NEUROELECTRIC THERAPY (NET) IN ADDICTION DETOXIFICATION

NeuroElectric Therapy (NET) is a benign and rapid, non-pharmacological detoxification treatment for the chemical dependent, either in-patient or out-patient, using very small amounts of electric current transcranially, with electtodes applied above the mastoid process. The pocketsize stimulator is used continuously for 7 to 10 days (3-4 days for nicotine), without supplementary drugs. Within this treatment period it eliminates the acute symptoms and also ameliorates the Chtonic Withdrawal Syndrome, which otherwise could last 18 months or longer, to a very substantial degree. By the end of treatment, 95% of 102 consecutive patients claimed they were free of craving, 75% that they were free of anxiery. NET has a reported drop-out rate of 1.6% over a period of seven years. The basis of this therapeutic success has been the marriage of precision clinical techniques to highly specific combinations of electrical current parameters, both developed over 20 years of reported clinical and research work. It is suggested that the mechanism of action may be the rapid restoration to normal of abnormal neurotransmitter levels by specific electrical signals. Clinical treatments and double-blind studies are briefly described and reviewed, with new data on sleep effects

The importance of interdisciplinary frameworks in social media mining: An exploratory approach between Computational Informatics and Social Network Analysis (SNA)

Social media content is one of the most visible sources of big data and is often used in health studies to draw inferences about various behaviors. Though much can be gleaned from social media data and mining, the approaches used to collect and analyze data are generally strengthened when examined through established theoretical frameworks. Health behavior, a theory driven field, encourages interdisciplinary collaboration across fields and theories to help us draw robust conclusions about phenomena. This pilot study uses a combined computer informatics and SNA approach to analyze information spread about mask-wearing as a personal mitigation effort during the COVID-19 pandemic. We analyzed one week’s worth of Twitter data (n = 10,107 tweets across 4,289 users) by using at least one of four popular mask-support hashtags (e.g., #maskup). We calculated network-measures to assess structures and patterns present within the Twitter network, and used exponential random graph modeling (ERGM) to test factors related to the presence of retweets between users. The pro-mask Twitter network was largely fragmented, with a select few nodes occupying the most influential positions in the network. Verified accounts, accounts with more followers, and those who generated more tweets were more likely to be retweeted. Contrarily, verified accounts and those with more followers were less likely to retweet others. SNA revealed patterns and structures theoretically important to how information spreads across Twitter. We demonstrated the utility of an interdisciplinary collaboration between computer informatics and SNA to draw conclusions from social media data

Incorporating a Sense of Community in a Group Exercise Intervention Facilitates Adherence

Participant attrition is detrimental for exercise intervention studies, particularly if dropout is not random. Community engagement has helped facilitate participant adherence, which is particularly applicable for group exercise programs. Developing a sense of community (SOC) helps participants feel that they belong and provides ongoing social support. This paper reports on strategies used during an 11-week high intensity functional training (HIFT) intervention with exceptionally high adherence (96.7%) that involved 30 participants (57% women, age 36.7 ± 4.5 years). Participants recorded their heart rate variability using a smartphone app daily throughout the study, completed three different weeks of fitness assessments, and attended six weeks of five days/week HIFT group exercise sessions led by a certified coach. Coaches used strategies to facilitate group interactions and individual feedback and engagement. Participants completed a follow-up survey that included 14 items from the SOC in sport scale (SCS), eight questions about group dynamics, and three open-ended study feedback questions that were coded using the SOC categories. All SCS items were highly rated (mean range = 4.51-4.93/5) as were the group dynamics items (mean range = 4.30-4.85/5). Common interests were the most mentioned SOC category in open-ended responses, and while the participants reported really enjoying the study, they provided constructive feedback for improving future studies. Using specific strategies to facilitate a SOC in exercise intervention research (e.g., group exercise, social media connections, and facilitating participant interactions) are recommended for both researchers and practitioners to avoid attrition and encourage adherence, particularly for programs with high daily participant burden

Process Evaluation of a Pilot Physical Activity and Social-Emotional Learning Curriculum Implemented in a Summer Care Program for Child and Adolescent Girls

Physical activity (PA) and social-emotional learning (SEL) are critical for healthy development, yet few programs have evaluated integrated promotion efforts within out-of-school summer contexts. The EmpowerHER program was piloted in a summer care program for girls. This study aimed to conduct a process evaluation, assessing the program\u27s fidelity to curriculum design and theory to make recommendations for continuous program improvement. The EmpowerHER curriculum was tailored towards girls (n=11, 10-14 years old) and implemented through a community summer care program. The 8-week program consisted of 90-minute sessions conducted twice per week during the summer of 2023 in Texas, USA. Fidelity was evaluated using the System for Observing Fitness Instruction Time (SOFIT), which characterized participant PA levels, lesson context, social interactions, and instructor interactions. Participants wore ActiGraph GT9X accelerometers to measure PA and completed surveys to assess perceptions of activities. SOFIT observations revealed varying levels of PA across sessions, with peaks in Sessions 4 (26%) and 5 (12%). Accelerometer data showed higher light PA (M=18.3±6.1 min) compared to moderate-to-vigorous PA (M=9.6±4.9 min) per session. Surveys indicated high enjoyment (M=4.6±0.3), learning (M=4.1±0.1), and perceived PA engagement (M=4.5±0.2). Participants expressed preferences for interactive activities and more gym time. Triangulating multi-method process data enabled nuanced optimization of intervention components session-by-session. The curriculum balanced educational components with PA opportunities, but would benefit from more consistent PA. Positive social interactions and participant feedback highlighted the program\u27s potential to enhance SEL. Future iterations should prioritize activities that foster positive relationships and maximize PA

