Evaluation of competency-driven training for facilitators delivering a psychological intervention for children in Lebanon: a proof-of-concept study.

AIMS: The mounting evidence for effective delivery of psychological interventions by non-specialists in low- and middle-income settings has led to a rapid expansion of mental health and psychosocial support trainings globally. As such, there is a demand for strategies on how to train and implement these services to attain adequate quality. This study aims to evaluate the added value of a competency-driven approach to training of facilitators for a group intervention for children with severe emotional distress in Lebanon. METHODS: In a controlled before and after study, 24 trainees were randomly allocated to participate in either a competency-driven training (CDT) or training-as-usual (TAU) (1 : 1) for a psychological intervention for children with severe emotional distress. We assessed the change in demonstrated competencies, using standardised role-plays, before and after the training. Measures included the 13-item Working with children-Assessment of Competencies Tool (WeACT), the 15-item ENhancing Assessment of Common Therapeutic factors (ENACT) and the 6-item Group facilitation: Assessment of Competencies Tool (GroupACT). The trainer in the experimental arm used pre-training and during training competency assessment scores to make real-time adjustment to training delivery. Due to COVID-19 pandemic restrictions, all activities were done remotely. RESULTS: CDT resulted in significantly better outcomes on increasing competencies on the WeACT (repeated measures analysis of variance; F(1, 22) = 6.49, p < 0.018) and on the GroupACT (Mann-Whitney U = 22, p < 0.003), though not statistically significant on the ENACT. There is no significant between-group difference on the reduction of harmful behaviours, mainly because both forms of training appear equally successful in eliminating such behaviours. CONCLUSIONS: This proof-of-concept study demonstrates the potential of CDT, using standardised assessment of trainee competencies, to contribute to better training outcomes without extending the duration of training. CDT can result in up to 18% greater increase in adequate competency, when compared to TAU. The study also yields recommendations for further enhancing the benefits of competency-driven strategies. A fully powered trial is needed to confirm these findings.

Post-translational modification of cortical GluA receptors in rodents following spinal cord lesion.

Previous studies investigating the pathophysiology of neuropathic pain caused by injury to the spinal cord suggest that pain may result, at least in part, from maladaptive plasticity in the somatosensory cortex and associated pain networks. However, little is known about the molecular and cellular mechanisms leading to maladaptive plasticity in the cortex and how they contribute to the development of neuropathic pain. AMPA-type glutamate receptors (GluARs) mediate fast excitatory synaptic transmission in the mammalian brain and play an important role in pain processing. Here we used an electrolytic lesion model of spinal cord injury in animals to study the expression and phosphorylation of GluA1 and 2 in the primary somatosensory cortex (S1). Experiments in rats and mice revealed that maladaptive plasticity and hypersensitivity after spinal cord lesion (SCL) are associated with a reduction in the fraction of GluA1 subunits that are phosphorylated at serine 831 (S831) in the hindlimb representation of S1 (S1HL). Manipulations that reduce the fraction of phosphorylated S831 in S1HL of non-lesioned animals, including low-frequency electrical stimulation and viral-mediated gene transfer of mutant S831, were associated with the development of hypersensitivity. Taken together, these findings suggest that phosphorylation of GluA1 at S831 plays an important role in the development of hypersensitivity after SCL.

Contribution of peripheral N-methyl-D-aspartate receptors to c-fos expression in the trigeminal spinal nucleus following acute masseteric inflammation.

