bluuebunny/crossref_metadata_2025 huggingface dataset:
Migraine in Women
Authors: Bobker Sarah , Klebanoff Louise , Broner Susan
Published: December 2017

Migraine is one of the most common neurological disorders, affecting women disproportionally at a rate of 3:1. Prior to puberty, boys and girls are equally affected, but the female preponderance emerges after puberty. Migraine pathophysiology is not fully understood, and although the hormonal effect of estrogen is significant, other factors are at play. This article will focus on the hormonal influence on migraine in women. Here we review our most recent understanding of migraine and menstrual migraine, including epidemiology, pathophysiology, and treatment strategies for this challenging disorder, as well as migraine during pregnancy, postpartum period, breastfeeding, perimenopause, and menopause. We also review the risks and benefits of exogenous hormone use in this population and discuss stroke risk in women with migraine aura. By understanding these aspects of migraine in women, we hope to arm practitioners with the knowledge and tools to help guide treatment of this debilitating disorder in this large population.
Delivery of a Personalized Treatment Approach to Women with Epilepsy
Authors: Pennell Page , Voinescu P.
Published: December 2017

Personalized treatment for women with epilepsy is essential, and requires thorough weighing of the risks and benefits of the initial diagnostic and therapeutic options chosen, with readjustments of the antiepileptic regimen throughout the patient's life.

Approximately one-third of women with epilepsy have a catamenial pattern, and the most common pattern is an increase in seizure frequency in the perimenstrual phase. These women are also more likely to experience a decrease in seizure frequency during pregnancy and menopause. A good treatment option for catamenial epilepsy is still lacking.

For contraception, an intrauterine device is currently the preferred choice. Prior to conception, it is advisable to review the known impact of different antiepileptic drugs on the developing fetus and to optimize the patient's treatment regimen. Pregnancy registries and observational studies have provided key data and continue to refine our understanding of the risks to the structural and cognitive development of the fetus of specific antiepileptic drugs, including polytherapies and newer medications. Different studies consistently report that valproic acid has notably high relative risks for congenital malformations, lower IQ, and features of autism. During pregnancy, there is growing evidence that therapeutic dose monitoring is beneficial for seizure control. Counseling about seizure safety and minimizing provoking factors during the peripartum period is important for the patient with epilepsy.

Clinical studies continue to investigate the complex relationship between cycling sex steroid hormones, epilepsy, and antiepileptic medications, with hopes to better explain drug clearance changes during pregnancy, changes in seizure frequency, and neuroendocrine abnormalities. Thorough understanding of these key factors and a continuous review of literature for updated data on different treatment options will enable optimal treatment recommendations that will improve the health of women with epilepsy and their children.
Stroke in Pregnancy
Authors: Feske Steven , Sells Christina
Published: December 2017

Pregnancy and the postpartum period confer an increased risk of stroke. The risk appears to be increased for all strokes during the puerperium and for hemorrhagic strokes during pregnancy. During pregnancy, physiologic systems are under increased stress to accommodate the growing fetus, which results in substantial hemodynamic, cardiovascular, hematologic, immunologic, and structural connective tissue changes that account for much of this increased risk. In addition, preeclampsia–eclampsia has major effects on the vascular system, and this disorder, unique to pregnancy, is another major contributor to this risk. The common independent vascular risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, and smoking, may also be present to contribute to the risks conferred by pregnancy. Though uncommon, stroke during pregnancy and in the postpartum period causes substantial morbidity and mortality in affected women, and it poses a significant risk to the fetus. This review will discuss the epidemiology of pregnancy-associated stroke, specific risk factors and mechanisms, clinical presentation and management, and future directions.
Subcutaneous Injection of Oxyfluorfen Herbicide to the Forearm: Case Report
Authors: Couceiro José , Garcia-Portal Gonzalo , Garcia Olga
Published: December 2017

Background Oxyfluorfen, a commercially available pesticide, commonly used for weed control in crop production, has been studied in terms of its toxicity, its carcinogenic properties, and its teratogenicity. We have found no reports, however, of the effects produced by an oxyfluorfen injection to the upper limb.

Methods We present the case of a 40 years old psychiatric patient, who reportedly injected her forearm accidentally while fumigating her garden. She was treated with irrigation and open forearm fasciectomy.

Results At 6 months, the patient had some tenderness at the scar; she wanted no further procedures done.

