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This study investigated the effects of a 12-hr per week education package for 7 children with autism spectrum disorders (ASD) within the context of the Italian public health system. Different from the US, the Italian public health system traditionally offers 1 to 3 hrs per week of speech, occupational, or physical therapy, and/or ABA-based activity for children with ASD. Hence, it is imperative to assess the criteria for effective ABA interventions to enable comparison with various models of care for children with ASD. We employed a treatment package based on the Comprehensive Application of Behavior Analysis to Schooling (CABAS®) model. Each participant received interventions for 4 hours a day, 3 days a week for one year. The results revealed a significant difference in the total scores and each sub-test score of both the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Childhood Autism Rating Scale-Second Edition (CARS-2) before and after one year of instruction. Our low-intensity intervention appears to effectively improve the participants’ various academic, verbal, and self-management skills, positively impacting their overall development. Our findings provide insights into testing the effectiveness of an alternative model of ABA intervention while also expanding the application of advanced ABA practices to enhance the developmental trajectory of young children. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a progressive osteoarticular disease affecting the whole joint. In the United Kingdom, OA is the most prevalent joint disease, with knee osteoarthritis (KOA) being the most common type of OA. Key symptoms of KOA include knee pain, stiffness, and loss of physical function. Different types of exercise can be performed in people with KOA, which exert different magnitudes of impact forces on the knee joint, whereby the National Institute for Health and Care Excellence (NICE) OA guidelines in fact recommend exercise as the core form of therapeutic OA management. However, the optimal type or dose – the cumulative intensity, duration, and frequency – of therapeutic exercise that most effectively provides KOA management is not currently known. This review aims to summarise and compare the literature, discussing optimal exercise modalities and doses for the management of KOA. All exercise modalities proved similarly beneficial at managing KOA with comparable improvements to knee pain, stiffness, and physical function, therefore with no optimal exercise modality identified. Benefits to KOA management was observed in everyone, including the elderly, obese, and those with severe KOA. Although, in those with severe KOA, walking was observed to only prevent further deterioration, rather than induce any symptomatic improvement. Furthermore, there was minimal difference between exercise modalities in relation to the improvements not only in KOA symptoms, but also modifiable KOA risk factors, adherence, adverse events, and QoL. Assessment of the dose-response relationship of each exercise modality showed that any dose of regular exercise was effective. Although, moderate intensity exercise performed three times weekly for 20-to-60-min appears optimal for KOA symptom control following most exercise modalities. Therefore, those with KOA should be encouraged to continue whatever exercise they currently do as should effectively manage symptoms, regardless of the modality or dose. However, those who do no exercise should use the present review in collaboration with clinicians via shared decision making to create a holistic exercise prescription. In summary, this review contributes to the literature through comprehensive discussion of different exercise modalities and doses in managing not only KOA symptoms, but modifiable KOA risk factors, exercise adherence, adverse events, and QoL. Additionally, summarised findings are discussed to give practical exercise recommendations to promote effective KOA management and recommendations for ongoing research.

Objectives: This study explores the feasibility and effects of low-intensity blood flow restriction exercise on forearm muscle strength and function in individuals with spinal cord injury. Study design: Pilot randomized clinical trial. Patients and methods: Ten male and female adult participants with chronic cervical and thoracic spinal cord injury underwent an 8-week low-intensity blood flow restriction exercise programme that targeted forearm muscles. Each participant’s contralateral forearm served as the control. Grip strength was the primary outcome measure, and participants also provided qualitative feedback on their experiences. Results: The study revealed a significant increase in participants’ forearm muscle strength on the experimental side engaged in low-intensity blood flow restriction training, with an average strength gain of 7.5 ± 0.36 kg after 16 exercise sessions (Cohen’s d = –6.32, 95% CI –8.34, –6.68). In comparison, the control side, following a conventional high- intensity exercise regimen without BFR, showed a more modest strength increase of 4.4 ± 0.67 kg. A mean Patient’s Global Impression of Change score of 2.2 reflected overall improvements in participants’ daily activities and health status. Conclusion: This study highlights the feasibility and effectiveness of low-intensity blood flow restriction exercise as a safe and promising approach to enhancing forearm muscle strength in individuals with spinal cord injury. The observed positive outcomes, coupled with a high level of participant satisfaction, underscore the potential of this innovative method to significantly improve limb muscle strength, thereby contributing to greater functional independence in this population.

