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Implementation Science Communications Oct 2022Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based... (Review)
Review
BACKGROUND
Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based interventions (EBIs) to address the adverse outcomes stemming from these experiences. Though EBIs are intended to be delivered according to set parameters, these EBIs are frequently adapted. However, little is known about existing adaptations of EBIs for children who experienced PTEs or other adversities. As such, this review aimed to determine: (1) why existing EBIs designed to address PTEs and other adversities experienced by children are adapted, (2) what processes are used to determine what elements should be adapted, and (3) what components of the intervention are adapted.
METHODS
Nine academic databases and publicly available search engines were used to identify academic and grey literature. Initial screening, full-text review, data extraction, and quality determinations were completed by two members of the research team. Data were synthesized narratively for each adapted EBI by research question.
RESULTS
Forty-two studies examining the adaptations of nine different EBIs were located, with Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools being the most commonly adapted EBIs. Most frequently, EBIs were adapted to improve fit with a new population and to address cultural factors. Most commonly, researchers in combination with others made decisions about adapting interventions, though frequently who was involved in these decisions was not described. Common content adaptations included the addition of intervention elements and the tailoring/tweaking/refining of intervention materials. Common contextual adaptations included changes to the intended population, changes to the channel of treatment delivery, and changes to who administered the intervention.
CONCLUSIONS
Most published studies of EBI adaptions have been developed to improve fit and address cultural factors, but little research is available about adaptations made by clinicians in day-to-day practice. Efforts should be made to evaluate the various types of adaptations and especially whether adaptations improve access to services or improve child outcomes in order to ensure that all children exposed to trauma can access effective treatment.
TRIAL REGISTRATION
The protocol for this systematic review was published with PROSPERO (CRD42020149536).
PubMed: 36209138
DOI: 10.1186/s43058-022-00348-5 -
Experimental Physiology May 2022What is the central question of this study? What are the profiles of acute physiological and psychophysical strain during and in recovery from different modes of...
NEW FINDINGS
What is the central question of this study? What are the profiles of acute physiological and psychophysical strain during and in recovery from different modes of heating, and to what extent do these diminish after repeated exposure? What is the main finding and its importance? Mode of heating affects the strain profiles during heat stress and recovery. Exercise in the heat incurred the greatest cardiovascular strain during heating and recovery. Humid heat was poorly tolerated despite heat strain being no greater than in other heating modes, and tolerance did not improve with multiple exposures.
ABSTRACT
Heat stress is common and arises endogenously and exogenously. It can be acutely hazardous while also increasingly advocated to drive health and performance-related adaptations. Yet, the nature of strain (deviation in regulated variables) imposed by different heating modes is not well established, despite the potential for important differences. We, therefore, compared three modes of heat stress for thermal, cardiovascular and perceptual strain profiles during exposure and recovery when experienced as a novel stimulus and an accustomed stimulus. In a crossover design, 13 physically active participants (five females) underwent 5 days of 60-min exposures to hot water immersion (40°C), sauna (55°C, 54% relative humidity) and exercise in the heat (40°C, 52% relative humidity), and a thermoneutral water immersion control (36.5°C), each separated by ≥4 weeks. Physiological (thermal, cardiovascular, haemodynamic) and psychophysical strain responses were assessed on days 1 and 5. Sauna evoked the warmest skin (40°C; P < 0.001) but exercise in the heat caused the largest increase in core temperature, sweat rate, heart rate (post hoc comparisons all P < 0.001) and systolic blood pressure (P ≤ 0.002), and possibly decrease in diastolic blood pressures (P ≤ 0.130), regardless of day. Thermal sensation and feeling state were more favourable on day 5 than on day 1 (P ≤ 0.021), with all modes of heat being equivalently uncomfortable (P ≥ 0.215). Plasma volume expanded the largest extent during immersions (P < 0.001). The current data highlight that exercising in the heat generates a more complex strain profile, while passive heat stress in humid heat has lower tolerance and more cardiovascular strain than hot water immersion.
Topics: Acclimatization; Body Temperature; Body Temperature Regulation; Cross-Over Studies; Female; Heart Rate; Heat Stress Disorders; Heat-Shock Response; Hot Temperature; Humans; Male; Water
PubMed: 35193165
DOI: 10.1113/EP089992 -
BMJ (Clinical Research Ed.) Mar 2018This article reviews important considerations for researchers who are designing adaptive clinical trials. These differ from conventional clinical trials because they...