Conclusion Oxyfluorfen appeared to produce a chemical burn to the forearm tissues including the fascia, removal of the chemical product, and a limited fasciectomy, resulted in a favorable outcome.
Three Mutations in the Bilateral Frontoparietal Polymicrogyria Gene GPR56 in Pakistani Intellectual Disability Families
Authors: Sawal Humaira , Harripaul Ricardo , Mikhailov Anna , Vleuten Kayla , Naeem Farooq , Nasr Tanveer , Hassan Muhammad , Vincent John , Ayub Muhammad , Rafiq Muhammad
Published: December 2017

Bilateral frontoparietal polymicrogyria (BFPP, MIM 606854) is a heterogeneous autosomal recessive disorder of abnormal cortical lamination, leading to moderate-to-severe intellectual disability (ID), seizure disorder, and motor difficulties, and caused by mutations in the G protein–coupled receptor 56 (GPR56) gene. Twenty-eight mutations in 40 different families have been reported in the literature. The clinical and neuroimaging phenotype is consistent in these cases. The BFPP cortex consists of numerous small gyral cells, with scalloping of the cortical–white matter junction. There are also associated white matter, brain stem, and cerebellar changes. GPR56 is a member of an adhesion G protein–coupled receptor family with a very long N-terminal stalk and seven transmembrane domains. In this study, we identified three families from Pakistan, ascertained primarily for ID, with overlapping approximately 1 Mb region (chr16:56,973,335–57,942,866) of homozygosity by descent, including 24 RefSeq genes. We found three GPR56 homozygous mutations, using next-generation sequencing. These mutations include a substitutional variant, c.1460T > C; p.L487P, (chr16:57693480 T > C), a 13-bp insertion causing the frameshift and truncating mutation, p.Leu269Hisfs*21 (NM_005682.6:c.803_804insCCATGGAGGTGCT; Chr16: 57689345_57689346insCCATGGAGGTGCT), and a truncating mutation c.1426C > T; p.Arg476* (Chr16:57693446C > T). These mutations fully segregated with ID in these families and were absent in the Exome Aggregation Consortium database that has approximately 8,000 control samples of South Asian origin. Two of these mutations have been reported in ClinVar database, and the third one has not been reported before. Three families from Pakistan with GPR56 mutations have been reported before. With the addition of our findings, the total number of mutations reported in Pakistani patients now is six. These results increase our knowledge regarding the mutational spectrum of the GPR56 gene causing BFPP/ID.
Das zeigt der Romberg-Test
Authors: Dolch Lisa
Published: December 2017

Assessments sind objektive standardisierte Testverfahren, mit denen sich in der Physiotherapie die Situation des Patienten beurteilen
lässt. Sie liefern Hinweise für die Optimierung und weitere Therapieplanung. Die AG Akademisierung stellt im VPTMAGAZIN valide Tests
steckbriefartig vor.
Comparison of Optic Disc Parameters in Hyperopic and Emmetropic Eyes of Healthy Children with HRT and OCT
Authors: Wenner Yaroslava , Brauer Vanessa , Kunze Kira , Besgen Volker , Kuhli-Hattenbach Claudia , Bertelmann Thomas , Sekundo Walter
Published: December 2017

Purpose To investigate, through Heidelberg retina tomography II (HRT II) and RTVue-100 optical coherence tomography (OCT), normal parameters of the optic nerve head (ONH) in highly hyperopic children, and compare these with a group of children with low hyperopia and emmetropia, as fundus examination of highly hyperopic children often shows crowding of the optic disc, which may be difficult to distinguish from mild optic disc swelling.

Patients and Methods ONH of the higher hyperopic eye was examined with HRT II and the peripapillary nerve fiber layer (RNFL) with RTVue-100, in 6 to 15-year-old full-term children with normal visual acuity and spherical equivalent ≥ + 3.0 D (hyperopic group) and < + 3.0 to − 1.0 D (emmetropic group).

Results Thirty highly hyperopic children and 33 emmetropic controls had a mean spherical equivalent of + 5.1 ± 1.5 D and a mean age of 8.4 ± 2.8 years, and + 1.0 ± 1.2 D and 9.6 ± 2.6 years, respectively. There was no significant difference in OCT-assessed RNFL thickness between the two groups. Compared to the emmetropic group, following HRT parameters were significantly smaller in the hyperopic group: Disc area (1.41 vs. 1.68 mm2, p = 0.023), cup area (0.19 vs. 0.37 mm2, p = 0.0001), cup volume (0.03 vs. 0.08 mm3, p = 0.02), cup/disc area (0.13 vs. 0.20, p = 0.006), linear cup/disc (0.33 vs. 0.42, p = 0.004), and mean cup depth (0.13 vs. 0.17 mm, p = 0.019).

Conclusion In children, ONH of highly hyperopic eyes are smaller than those of emmetropic eyes. RNFL thickness and neural rim volume are similar to emmetropic eyes. They can therefore appear more crowded.
Management decision based on lymphovascular involvement leads to favorable outcomes after endoscopic treatment of esophageal squamous cell carcinoma
Authors: Takahashi Kazuya , Hashimoto Satoru , Mizuno Ken-ichi , Kobayashi Takamasa , Tominaga Kentaro , Sato Hiroki , Kohisa Junji , Ikarashi Satoshi , Hayashi Kazunao , Takeuchi Manabu , Yokoyama Junji , Kawai Hirokazu , Sato Yuichi , Kobayashi Masaaki , Terai Shuji
Published: December 2017

Background Esophageal squamous cell carcinoma (ESCC) invading the muscularis mucosae (MM) and submucosa up to 200 µm (SM1) has a risk of metastasis. The aims of this study were to investigate the long-term outcome of endoscopic submucosal dissection (ESD) for MM/SM1 ESCC and to assess the management after ESD in our hospital.