The rapid and accurate detection of forest disturbances in temperate forests has become increasingly crucial as policy demands and climate pressure on these forests rise. The cloud-penetrating Sentinel-1 radar constellation provides frequent and high-resolution observations with global coverage, but few studies have assessed its potential for mapping disturbances in temperate forests. This study investigated the sensitivity of temporally dense C-band backscatter data from Sentinel-1 to varying management-related disturbance intensities in temperate forests, and the influence of confounding factors such as radar backscatter signal seasonality, shadow, and layover on the radar backscatter signal at a pixel level. A unique network of 14 experimental sites in the Netherlands was used in which trees were removed to simulate different levels of management-related forest disturbances across a range of representative temperate forest species. Results from six years (2016–2022) of Sentinel-1 observations indicated that backscatter seasonality is dependent on species phenology and degree of canopy cover. The backscatter change magnitude was sensitive to medium- and high-severity disturbances, with radar layover having a stronger impact on the backscatter disturbance signal than radar shadow. Combining ascending and descending orbits and complementing polarizations compared to a single orbit or polarization was found to result in a 34% mean increase in disturbance detection sensitivity across all disturbance severities. This study underlines the importance of linking high-quality experimental ground-based data to dense satellite time series to improve future forest disturbance mapping. It suggests a key role for C-band backscatter time series in the rapid and accurate large-area monitoring of temperate forests and, in particular, the disturbances imposed by logging practices or tree mortality driven by climate change factors. [ABSTRACT FROM AUTHOR]

Transcranial ultrasonic neuromodulation is a rapidly burgeoning field where low-intensity transcranial focused ultrasound (tFUS), with exquisite spatial resolution and deep tissue penetration, is used to non-invasively activate or suppress neural activity in specific brain regions. Over the past decade, there has been a rapid increase of tFUS neuromodulation studies in healthy humans and subjects with central nervous system (CNS) disease conditions, including a recent surge of clinical investigations in patients. This narrative review summarized the findings of human neuromodulation studies using either tFUS or unfocused transcranial ultrasound (TUS) reported from 2013 to 2023. The studies were categorized into two separate sections: healthy human research and clinical studies. A total of 42 healthy human investigations were reviewed as grouped by targeted brain regions, including various cortical, subcortical, and deep brain areas including the thalamus. For clinical research, a total of 22 articles were reviewed for each studied CNS disease condition, including chronic pain, disorder of consciousness, Alzheimer's disease, Parkinson's disease, depression, schizophrenia, anxiety disorders, substance use disorder, drug-resistant epilepsy, and stroke. Detailed information on subjects/cohorts, target brain regions, sonication parameters, outcome readouts, and stimulatory efficacies were tabulated for each study. In later sections, considerations for planning tFUS neuromodulation in humans were also concisely discussed. With an excellent safety profile to date, the rapid growth of human tFUS research underscores the increasing interest and recognition of its significant potential in the field of non-invasive brain stimulation (NIBS), offering theranostic potential for neurological and psychiatric disease conditions and neuroscientific tools for functional brain mapping. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Resistance training (RT) programs promote skeletal muscle hypertrophy through the progressive physiological stress applied to an individual. Currently, the vast majority of studies regarding the hypertrophic response to RT have focused on either sedentary or untrained individuals. This critically appraised topic focuses on the hypertrophic response to high- and low-load RT in resistance-trained men. Clinical Question: In experienced male weightlifters, does high-load RT lead to greater increases in muscle mass than low-load RT? Summary of Key Findings: Six studies met the inclusion criteria, while 4 studies were included in the analysis. Each of the 4 studies showed that low-load RT elicited hypertrophic gains similar to high-load RT when sets were taken to failure. Three of the studies were not volume equated, indicating a dose–response relationship between training volume-load and skeletal muscle hypertrophy. One of the studies was volume equated, indicating that skeletal muscle hypertrophy could be achieved at levels comparable to those observed in high-load protocols as a result of high levels of metabolic stress and the concomitant recruitment of high-threshold motor units that can occur during fatiguing contractions. Clinical Bottom Line: Evidence suggests that low-load training produces hypertrophic gains similar to those observed in high-load RT protocols when sets are taken to failure in resistance-trained men. Strength of Recommendation: There is moderate to strong evidence to suggest that low-load RT elicits hypertrophic gains similar to those observed in high-load RT protocols when sets are taken to failure in resistance-trained men. [ABSTRACT FROM AUTHOR]

