The feasibility of verbal and virtual reality exposure for youth with academic performance worry.

With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.

Development and Feasibility of a Home Pulmonary Rehabilitation Program With Health Coaching.

BACKGROUND: Pulmonary rehabilitation (PR) is an effective intervention for COPD. However, traditional center-based PR programs suffer from low uptake. Home-based PR is a viable solution, but few studies have shown the effectiveness of remote PR, as there is a scarcity of systems that can be easily adopted in clinical practice. The aim of this report is to communicate the development and feasibility of a home PR program that includes commercially available technology that allows the PR health coach to follow the patient through his or her PR process and to present the design of a prospective clinical trial. METHODS: We developed a home PR system that includes a computer tablet, an activity monitor, and an oximeter connected to a cloud server. The home PR consists of 12 min of walking and 6 full-body exercises, to be completed 6 d/week, plus weekly telephone calls with the PR health coach. Two pilot studies were conducted in subjects with moderate-to-severe COPD. The first aimed to fine-tune the system development (N = 3), and the second tested the program feasibility of the 8-week program (N = 12). RESULTS: In pilot study 1, PR monitoring data from the subjects' home PR sessions were transmitted to the health coach application successfully. On a 10-point scale, participants rated the system as helpful (median = 8, interquartile range 8-9) and simple to use (median = 10, interquartile range 9-10). In pilot study 2, adherence ± SD for prescribed use was 87 ± 0.24%. Overall, participants gave the home PR system a rating of 6.2 ± 0.94 on a 7-point scale. CONCLUSIONS: A home PR program was developed that integrated health coaching and a home PR system that facilitated remote monitoring. Pilot testing indicated that the program is well-developed and feasible in a population of individuals with COPD. (ClinicalTrials.gov registration NCT02999685.).

Adolescent and adult drivers' mobile phone use while driving with different interlocutors.

PURPOSE: We examined the frequency of adolescents' and their parents' mobile phone use while driving (MPUWD) in the context of their peer and parent-child interlocutors (i.e., communication partners), considering individual differences in perceived risk and symptoms of technology addiction. METHODS: Ninety-four participants (47 parent-adolescent dyads) completed a survey battery measuring their symptoms of technology addiction, perceived risk of MPUWD, and MPUWD with family members and with their peers as assessed via the proportion of trips when drivers used a mobile phone to communicate. RESULTS: For both adolescents and their parents across both types of interlocutors (parent-child, peer), stronger risk perceptions were associated with less MPUWD, and stronger symptoms of technology addiction were associated with more MPUWD. A three-way interaction among technology addiction, interlocutor (parent-child, peer), and driver (parent, adolescent) was observed. For adolescents, the association between technology addiction and MPUWD was significantly stronger for MPUWD with their peers than it was for their MPUWD with their parents; this association was not observed for parents. Parents engaged in MPUWD with their children as frequently as adolescents engaged in MPUWD with their peers. CONCLUSIONS: Symptoms of technology addiction play a stronger role for adolescents' MPUWD with their peers than it does for adolescents' MPUWD with their parents. These and other driver-by-interlocutor interactions should be considered in future research on distracted driving and in prevention efforts.

Evaluating the Effect of a Mechanical Adjunct to Improve the Installation of Child Restraint Systems to Vehicles.

OBJECTIVES: We explored if an alternative CRS design that utilized a mechanical adjunct to amplify the force applied to the adult seat belt (intervention CRS) results in more accurate and secure attachment between the CRS and the vehicle compared to similar CRS models that use LATCH or the existing adult seat belt. We conducted three separate studies to address this question and additionally explored: (1) the contribution of prior CRS installation experience (Study 1), (2) the value-added of CRS labeling (Study 2), and (3) paper-based vs. video instructions (Study 3). METHODS: In Studies 1 and 2 we assessed a forward facing combination CRS design (intervention CRS) compared to a commercially available LATCH equipped model (control CRS) and in Study 3 we conducted a similar study using a convertible model of both the intervention and control CRS. Participants installed both CRS in a contemporary minivan and could choose which type of attachment to use for the control CRS (LATCH or seat belt); order of installation was counter-balanced. Evaluators systematically examined installations for accuracy and security. RESULTS: Study 1: A greater proportion of participants in both the experienced and inexperienced groups was able to securely install the intervention CRS compared to the control CRS: (45% vs. 16%, p =.0001 for experienced) and (37% vs. 6%, p =.003 for inexperienced). No differences between the CRS were observed for accuracy of installation in either user group. Study 2: A greater proportion of participants were able to securely install the enhanced intervention CRS compared to the control CRS: (62% vs. 9%, p =.001). The intervention CRS demonstrated reduced installation accuracy: (30% vs. 61%, p =.001). Study 3: A greater proportion of participants was able to securely install the intervention CRS compared to the control CRS: 79% vs. 66% p =.03, but this effect was smaller than in the previous studies. Participants were less likely to achieve an accurate installation with the intervention CRS compared to the control CRS: 54% vs. 79%, p =.004. Common accuracy errors in each study included twisting or misrouting the seatbelt when installing the intervention CRS. CONCLUSIONS: Our results suggest that novel CRS designs that utilize mechanical advantage to facilitate attachment of the CRS to the vehicle result in a tighter installation compared to LATCH equipped models, but an increase in accuracy errors occurred.

Yaw rate and linear velocity stabilized manual wheelchair.

We present the development of a prototype novel low-power, inexpensive stability control system for manual wheelchairs. Manual wheelchairs, while providing the ability to maneuver in relatively small indoor spaces, have a high center of gravity making them prone to tipping. Additionally, they can easily slide on sloped surfaces and can even spin and tip when attempting to turn or brake too quickly. When used on ramps and in outdoor environments where the surface is rarely perfectly flat (slopes greater than 1∶20 (5%) are common), wheelchair users can easily encounter potentially dangerous situations. The design and evaluation of an accident prevention system for independent manual wheelchair users that increases independence by enabling mobility with greater confidence and safety is described. The system does not limit a wheelchair user's ability to manually brake, rather, if the system detects that the wheelchair is out of control, braking force will be added by the system to either one or both wheels. The prototype utilized inexpensive bicycle technologies for the wheel brake and electrical power generator assemblies. Custom servos were designed along with custom electronics and firmware in the prototype to evaluate performance. The goal of the project was to derive specifications for a control and actuation system that utilizes inexpensive bicycle components in this cost-sensitive application. The design is detailed and the final specifications provided.