Methods This was a retrospective cohort study conducted at a single institution. Patients with MM or SM1 ESCC who were treated with ESD were included. Additional prophylactic therapy was added if lymphovascular involvement (LVI) was noted in the ESD specimens.

Results A total of 102 patients were analyzed. The median length of follow-up was 71.5 months (range 9 – 144 months) and the median number of CTs was 6 (range 0 – 24). LVI was found in 21 patients (20.6 %), and 12 patients underwent additional prophylactic therapy. The 5-year overall survival, disease-specific survival, and tumor-free survival rates were 84.1 %, 97.5 %, and 82.1 %, respectively. A total of 26 patients died, but only 2 of them died from ESCC. The cumulative metastasis rate was 11.8 %, and LVI was a significant predictor of metastasis (hazard ratio 5.42, 95 % confidence interval 1.39 – 21.18; P = 0.02). There were no differences between patients with MM ESCC and those with SM1 ESCC.

Conclusions The long-term outcome after ESD for MM/SM1 ESCC was favorable with additional prophylactic therapy and strict adherence to follow-up. These results indicate that our management decision based on LVI is a valid approach and that ESD can be offered as a therapeutic option to MM/SM1 ESCCs.
A systematic method for constructing discrete Painlevé equations in the degeneration cascade of the E8 group
Authors: Willox R. , Ramani A. , Grammaticos B.
Published: December 2017

We present a systematic and quite elementary method for constructing discrete Painlevé equations in the degeneration cascade for E8(1). Starting from the invariant for the autonomous limit of the E8(1) equation one wishes to study, the method relies on choosing simple homographies that will cast this invariant into certain judiciously chosen canonical forms. These new invariants lead to mappings the deautonomisations of which allow us to build up the entire degeneration cascade of the original mapping. We explain the method on three examples, two symmetric mappings and an asymmetric one, and we discuss the link between our results and the known geometric structure of these mappings.
Determination of electrical properties of degraded mixed ionic conductors: Impedance studies with applied dc voltage
Authors: Bayer T. J. M. , Carter J. J. , Wang Jian-Jun , Klein Andreas , Chen Long-Qing , Randall C. A.
Published: December 2017

Under electrical bias, mixed ionic conductors such as SrTiO3 are characterized by oxygen vacancy migration which leads to resistance degradation. The defect chemistry to describe the relationship between conductivity and oxygen vacancies is usually obtained by high temperature conductivity data or quenching experiments. These techniques can investigate the equilibrated state only. Here, we introduce a new approach using in-situ impedance studies with applied dc voltage to analyze the temperature dependent electrical properties of degraded SrTiO3 single crystals. This procedure is most beneficial since it includes electric field driven effects. The benefits of the approach are highlighted by comparing acceptor doped and undoped SrTiO3. This approach allows the determination of the temperature activation of both anodic and cathodic conductivity of Fe-doped SrTiO3 in the degraded state. The anodic activation energy matches well with the published results, while the activation energy of the degraded cathode region reported here is not in agreement with earlier assumptions. The specific discrepancies of the experimental data and the published defect chemistry are discussed, and a defect chemistry model that includes the strong temperature dependence of the electron conductivity in the cathode region is proposed.
Enhancement of magnetocaloric effect in mischmetal doped La-Fe-Si alloys
Authors: Wang Gaofeng , Zhao Zengru , Zhang Xuefeng , Ma Qiang , Li Yongfeng , Liu Yanli , Mu Lijuan , Zhang Yan
Published: December 2017

The influence of partial substitution of mischmetal on the structure, Curie temperature and magnetocaloric effect has been investigated in La1-xMxFe11.5Si1.5 alloys. X-ray diffraction patterns indicate the alloys crystallize mainly in NaZn13-type cubic structure and the amount of secondary α-Fe phase obviously reduces in the mischmetal doped alloys. As the content of mischmetal increases, the Curie temperature is reduced from 198.1 K for x = 0 to 184.2 K for x = 0.3 and the thermal hysteresis is enlarged from 3.5 K for x = 0 to 8.2 K for x = 0.3. Upon a field change from 0 to 3 T, the obtained maximum isothermal entropy change values are 17.2, 19.8, 37.8 and 47.9 J/kgK for x = 0, 0.1, 0.2 and 0.3, respectively. The entropy changes due to the latent heat of first-order transitions are estimated to be 11.3, 14.7, 18.5 and 23.4 J/kgK for x = 0, 0.1, 0.2 and 0.3, respectively. The enhancement of giant magnetocaloric MCE in La1-xMxFe11.5Si1.5 alloys originates from the strengthened itinerant electron metamagnetic transitions by adding the mischmetal. Our result suggests that the mischmetal doped NaZn13-type La-Fe-Si alloys are potential candidates of refrigerants for magnetic refrigeration.
A sealable ultrathin window sample cell for the study of liquids by means of soft X-ray spectroscopy
Authors: Grötzsch D. , Streeck C. , Nietzold C. , Malzer W. , Mantouvalou I. , Nutsch A. , Dietrich P. , Unger W. , Beckhoff B. , Kanngießer B.
Published: December 2017

