By focusing on repeated sequential episodes over time in which a client conveys distress, followed by the therapist's response, this paper sheds light on the interactional trajectory through which a client and therapist are able to resolve impasses to emotional exploration and to successfully secure extended and intense emotional work. Copyright © 2020 Muntigl.The question of cardiac strain arises when considering the emerging class of recreational runners whose running strategy could be a non-optimal running pace. Heart rate (HR) monitoring, which reflects exercise intensity and environmental factors, is often used for running strategies in marathons. However, it is difficult to obtain appropriate feedback for only the HR value since the cardiovascular drift (CV drift) occurs during prolonged exercise. The cardiac cost (CC HR divided by running velocity) has been shown to be a potential index for evaluation of CV drift during the marathon race. We sought to establish the relationship between recreational marathoners' racing strategy, cardiac drift, and performance. We started with looking for a trend in the speed time series (by Kendall's non-parametric rank correlation coefficient) in 280 (2 h30-3 h40) marathoners. We distinguished two groups, with the one gathering the large majority of runners (n = 215, 77%), who had a significant decrease in their speed duringat, Palacin, Correa and Pycke.Biological siblings of children with autism spectrum disorder (ASD) have increased risk of receiving an ASD diagnosis. In the U.S., most children with ASD are diagnosed after the optimal age to initiate early intervention which can reduce symptom severity and improve outcomes. Recent evidence suggests magnetic resonance imaging (MRI) in the first year of life can predict later diagnostic status in high-risk siblings. We investigated whether MRI-based screening is a cost-effective method for assigning early intervention. A hybrid decision tree/Markov model was used to evaluate two MRI-based screening strategies at 6 and 12 months of age. Primary outcomes were costs in U.S. dollars and quality-adjusted life years (QALYs). Results were reported as incremental cost-effectiveness ratios (ICERs). Costs were estimated from societal, health care, and educational perspectives. One-way and probabilistic sensitivity analyses were performed. From a societal perspective, the ICER for MRI-based screening at 6 months was $49,000 per QALY when compared to the status quo, implying that such screening is cost-effective at willingness-to-pay (WTP) thresholds of $50,000-$100,000 per QALY. From the health care and educational perspectives, the ICERs were larger at $99,000 and $76,000 per QALY, respectively.  https://www.selleckchem.com/Androgen-Receptor.html  Sensitivity analysis identified that the parameters most influential in affecting cost-effectiveness were the prevalence of ASD and/or co-occurring intellectual disability. MRI specificity also has significant impacts which add to the uncertainty of the results. Future work is needed to determine the sensitivity and, in particular, the specificity of MRI with more certainty. Notably, the cost of the MRI-based screening had the least impact. Copyright © 2020 Williamson, Elison, Wolff and Runge.Background Patients with idiopathic rapid eye movement behavior disorder (IRBD) have been suggested to exhibit altered cerebral perfusion and abnormal cerebral blood flow, which imply a possibility of cerebral autoregulation (CA) impairment. We aimed to investigate the dynamic CA (dCA) in patients with IRBD during wakefulness and to explore the correlations between dCA parameters and clinical measurements. Methods We assessed the dCA capability of 30 patients with IRBD and 36 sex- and age-matched healthy controls by using transcranial Doppler and finger plethysmography. CA function was evaluated by transfer function analysis based on spontaneous oscillation of cerebral blood flow and arterial blood pressure. Transfer function parameters (phase difference and gain) were used to quantify the CA. Results No significant differences were observed between the right and left middle cerebral artery dCA parameters (phase difference and gain) of both groups. Patients with IRBD had significantly lower phase difference than the healthy controls, indicating their impaired CA capability. Besides, the value of gain in patients with IRBD was higher than the healthy controls, but the difference did not reach statistical level. Conclusions CA function is compromised in patients with IRBD during wakefulness, which might be an intermediate link between IRBD and neurological symptoms. Copyright © 2020 Lv, Wang, Sun, Jin, Liu, Deng, Lv, Jia, Guo and Yang.Device titration is a major challenge when using deep brain stimulation (DBS) to treat behavioral disorders. Unlike in movement disorders, there is no reliable real-time clinical feedback for changes in complex behaviors resulting from DBS. Here, a female patient receiving DBS of the nucleus accumbens for the treatment of morbid obesity underwent cognitive testing via the flanker task alongside traditional methods of device titration. One set of stimulation parameters administered during titration resulted in acute cognitive improvement (p = 0.033) and increased frontal engagement as measured by electroencephalography (left anterior p = 0.007, right anterior p = 0.005) relative to DBS-OFF. The same parameters resulted in the most weight-loss during long-term continuous stimulation (47.8 lbs lost in 129 days) compared to the results of other stimulation settings. Diffusion tensor imaging analyses showed increased connectivity to dorsal attention networks and decreased connectivity to the default mode network for optimal parameters (p less then 0.01). Our results provide evidence that targeted cognitive testing is a potentially useful tool for capturing acute effects of DBS stimulation during titration and predicting long-term treatment outcomes. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT01512134. Copyright © 2020 Weichart, Sederberg, Sammartino, Krishna, Corrigan and Rezai.Narrative exposure therapy (NET) is an individual therapeutic approach that has an emerging evidence base for children. It was initially trialed with refugee and asylum seeking populations, in low, middle and high-income settings, utilizing either lay or professional therapists. The results of treatment trials for PTSD in refugee children with NET (or the child "KIDNET" adaptation) demonstrates how this is an effective intervention, is scalable and culturally dexterous. This paper describes, in five cases from clinical practice settings, the applicability of NET into broader, routine practice. The cases outlined describe the use of NET with adolescents with autism spectrum disorders, psychotic symptoms, and intellectual disabilities; histories of forced abduction into child soldiering; complex physical health problems needing multiple interventions; and victims of childhood sexual abuse. The cases are discussed with regards to how the NET lifeline facilitated engagement in treatment, practical adaptations for those with intellectual disabilities and how NET, with its relatively short training for health professionals, can be modified to different contexts and presentations.