This article reviews important considerations for researchers who are designing adaptive clinical trials. These differ from conventional clinical trials because they allow and even enforce continual modifications to key components of trial design while data are being collected. This innovative approach has the potential to reduce resource use, decrease time to trial completion, limit allocation of participants to inferior interventions, and improve the likelihood that trial results will be scientifically or clinically relevant. Adaptive designs have mostly been used in trials evaluating drugs, but their use is spreading. The US Food and Drug Administration recently issued guidance on adaptive trial designs, which highlighted general principles and different types of adaptive clinical trials but did not provide concrete guidance about important considerations in designing such trials. Decisions to adapt a trial are not arbitrary; they are based on decision rules that have been rigorously examined via statistical simulations before the first trial participant is enrolled. The authors review important characteristics of adaptive trials and common types of study modifications and provide a practical guide, illustrated with a case study, to aid investigators who are planning an adaptive clinical trial
Topics: Clinical Trials as Topic; Data Interpretation, Statistical; Guidelines as Topic; Humans; Reproducibility of Results; Research Design; United States
PubMed: 29519932
DOI: 10.1136/bmj.k698 -
Philosophical Transactions of the Royal... Apr 2022Shifting range limits are predicted for many species as the climate warms. However, the rapid pace of climate change will challenge the natural dispersal capacity of...
Shifting range limits are predicted for many species as the climate warms. However, the rapid pace of climate change will challenge the natural dispersal capacity of long-lived, sessile organisms such as forest trees. Adaptive responses of populations will, therefore, depend on levels of genetic variation and plasticity for climate-responsive traits, which likely vary across the range due to expansion history and current patterns of selection. Here, we study levels of genetic and plastic variation for phenology and growth traits in populations of red spruce (), from the range core to the highly fragmented trailing edge. We measured more than 5000 offspring sampled from three genetically distinct regions (core, margin and edge) grown in three common gardens replicated along a latitudinal gradient. Genetic variation in phenology and growth showed low to moderate heritability and differentiation among regions, suggesting some potential to respond to selection. Phenology traits were highly plastic, but this plasticity was generally neutral or maladaptive in the effect on growth, revealing a potential liability under warmer climates. These results suggest future climate adaptation will depend on the regional availability of genetic variation in red spruce and provide a resource for the design and management of assisted gene flow. This article is part of the theme issue 'Species' ranges in the face of changing environments (Part II)'.
Topics: Acclimatization; Climate Change; Genotype; Phenotype; Picea; Plastics
PubMed: 35184589
DOI: 10.1098/rstb.2021.0008 -
Journal of Physiological Anthropology Jul 2022This review mainly aimed to introduce the findings of research projects comparing the responses of tropical and temperate indigenes to heat. From a questionnaire survey... (Review)
Review
This review mainly aimed to introduce the findings of research projects comparing the responses of tropical and temperate indigenes to heat. From a questionnaire survey on thermal sensation and comfort of Indonesians and Japanese, we found that the thermal descriptor "cool" in tropical indigenes connotes a thermally comfortable feeling, suggesting that linguistic heat acclimatization exists on a cognitive level. Ten male students born and raised in Malaysia were invited to Fukuoka, Japan, and compared their responses with 10 Japanese male students with matched physical fitness and morphological characteristics. Cutaneous thermal sensitivity: The sensitivities were measured at 28 °C. The forehead warm sensitivity was significantly blunted in Malaysians. The less sensitivity to the warmth of tropical indigenes is advantageous in respect to withstanding heat stress with less discomfort and a greater ability to work in hot climates. Passive heat stress: Thermoregulatory responses, especially sweating, were investigated, during the lower leg hot bathing (42 °C for 60 min). The rectal temperature at rest was higher in Malaysians and increased smaller during immersion. There was no significant difference in the total amount of sweating between the two groups, while the local sweating on the forehead and thighs was lesser in Malaysians, suggesting distribution of sweating was different from Japanese. Exercise: Malaysian showed a significantly smaller increase in their rectal temperature during 55% maximal exercise for 60 min in heat (32 °C 70% relative humidity), even with a similar sweating and skin blood flow response in Japanese. The better heat tolerance in Malaysians could be explained by the greater convective heat transfer from the body core to the skin due to the greater core-to-skin temperature gradient. In addition, when they were hydrated, Malaysian participants showed better body fluid regulation with smaller reduction in plasma volume at the end of the exercise compared to the non-hydrated condition, whereas Japanese showed no difference between hydration conditions. We further investigated the de-acclimatization of heat adaptation by longitudinal observation on the heat tolerance of international students who had moved from tropical areas to Fukuoka for several years.