A new sample cell concept for the analysis of liquids or solid-liquid interfaces using soft X-ray spectroscopy is presented, which enables the complete sealing of the cell as well as the transport into vacuum via, for example, a load-lock system. The cell uses pressure monitoring and active as well as passive pressure regulation systems, thereby facilitating the full control over the pressure during filling, sealing, evacuation, and measurement. The cell design and sample preparation as well as the crucial sealing procedure are explained in detail. As a first proof-of-principle experiment, successful nitrogen K-edge fluorescence yield near-edge X-ray absorption fine structure experiments of a biomolecular solution are presented. For this purpose, it is shown that the careful evaluation of all involved parameters, such as window type or photon flux, is desirable for optimizing the experimental result.
Nanoparticle synthesis by high-density plasma sustained in liquid organosilicon precursors
Authors: Gangwar R. K. , Hamdan A. , Stafford L.
Published: December 2017

A high-density plasma in a pin-to-pin configuration was sustained in liquid organosilicon precursors (hexamethyldisiloxane, tetraethyl orthosilicate, and tetramethylcyclotetrasiloxane) by the application of a high-voltage at a frequency of 1 kHz and a duty cycle of 30%. For all organosilicon precursors investigated, the current-voltage characteristics revealed a spark mode, with typical discharge duration of about 50 ns. Both the number of microdischarges and the total amount of charges per microdischarge increased with the amplitude of the applied voltage. The optical emission spectroscopy revealed strong emission from the C2 Swan system along with H I, Si I, and O I emission lines, indicating very high fragmentation levels of the organosilicon precursors upon discharge ignition. This was confirmed by Transmission Electron Microscopy and Energy-Dispersive X-ray spectroscopy indicating the formation of amorphous silicon oxycarbide nanoparticles. However, W I emission lines as well as W crystalline nanoparticles could also be seen; a feature ascribed to plasma-electrode interactions.
Simulation study of terahertz radiation generation by circularly polarized laser pulses propagating in axially magnetized plasma
Authors: Saroch Akanksha , Jha Pallavi
Published: December 2017

This paper deals with a two-dimensional simulation study of terahertz radiation emission in the wake of circularly polarized laser pulses propagating in uniformly magnetized plasma, using the XOOPIC code. The external magnetic field is applied along the direction of propagation of the laser pulse. It is seen that linearly polarized terahertz radiation is emitted off-axis, along the propagation direction, in plasma. This emitted radiation is also seen to be transmitted in vacuum. Simulation studies reveal that no such radiation is generated on-axis for the given configuration.
First principles calculation for Gilbert damping constants in ferromagnetic/non-magnetic junctions
Authors: Hiramatsu R. , Miura D. , Sakuma A.
Published: December 2017

We evaluated an intrinsic α in ferromagnetic (FM)/non-magnetic (NM) junctions from first principles (FM = Co, Fe, and Ni and NM = Cu, Pd, and Pt) to investigate the effects of the inserted NM layer. α is calculated by liner muffin-tin orbital methods based on the torque-correlation model. We confirmed that Gilbert damping is enhanced and saturated as NM thickness increases, and that the enhancement is greater in NM materials having a stronger spin-orbital interaction. By contrast, the calculated FM thickness dependences of α show that Gilbert damping tends to decrease and be saturated as the FM thickness increases. Under the torque-correlation model, the dependences of α on FM and NM thickness can be explained by considering the electronic structure of the total system, including junction interfaces, which exhibit similar behaviors derived by spin pumping theory.
Origins of plateau formation in ion energy spectra under target normal sheath acceleration
Authors: DuBois Timothy C. , Siminos Evangelos , Ferri Julien , Gremillet Laurent , Fülöp Tünde
Published: December 2017

Target normal sheath acceleration (TNSA) is a method employed in laser–matter interaction experiments to accelerate light ions (usually protons). Laser setups with durations of a few 10 fs and relatively low intensity contrasts observe plateau regions in their ion energy spectra when shooting on thin foil targets with thicknesses of the order of 10 μm. In this paper, we identify a mechanism which explains this phenomenon using one-dimensional particle-in-cell simulations. Fast electrons generated from the laser interaction recirculate back and forth through the target, giving rise to time-oscillating charge and current densities at the target backside. Periodic decreases in the electron density lead to transient disruptions of the TNSA sheath field: peaks in the ion spectra form as a result, which are then spread in energy from a modified potential driven by further electron recirculation. The ratio between the laser pulse duration and the recirculation period (dependent on the target thickness, including the portion of the pre-plasma which is denser than the critical density) determines if a plateau forms in the energy spectra.
Magnetic field response of doubly clamped magnetoelectric microelectromechanical AlN-FeCo resonators
Authors: Bennett S. P. , Baldwin J. W. , Staruch M. , Matis B. R. , LaComb J. , van 't Erve O. M. J , Bussmann K. , Metzler M. , Gottron N. , Zappone W. , LaComb R. , Finkel P.
Published: December 2017