In this study, we examined the contribution of N-methyl-D-aspartate (NMDA) receptors on c-fos expression in the trigeminal brainstem nuclei following acute muscle inflammation. Mustard oil (MO; 20%, 30 microL) injected into the masseter muscle induced extensive peripheral edema and Fos-like immunoreactivity (Fos-LI) in several trigeminal brainstem areas including the subnucleus caudalis of the trigeminal spinal nucleus (Vc), the ventral and dorsal regions of the Vc/subnucleus interpolaris transition zone, and the paratrigeminal nucleus. In order to assess the effect of antagonizing NMDA receptors on MO-induced Fos-LI, rats were pre-treated with two different doses of i.v. MK-801 (0.3 mg/kg, 3 mg/kg), a non-competitive NMDA receptor antagonist, 30 min prior to MO injection. Additional groups of rats received MK-801 (0.3 mg/kg) directly in the masseter muscle or in the biceps muscle 5 min prior to MO injection. A higher dose of i.v. MK-801 (3 mg/kg) and MK-801 given locally into the masseter muscle (0.3 mg/kg) produced a significant reduction in total number of MO-induced Fos-LI. Further analyses revealed that pre-treatment with MK-801 (3 mg/kg i.v.) significantly reduced the Fos-LI all throughout the Vc. Only at the caudal Vc, there was a dose-dependent reduction of MO induced Fos-LI. Pre-treatment with masseteric MK-801 also significantly reduced the Fos-LI in the caudal Vc, with the effect greater than that produced by the same dose of MK-801 given intravenously. These results suggest that peripheral NMDA receptors contribute to nociceptive processing from craniofacial muscles.

Gastric wall abscess, a rare endosonographic differential diagnosis of intramural tumors: successful endoscopic treatment.

Abscesses in the gastric wall are extremely rare. As the mucosa remains intact in most cases, clear differential diagnosis is required in order to distinguish the condition from the more frequent intramural mesenchymal tumors. Endoscopic ultrasonography provides a valuable tool for imaging intramural tumors, but this approach does not allow a definitive assessment of malignancy. We report about two patients with intramural abscesses in the gastric wall. Endosonography showing eccentric tumors from the gastric wall in the two patients. The endosonographic image was inhomogenous, the wall layer structure of the gastric wall was not preserved. A laparotomy was carried out on the first patient. In the second case, the diagnosis was easy, as pus was emptying from a small opening in the mucosa, which had already been detected at gastroscopy. Endoscopic intervention was carried out based on the endosonographic findings. In one patient, mucosa and submucosa were opened by a needle knife. These cases show that gastric wall abscesses do not have a typical endoscopic ultrasound appearance. However, endosonography is an essential method prior to endoscopic interventional therapy.

Frequency of platelet-specific antigens among Indonesians.

This study reports the frequencies of the alloantigens of four major platelet-specific alloantigen systems among Indonesians. One hundred and sixty-eight unrelated Indonesian blood donors were phenotyped for the alloantigens of the Zw (PIA, HPA-1), Bak (HPA-3), Yuk (Pen, HPA-4), and Br (HPA-5) systems by use of a glycoprotein-specific immunoassay. All were positive for the alloantigens Zwa, Yukb, and Brb. Three (1.79%) and 1 (0.59%) of the 168 donors were positive in testing for Zwb and Yuk(a) antigens, respectively. Fifteen (9.26%) of 162 Indonesians had Br(a) antigens. Of the 166 donors tested, 121 (72.89%) were Bak(a) positive and 134 (80.72%) were Bakb positive. In addition, the phenotype frequency of Nak(a) was determined by using monoclonal antibody OKM5 in a platelet enzyme-linked immunosorbent assay. Its frequency in the present cohort was 95.83 percent (161/168). This study confirms the differences in platelet antigen distributions in Asians and whites. Both glycoprotein IV deficiency and the Yuk polymorphism are also found among Indonesians.

Electronic holography and speckle methods for imaging through tissue using femtosecond gated pulses.

Electronic holography and speckle interferometry are combined with femtosecond gating techniques to form images of absorbing structures embedded in organic tissue. The method takes advantage of the inherent instability of living tissue.

Down syndrome in two siblings with 47,XY,+21 and 46,XY/46,XY,-21,+t(21q;21q).

This is the first report in the literature of siblings affected with Down syndrome; one sibling had a nondisjunction of chromosome 21 and the other a (21q;21q) translocation.