacy of PBS plans developed for special education students. This was accomplished by documenting the content of plans developed by two different groups of educators using a rating instrument based on the key concepts of PBS planning. Results revealed that the majority of plans developed by teams without identified training and expertise in PBS were rated as substantively inadequate, lacking critical information related to effective behavioral support planning. The implications of the results for everyday practice in the schools and directions for future research are discussed.