Magnetoelectric (ME) cantilever resonators have been successfully employed as magnetic sensors to measure low magnetic fields; however, high relative resolution enabling magnetometry in high magnetic fields is lacking. Here, we present on-chip silicon based ME microelectromechanical (MEMS) doubly clamped resonators which can be utilized as high sensitivity, low power magnetic sensors. The resonator is a fully suspended thin film ME heterostructure composed of an active magnetoelastic layer (Fe0.3Co0.7), which is strain coupled to a piezoelectric signal/excitation layer (AlN). By controlling uniaxial stress arising from the large magnetoelastic properties of magnetostrictive FeCo, a magnetically driven shift of the resonance frequency of the first fundamental flexural mode is observed. The theoretical intrinsic magnetic noise floor of such sensors reaches a minimum value of 35 pT/Hz. This approach shows a magnetic field sensitivity of ∼5 Hz/mT in a bias magnetic field of up to 120 mT. Such sensors have the potential in applications required for enhanced dynamic sensitivity in high-field magnetometry.
Seasonal and diurnal methane and carbon dioxide emissions from the littoral area of the Miyun Reservoir in Beijing, China
Authors: Li Gang , Li Hongli , Yang Meng , Lei Ting , Zhang Mingxiang , Bridgewater Peter , Wu Shuhong , Lei Guangchun
Published: December 2017

Reservoirs have been regarded as hot spots for greenhouse gas emissions since the 1990s. However, there is scant research about littoral zones of reservoirs. In the present study, static closed chamber and gas chromatograph techniques were used to measure methane (CH4) and carbon dioxide (CO2) flux in the littoral area of a temperate reservoir from 2009 to 2010. The littoral area comprises three zones, namely supralittoral, eulittoral and infralittoral. The patterns of CH4 and CO2 emissions from these three littoral zones were significantly different during the sampling periods, with the eulittoral zone having the highest CH4 flux and the supralittoral zone having the highest CO2 flux. Temperature and biomass correlated with CH4 and CO2 emissions. Measurement of CO2 emissions after removing vegetation varied in each zone and according to time of sampling. A large littoral area of the reservoir sampled herein will be submerged and converted to a pelagic area with deep standing water after the South to North Water Transfer Project is completed, in 2050. The results of the present study suggest further research and monitoring are needed, and should focus on likely effects of extreme climate events and the effects of human-mediated factors on greenhouse gas emissions.
Instrument Constituencies and the Advocacy Coalition Framework: an essay on the comparisons, opportunities, and intersections
Authors: Weible Christopher M
Published: December 2017

The purpose of this essay is to analyze two theories. One is a relatively new approach called Instrument Constituencies. The other is an established approach called the Advocacy Coalition Framework (ACF). This essay begins by comparing the two theories by an explicit set of criteria. It then lays out opportunities for refinement and advancement of Instrument Constituencies towards its better placement, usefulness, and longevity as a policy process theory. Research prospects at the intersection of Instrument Constituencies and the ACF are then presented with a set of research questions and hypotheses. This essay concludes with a summary of insights about the field of policy processes gained from this theoretical exploration. While there are opportunities for improvements and important caveats for consideration, this essay makes an optimistic argument for the potential of Instrument Constituencies to offer generalizable and context-specific knowledge in helping to advance policy process research.
Orientation Phase Goal 3
Authors: Eddington Kari M. , Strauman Timothy J. , Vieth Angela Z. , Kolden Gregory G.
Published: December 2017

People with depression often focus too little on promotion goals (i.e., making good things happen). Pursuing promotion goals is important because they provide opportunities for experiencing positive emotions. The third goal in the orientation phase of self-system therapy is to encourage clients to focus on promotion goals. The therapist completes an assessment of what the client does or does not do during a typical week to determine activities that can reinstate a sense of reward, accomplishment, or progress. Chapter 4 focuses on increasing involvement with activities that can make good things happen. Worksheets are designed to help identify activities that can produce experiences of pleasure and pride and make specific plans to follow through with those activities.
Concluding Treatment and Preventing Relapse
Authors: Eddington Kari M. , Strauman Timothy J. , Vieth Angela Z. , Kolden Gregory G.
Published: December 2017

Chapter 10 focuses on end-of-treatment issues, such as maintaining gains, continuing to monitor depressive symptoms, addressing fears about relapse, and identifying long-term goals for continued growth and self-improvement. As clients approach the end of the self-system therapy program, it is important to recognize the progress they have made and to make plans to keep their progress going. Self-regulation is a lifelong process. Worksheets are provided to help set realistic goals for continued work after therapy and to develop a plan for maintaining progress, including work on daily goals and challenging situations. Clients often experience anxiety and uncertainty about finishing therapy. One goal of this skills-based treatment program is to provide the tools for continuing to make progress independently.
Adaptation Phase (Sessions 9–15)
Authors: Eddington Kari M. , Strauman Timothy J. , Vieth Angela Z. , Kolden Gregory G.
Published: December 2017