Topics: Acclimatization; Body Temperature; Body Temperature Regulation; Climate; Hot Temperature; Humans; Male; Sweating
PubMed: 35836266
DOI: 10.1186/s40101-022-00302-3 -
Sports Medicine (Auckland, N.Z.) Jul 2023Heat adaptation regimes are used to prepare athletes for exercise in hot conditions to limit a decrement in exercise performance. However, the heat adaptation literature... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Heat adaptation regimes are used to prepare athletes for exercise in hot conditions to limit a decrement in exercise performance. However, the heat adaptation literature mostly focuses on males, and consequently, current heat adaptation guidelines may not be optimal for females when accounting for the biological and phenotypical differences between sexes.
OBJECTIVES
We aimed to examine: (1) the effects of heat adaptation on physiological adaptations in females; (2) the impact of heat adaptation on performance test outcomes in the heat; and (3) the impact of various moderators, including duration (minutes and/or days), total heat dose (°Cmin), exercise intensity (kcalmin), total energy expended (kcal), frequency of heat exposures and training status on the physiological adaptations in the heat.
METHODS
SPORTDiscus, MEDLINE Complete and Embase databases were searched to December 2022. Random-effects meta-analyses for resting and exercise core temperature, skin temperature, heart rate, sweat rate, plasma volume and performance tests in the heat were completed using Stata Statistical Software: Release 17. Sub-group meta-analyses were performed to explore the effect of duration, total heat dose, exercise intensity, total energy expended, frequency of heat exposure and training status on resting and exercise core temperature, skin temperature, heart rate and sweat rate. An explorative meta-regression was conducted to determine the effects of physiological adaptations on performance test outcomes in the heat following heat adaptation.
RESULTS
Thirty studies were included in the systematic review; 22 studies were meta-analysed. After heat adaptation, a reduction in resting core temperature (effect size [ES] = - 0.45; 95% confidence interval [CI] - 0.69, - 0.22; p < 0.001), exercise core temperature (ES = - 0.81; 95% CI - 1.01, - 0.60; p < 0.001), skin temperature (ES = - 0.64; 95% CI - 0.79, - 0.48; p < 0.001), heart rate (ES = - 0.60; 95% CI - 0.74, - 0.45; p < 0.001) and an increase in sweat rate (ES = 0.53; 95% CI 0.21, 0.85; p = 0.001) were identified in females. There was no change in plasma volume (ES = - 0.03; 95% CI - 0.31, 0.25; p = 0.835), whilst performance test outcomes were improved following heat adaptation (ES = 1.00; 95% CI 0.56, 1.45; p < 0.001). Across all moderators, physiological adaptations were more consistently observed following durations of 451-900 min and/or 8-14 days, exercise intensity ≥ 3.5 kcalmin, total energy expended ≥ 3038 kcal, consecutive (daily) frequency and total heat dose ≥ 23,000 °Cmin. The magnitude of change in performance test outcomes in the heat was associated with a reduction in heart rate following heat adaptation (standardised mean difference = - 10 beatsmin; 95% CI - 19, - 1; p = 0.031).
CONCLUSIONS
Heat adaptation regimes induce physiological adaptations beneficial to thermoregulation and performance test outcomes in the heat in females. Sport coaches and applied sport practitioners can utilise the framework developed in this review to design and implement heat adaptation strategies for females.
Topics: Male; Humans; Female; Hot Temperature; Thermotolerance; Adaptation, Physiological; Exercise; Body Temperature Regulation
PubMed: 37222863
DOI: 10.1007/s40279-023-01831-2 -
International Journal of Environmental... Sep 2021Several aspects of cognition can be affected after cold exposure, but contradictory results have been reported regarding affected cognitive domains. The aim of the... (Review)
Review
Several aspects of cognition can be affected after cold exposure, but contradictory results have been reported regarding affected cognitive domains. The aim of the current systematic review was to evaluate the effects of specific cold exposure on cognitive performance in healthy subjects. A systematic search was performed using MEDLINE (through PubMed), EMBASE (Scopus) and PsycINFO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were healthy subjects exposed to a cold environment (either simulated or not) and cognitive performance related to cold exposure with an experimental design. The literature search identified 18 studies, eight studies investigated the effect of cold air exposure and ten the effect of cold water immersion on cognitive performance of healthy subjects. There were several differences among the studies (environmental temperature reached, time of exposure, timing, and type of cognitive test administration). Cold exposure induced in most of the experimental settings (15 of 18) an impairment of CP even before accidental hypothermia was established. The most investigated and affected cognitive domains were attention and processing speed, executive function, and memory. Gender differences and effects of repeated exposure and possible acclimation on cognitive performance need further studies to be confirmed.