An Observational Analysis of ‘Me Too’ Narratives from YouTube

The ‘me too’ movement originated to help survivors of sexual violence by providing resources and building a community of advocates to exemplify the magnitude of sexual violence victimization. This movement gained momentum via Twitter due to the viral hashtag—#metoo. YouTube is often used as a means of expression in younger generations, thus sexual violence survivors began using the platform as a way to disseminate ‘me too’ narratives. Therefore, this study aimed to examine how sexual violence narratives resulting from the ‘me too’ movement are being told on YouTube and understand the components of the narratives related to self-blaming mindsets. Based on predetermined search criteria, researchers identified and screened YouTube videos of people sharing ‘me too’ narratives, and developed themes and codes (e.g., type of violence, perpetrator characteristics). Descriptive statistics and a logistic regression were conducted using demographic, experience, and attitudinal data to predict self-blaming mindsets. Sixty-two YouTube videos were included, consisting of 96 individual ‘me too’ stories. The sample was mostly female, and perpetrators were predominately strangers. The model explained 19.3% of the variance in self-blaming attitudes. Odds of self-blaming rose 4.589 times for those who experienced sexual harassment, and 6.109 times for those who experienced rape. If the perpetrator was not mentioned in the video, odds of self-blaming dropped by 89.4%. This study suggests self-blaming beliefs are prominent among victims, even when they have the space to share their story. Overall, our findings support the continued need for further education and support for victims

Adherence to physical activity guidelines associated with self-care management and self-regulatory efficacy for type 2 diabetes among Black/African American men

Background: Existing literature primarily focuses on predominantly Caucasian populations, creating a gap in understanding the factors influencing physical activity (PA) adherence and self-care behaviors specifically in Black/African American men with Type 2 diabetes (T2D), a group disproportionately affected by the condition. This study aimed to examine the relationship between adherence to PA guidelines, self-care management and self-regulatory efficacy for T2D among Black/African American men. Methods: Cross-sectional data from 1225 Black/African American men with T2D were analyzed, with adherence to PA guidelines defined as 450 Metabolic Equivalent of Task (MET)-minutes/week or more. Self-care management and self-regulatory efficacy were measured using validated questionnaires. Results: Descriptive statistics, bivariate analyses and logistic regression models were used to analyze the relationships between PA adherence, self-care management and self-regulatory efficacy. The average of participants’ age was 41.9 years old (±14.5), and number of chronic conditions was 2.5 (±1.9). Participants who adhered to PA guidelines demonstrated significantly higher self-care management and self-regulatory efficacy compared to non-adherents. Younger participants (aged 21–40) reported an average of 4.33 days per week of self-care management, while middle-aged and older participants (aged 40 and above) reported 4.42 days. Non-adherents across all age groups reported lower self-care management and self-regulatory efficacy scores. Logistic regression analysis revealed that self-regulatory efficacy, age, Body Mass Index (BMI) and employment status were significant predictors of PA adherence. Higher self-regulatory efficacy is associated with improved confidence in managing T2D, making individuals more likely to engage in regular PA, which is essential for effective diabetes management. Conclusions: Targeted interventions to enhance self-regulatory efficacy and promote PA adherence, particularly tailored to address barriers faced by younger and unemployed individuals, could have substantial benefits for diabetes self-management

Evaluating the effects of increasing physical activity to optimize rehabilitation outcomes in hospitalized older adults (MOVE Trial): Study protocol for a randomized controlled trial

Background: Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge. Physical activity levels in rehabilitation are also low. It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation will lead to better mobility outcomes at discharge. Methods/Design: A single blind, parallel-group, multisite randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. The cost effectiveness of the intervention will also be examined. Older people (age >60 years) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals. A computer-generated blocked stratified randomization sequence will be used to assign 198 participants in a 1:1 ratio to either an 'enhanced physical activity' (intervention) group or a 'usual care plus' (control) group for the duration of their inpatient stay. Participants will receive usual care and either spend time each week performing additional physical activities such as standing or walking (intervention group) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games (control group). Self-selected gait speed will be measured using a 6-meter walk test at discharge (primary outcome) and 6 months follow-up (secondary outcome). The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge. Additional measures of mobility (Timed Up and Go, De Morton Mobility Index), function (Functional Independence Measure) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up. The trial commenced recruitment on 28 January 2014. Discussion: This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000884707(Date of registration 08 August 2013); ClinicalTrials.gov Identifier NCT01910740(Date of registration 22 July 2013)

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Assessing learners through the WWW

This presentation discusses and demonstrates use of the WWW to enhance assessment and flexibility in learning contexts. Case studies from Australian Universities demonstrate emerging practices and reflections. Adopted changes to interaction and assessment illustrate the shift towards flexible learning through WWW technology. Discussion includes instructional design, staff development and media/technology issues