Chapter 7 provides a session-by-session guide to the adaptation phase of self-system therapy, which focuses on reducing chronic, distressing self-discrepancies and modifying unsuccessful patterns of self-regulation. The approaches and tactics used by therapists can be broadly categorized as altering one or more of the maladaptive aspects of self-regulation or as compensating for aspects of self-regulation that are not optimal targets for change. To address various clients’ therapy goals, the therapist can use three freestanding modules, each of which has a broad goal for the final phase of treatment, and they can be completed in any order. The Module 1 goal is to reduce self-discrepancy and increase self-congruency; the Module 2 goal is to modify the client’s regulatory style; and the Module 3 goal is to manage perfectionistic tendencies. The therapist uses the adaptation phase of therapy to help the client reduce self-discrepancies, modify regulatory style, and manage perfectionistic tendencies.
Introductory Information for Therapists
Authors: Medalia Alice , Herlands Tiffany , Saperstein Alice , Revheim Nadine
Published: December 2017

Chapter 1 discusses what cognitive remediation is, why and where it is done, and who can benefit. From a psychiatric rehabilitation perspective, cognitive remediation is considered one of the skill-training interventions. Like other psychiatric rehabilitation interventions, it focuses on individuals’ skills and supports to improve the success and satisfaction they experience in their chosen living, learning, working, and social environments. Many psychiatric illnesses are associated with cognitive deficits in the areas of attention, memory processing speed, and executive functioning. Cognitive remediation is intended to help people develop the underlying cognitive skills that can make them better able to function in daily tasks, including school, work, social interactions, and independent living.
Treatment Planning
Authors: Medalia Alice , Herlands Tiffany , Saperstein Alice , Revheim Nadine
Published: December 2017

Chapter 6 describes how to use treatment plans to guide cognitive remediation sessions. Personalized treatment planning takes into account the multiple factors unique to each client that impact how they use cognition in everyday life. Neuropsychological Educational Approach to Remediation (NEAR) treatment plans address current cognitive deficits, the client’s need for structure, motivation and goals, learning style and barriers, endurance, frustration tolerance, approach to tasks, and task repertoire. The treatment plan should be updated periodically because each of these factors may change over time. Treatment plan components are reviewed, and case examples are provided.
Strategies for Treating Specific Cognitive Deficits and Working with Clients
Authors: Medalia Alice , Herlands Tiffany , Saperstein Alice , Revheim Nadine
Published: December 2017

Clients come to The Learning Center with unique combinations of cognitive profiles, learning styles, personalities, levels of motivation, and levels of insight. As a result, the therapist has to strategically plan and adapt to the needs of each client over the course of the training sessions. This involves consideration of the type of training, compensatory strategies, and learning enhancements that can best motivate the client to engage with the programmatic training and to set and achieve goals. Chapter 7 describes specific approaches to remediating particular cognitive deficits and provides general guidance for in-session coaching of clients.
Bridging Groups
Authors: Medalia Alice , Herlands Tiffany , Saperstein Alice , Revheim Nadine
Published: December 2017

Bridging groups are verbal discussion and skill-building groups that foster the transfer of cognitive improvement from the therapeutic setting to everyday life. In cognitive remediation, this process of generalization refers to the application of cognitive skills and compensatory strategies acquired in the sessions to situations outside of the group. Bridging exercises complement the computer-based learning activities and can be broadly categorized as metacognitive or skill building. Chapter 9 provides a framework for the structure and organization of bridging groups and describes how to engage group members in the learning process. Examples of bridging discussions and learning activities are provided.
Emergence of a Population Approach to Evidence-Based Parenting Support
Authors: Sanders Matthew R. , Prinz Ronald J.
Published: December 2017

The population approach to parenting support evolved over a period of four decades from its historical roots in behavioral parent training. Impetus for this evolution came from three primary sources: (a) the undoubted success of parent training models based primarily on social learning theory in assisting parents of children with conduct problems; (b) the recognition that traditional ways of delivering parenting programs were reaching few parents; and (c) the success of public health approaches in modifying health risk behaviors. This chapter introduces the Triple P—Positive Parenting Program as a multilevel system of parenting support. We highlight the defining features of the multilevel system, including its logic model and the essential criteria that need to be met for a population approach to work.
Applications of Positive Parenting
Authors: Mazzucchelli Trevor G.
Published: December 2017

Since its inception, developers of the Triple P—Positive Parenting Program have been concerned with the generalization of positive parenting skills and how learning in one context can be applied to another. Triple P continues to be concerned with generalization and transfer of learning. However, since Triple P has evolved into a multilevel system of intervention, developers and researchers are now concerned with the extent to which the system can be applied to address a range of problems and support a variety of different populations. This chapter introduces a series of chapters illustrating how the Triple P system can play a valuable role in addressing the needs of families with children with a diverse range of problems and for children of various ages and levels of development. It concludes that Triple P is a robust approach and has enormous potential to improve the lives of children and families.
Parenting Support for Children with Developmental Disability
Authors: Mazzucchelli Trevor G. , Studman Lisa J.
Published: December 2017