Topics: Acclimatization; Adult; Attention; Cognition; Cognitive Dysfunction; Executive Function; Humans
PubMed: 34574649
DOI: 10.3390/ijerph18189725 -
Journal of UOEH Sep 2013The incidence of heat-related illness in the workplace is linked to whether or not workers have acclimated to a hot environment. Heat acclimation improves endurance work... (Review)
Review
The incidence of heat-related illness in the workplace is linked to whether or not workers have acclimated to a hot environment. Heat acclimation improves endurance work performance in the heat and thermal comfort at a given work rate. These improvements are achieved by increased sweating and skin blood flow responses, better fluid balance and cardiovascular stability. As a practical means of acclimatizing the body to heat stress, daily aerobic exercise training is recommended since thermoregulatory capacity and blood volume increase with physical fitness. In workers wearing personal protective suits in hot environments, however, little psychophysiological benefit is received from short-term exercise training and/or heat acclimation because of the ineffectiveness of sweating for heat dissipation and the aggravation of thermal discomfort with the accumulation of sweat within the suit. For a manual laborer who works under uncompensable heat stress, better management of the work rate, the work environment and health is required.
Topics: Acclimatization; Blood Flow Velocity; Blood Volume; Body Temperature Regulation; Environment Design; Exercise; Heat Exhaustion; Hot Temperature; Humans; Occupational Diseases; Occupational Exposure; Protective Clothing; Skin; Sweating; Task Performance and Analysis; Workplace
PubMed: 24077586
DOI: 10.7888/juoeh.35.183 -
Global Health, Science and Practice Dec 2023Through the collection and utilization of timely data, program implementers can review feedback and make rapid adjustments and adaptations to interventions while they...
Through the collection and utilization of timely data, program implementers can review feedback and make rapid adjustments and adaptations to interventions while they are in progress.Responsive feedback mechanisms (RFMs), which emphasize flexibility and iterative adaptation, provide opportunities for improving the fit and feasibility of a program, as well as its effectiveness. The (re)solve project-a 5-year, multicountry project testing new, context-specific solutions to address unmet need for family planning-used responsive feedback to ensure products and services designed and implemented were responsive to the context and preferences of health care workers, women, and girls. The adaptive learning meeting (ALM) cycle was designed as an RFM during implementation. This frequent series of rapid, actionable, cross-team meetings builds on several existing frameworks and practices. The ALM cycle used rapid, close to real-time data and observations from a wide range of stakeholders; routine monitoring data; and a structured, facilitated process to examine and act on feedback. Each cycle was repeated every 2 weeks for 3 months in Burkina Faso. During each cycle, the team interpreted data and feedback from multiple sources; assessed pragmatic, actionable options to address the feedback; and identified and agreed upon short- and long-loop adaptations that could improve the implementation process, coordination, efficiency, and outputs of the project. The ALM cycle proved helpful in engendering practices of surfacing and checking assumptions, careful interpretation of data, options analysis, and decision-making. The emphasis was on actionable feedback for improvement of the intervention rather than rigor of results and findings. The (re)solve project's experience with designing, structuring, and implementing the ALM cycle to address challenges and gaps in implementation can be informative for similar programs seeking to implement RFMs in complex and dynamic settings, especially where technology-based RFMs are not an option.
Topics: Humans; Female; Burkina Faso; Learning
PubMed: 38110203
DOI: 10.9745/GHSP-D-22-00217 -
Nature Communications Apr 2023At the molecular level, the evolution of life is driven by the generation and diversification of adaptation mechanisms. A universal description of adaptation-capable...
At the molecular level, the evolution of life is driven by the generation and diversification of adaptation mechanisms. A universal description of adaptation-capable chemical reaction network (CRN) structures has remained elusive until now, since currently-known criteria for adaptation apply only to a tiny subset of possible CRNs. Here we identify the definitive structural requirements that characterize all adaptation-capable collections of interacting molecules, however large or complex. We show that these network structures implement a form of integral control in which multiple independent integrals can collaborate to confer the capacity for adaptation on specific molecules. Using an algebraic algorithm informed by these findings, we demonstrate the existence of embedded integrals in a variety of biologically important CRNs that have eluded previous methods, and for which adaptation has been observed experimentally. This definitive picture of biological adaptation at the level of intermolecular interactions represents a blueprint for adaptation-capable signaling networks across all domains of life, and for the design of synthetic biosystems.
Topics: Adaptation, Physiological; Acclimatization; Signal Transduction
PubMed: 37081018
DOI: 10.1038/s41467-023-38011-9