Children with a developmental disability are at a substantially greater risk, when compared to their typically developing peers, of showing a variety of emotional and behavioral problems. These problems can have a profound impact on the child’s and family’s life course. Child, parenting, and family factors have all been implicated in the development and maintenance of these problems, but there is evidence that improving parenting practices can lead to a reduction in child problem behaviors, improvements in child adaptive skills, and enhanced parental adjustment and relationship quality. This chapter describes a system of parenting support, known as Stepping Stones Triple P (SSTP), for families of children with a disability. Since evidence has accumulated for the efficacy of the interventions that comprise the SSTP system, recommendations for integrating SSTP into existing services are provided. Current and future research directions are also briefly outlined.
Children and Adolescents with Chronic Health Conditions
Authors: Morawska Alina
Published: December 2017

Chronic childhood health conditions are common and significantly affect the child and family. This chapter begins by describing the central role parents play in children’s health outcomes and illness management and the impact the child’s health condition has on parents and the family. Few parenting interventions have been evaluated, and most focus on medical aspects rather than psychosocial factors related to child and family well-being. Existing approaches to parenting support are described, followed by an exploration of the evidence for Triple P interventions. Recent research using Positive Parenting for Healthy Living, a brief parenting intervention for parents with children with chronic health conditions, is showing promising outcomes. Policy and service implications of recent research are summarized.
Working with Grandparents and Extended Family Members
Authors: Kirby James N.
Published: December 2017

Many parents and families require the help of grandparents or other extended family members in helping with the upbringing of children. This chapter focuses on the role of grandparents, specifically addressing some of the benefits and challenges this raises for family dynamics. There are five key areas reviewed: (a) why the inclusion of grandparents is helpful; (b) what grandparent factors affect families; (c) the role parenting interventions can have with extended family members; (d) how Triple P has and can be applied to this population; and (e) a number of clinical implications to consider when working with grandparents. Overall, the aim of this chapter is to provide some insights into how the involvement of grandparents can enhance parenting and family outcomes. These insights can then be used as examples when considering the involvement of other extended family members in the regular care of children.
Parents with Serious Mental Health Problems
Authors: Calam Rachel , Wittkowski Anja
Published: December 2017

Parenthood can be more challenging when a parent experiences serious mental health problems, which can negatively affect family life and children’s emotional, social, and behavioral development. Parental distress and mental health problems increase the risk of mental health problems in children and adolescents. Data suggest that well over half of service users with psychosis or psychiatric disorder are also parents. This chapter focuses on research into mental health difficulties in the perinatal period and parenting with psychosis and with bipolar disorder. To date, promising outcomes have been found for initial trials investigating the delivery of parenting support to parents with serious mental health conditions, particularly bipolar disorder, but empirical work is limited. The chapter identifies priority areas for research to refine approaches to parenting support to best suit different mental health conditions and contexts.
Parenting Support and the School System
Authors: Hodges Julie , Healy Karyn L.
Published: December 2017

Children’s academic and well-being outcomes are influenced by both the home and the school environments. This means that parents and schools have a shared responsibility for promoting children’s development. Research shows that when parents and schools work together, students, parents, and teachers all benefit. One way in which schools can engage parents in their child’s education is by offering parenting support through parenting programs like the Triple P—Positive Parenting Program. Triple P can assist parents to develop effective morning, afternoon, and bedtime routines and to help students gain the self-management skills and the self-confidence necessary to succeed at school. This chapter discusses strategies and considerations for successfully implementing Triple P in schools, taking into account the school setting, workforce, and factors affecting parent participation.
A Framework for Successful Implementation of the Triple P System
Authors: McWilliam Jenna , Brown Jacquie
Published: December 2017

When effective practices are supported by effective implementation procedures, they have a higher potential for impact. This chapter summarizes what we know about the implementation of the Triple P—Positive Parenting Program from research, evaluation, and experience from the field. It gives an overview of the science of implementing evidence-based parenting programs, a summary of research on Triple P implementation, and an introduction to the Triple P Implementation Framework (the Framework). The Framework was developed by Triple P’s purveyor organization and aims to support implementing communities and organizations to enhance practitioners’ use of Triple P, increase sustained service delivery, and widen the reach of Triple P in their communities. Through the Framework, communities and organizations are supported to adopt effective implementation practices as they are implementing Triple P.
Promoting Program Fidelity through Peer-Assisted Supervision and Support
Authors: McPherson Kerri E. , Schroeter Birgit
Published: December 2017

This chapter makes the case for the adoption of practitioner supervision as a quality assurance mechanism for the implementation of parenting interventions. This chapter addresses the need for effective and efficient supervision and posttraining support for the evidence-based program workforce to ensure the sustainability of delivery and the ongoing maintenance of program fidelity. Alongside other fidelity mechanisms, supervision can help develop practitioners’ confidence and competence in delivery and promote adherence to intervention protocols. Peer supervision has the potential to be both efficient and effective and may be more acceptable to stakeholders than traditional hierarchical supervision models. The Peer-Assisted Supervision and Support model is described, and findings describing its acceptability and feasibility to parenting program practitioners are presented.
Learnings from Large-Scale, Population-Level Implementation of Parenting Support
Authors: Mazzucchelli Trevor G.
Published: December 2017

There is considerable evidence supporting the efficacy and effectiveness of parenting interventions based on social learning principles for a range of social, emotional, and health problems, involving different types of families and through a variety of delivery systems. The challenge now is “going to scale” in order to have a positive impact at a population level. This chapter introduces three best practice exemplars that have taken place in the United States, Ireland, and Australia, where a full multilevel systems approach to parenting support has been applied and evaluated. These applications provide important lessons regarding the barriers and facilitators that can influence an initiative’s success and degree of impact. By illustrating how these approaches have involved different populations, behavioral targets, evaluation designs, and means of assessing outcome, they also hint at the many possibilities that are available in future dissemination efforts.
Program Development, Quality Assurance, and Innovation
Authors: Mazzucchelli Trevor G.
Published: December 2017

Over the past four decades, enormous advances have been made in the field of evidence-based parenting support (EBPS). Despite this progress, to remain relevant to the needs of successive generations of families, it is essential that parenting programs continue to evolve and adapt. This chapter introduces a series of chapters that reflect on what has been accomplished and consider future directions for the field. It is asserted that EBPS has the potential to make a major contribution to the long-term mental and physical health and well-being of children and adults and could also play a role in the resolution of many other problems of global significance. Further innovation in EBPS will occur if the potential of EBPS is recognized, future needs and preferences of families are anticipated, new technologies are embraced, and conditions are created in organizational contexts and research environments that are likely to foster innovation.
E Skill: Experience My Emotions
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Barlow David H.
Published: December 2017

Chapter 8 of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children: Workbook (UP-C) focuses on emotional awareness by teaching a new Emotion Detective skill to experience feelings while learning three present-moment awareness steps— learning to pay attention to what is going on in the present moment without thinking about the past or the future, experiencing feelings without avoiding them or doing something to make them go away, and beginning to approach or face things or situations the child has been avoiding in the past because they make the child feel scared, sad, angry, or worried. Child clients practice these present-moment awareness steps using their five senses, and they also learn about and practice non-judgmental awareness.
Consider How I Feel for Parents
Authors: Jill Ehrenreich-May , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Barlow David H.
Published: December 2017

Chapter 13 covers four sessions. In Session 1, parents learn about the structure of the UP-C treatment, the three-component model of emotions, and the cycle of avoidance. In Session 2, parents learn how to connect their child’s emotional experiences and the parents’ own reactions. They learn about four emotional parenting behaviors and learn how to decrease criticism and use positive reinforcement. Session 3 covers the concept of acting opposite to an emotional behavior. This session covers ways parents can reinforce positive behaviors or effective attempts at coping. Session 4 focuses on how children express and experience emotions in their bodies. Parents are taught to help children scan their bodies to become aware of body sensations. Parents learn about sensational exposures and the importance of supporting their children in completing them at home. Parents learn about the opposite parenting behavior of expressing empathy when children are struggling with strong emotions.
Building and Keeping Motivation
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 1 provides the adolescent client with tools to help identify three top problems that the client and therapist will keep track of during treatment. Goals related to these top problems are then identified. Tips for creating helpful, practical goals (“SMART goals”) are outlined. These goals should be specific, measurable, attainable, relevant, and time-bound. The adolescent is then prompted to consider his or her motivation for coming to therapy and for working on emotions and behaviors that are not working well.
Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

The therapy manuals included in this volume—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) and Adolescents (UP-A)—include evidence-based treatment strategies to assist child and adolescent clients to function better in their lives. The manuals include specific guidelines for treatment delivery, and they also contain information about how to introduce parent-directed strategies to help promote long-term uptake of youth-directed therapy skills. The evidence-based treatment skills presented may be applied by therapists to children and adolescents with a wide variety of emotional disorders. This treatment guide takes a transdiagnostic approach to the treatment of emotional disorders. Some of the disorders that may be targeted include anxiety disorders and depressive disorders. This treatment is flexible enough for use with some trauma and stress-related disorders (including adjustment disorders), somatic symptom disorders, tic disorders and obsessive-compulsive disorders. The transdiagnostic presentation of evidence-based intervention techniques within these treatments may be particularly useful for children and adolescents presenting with multiple emotional disorders or mixed/subclinical symptoms of several emotional disorders.
Core Module 2: Getting to Know Your Emotions and Behaviors
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 2 provides education regarding the nature of several key emotions (such as anger, happiness, anxiety, sadness, fear), including a discussion of the structure and function of these emotions. Emotion identification skills are introduced. The three parts of an emotional experience are presented (thoughts, feelings, behaviors) and adolescents learn to track the before, during, and after of their emotional experiences. The role of avoidance or other relevant emotional behaviors in the development and maintenance of emotion cycles is also covered. This chapter sets the stage for both the “transdiagnostic” focus and the focus on problematic emotional behaviors in the UP-A.