Abstract Psychological Wellbeing Practitioners (PWPs) are central to NHS Talking Therapies services for depression and anxiety (TTad; formerly 'IAPT'). This workforce has been trained to deliver low-intensity treatments for mild to moderate depression and anxiety. In practice, PWPs routinely work with more complex clients, likely due to a combination of reasons. Over half of referrals experience concurrent personality difficulties, which are linked to poorer treatment outcomes, and PWPs describe feeling unskilled to work with these clients. This study aimed to develop and pilot a Continuing Professional Development workshop for PWPs about enhancing practice in the context of concurrent personality difficulties; and evaluate acceptability, feasibility and potential impacts on clinical skills and attitudes. This is an audit of routine feedback from a pilot of the workshop offered in a single TTad PWP workforce (n =139). The workshop was successfully developed and a series of five workshops were delivered to 74% of the PWP workforce. Feedback was overwhelmingly positive, and a majority of PWPs reported improved confidence in key skills covered during the workshop, and a positive attitude towards working with clients with personality difficulties after the workshop. PWPs described enhanced capability, opportunity and motivation to undertake work with this client group following the workshop. The workshop showed potential to improve PWP confidence and skill to support TTad clients in the context of personality difficulties, although it is not yet known if this translates to better treatment outcomes for clients. Implications for practice and future research are discussed. Key learning aims (1) Understand the feasibility of gathering feedback and outcome data of a Continuing Professional Development (CPD) workshop delivered in routine practice for PWPs. (2) Understand PWP perspectives on attending a CPD workshop to support tailoring PWP treatments for depression and anxiety in the context of personality difficulties. (3) Reflect on potential opportunity to enhance PWP treatments in the context of personality difficulties via brief training workshops. (4) Consider how COM-B can be used to explore barriers and enablers to PWPs implementing new learning to their practice. [ABSTRACT FROM AUTHOR]

Abstract The prevalence of mental health conditions is high for autistic adults. Yet, the IAPT manual states that referral rates into NHS Talking Therapies Services (NHS-TTS) do not reflect this nationally. Non-adapted treatment has been identified as a key barrier to accessing these services. It is therefore imperative that clinicians adapt to the needs of autistic individuals to make treatment accessible and effective. However, there is limited research in the field, especially for low-intensity cognitive behavioural therapy (LICBT). This service evaluation explores adapted LICBT for autistic adults within Plymouth's NHS-TTS and Autism Service. It investigated clinical outcomes of adapted group and one-to-one LICBT with 84 participants. It hypothesised that psychometric measures for anxiety and depression would be lowered on treatment completion, whilst exploring whether either intervention showed a greater reduction. Additionally, semi-structured interviews were conducted with six participants from the sample to gather perspectives on what aspects of treatment were favourable or require improvement. A factorial ANOVA revealed that psychometric measures reduced on completion across both interventions, with a greater decrease for one-to-one treatment and the anxiety measure. In addition, four themes and nine subthemes emerged following a thematic analysis, which focus on different aspects of treatment, such as content, structure, interaction, and barriers to engagement. Findings indicated that adapted LICBT was associated with lower anxiety and depression for autistic adults. This consequently has implications for improving the current LICBT provisions being offered to autistic adults within the NHS-TTS. Key learning aims (1) To understand some of the barriers autistic people face accessing an NHS Talking Therapies Service (NHS-TTS) and cognitive behavioural therapy (CBT). (2) To reflect on the importance of adapting practice and CBT for autistic people. (3) To present potential adaptations to low-intensity CBT for autistic adults with anxiety and depression. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) provides high-contrast resolution and is the preferred diagnostic tool for neurological disease. However, long exam times discourage MRI in emergency settings, and high-field MRI scanners (1.5-3T) require dedicated imaging suites. New, portable low-field-strength MRI machines (0.064T) have lower resolution than fixed MRI, but do not require restrictive environments or intrahospital transport. We present a case of a 78-year-old male with altered mental status who underwent 0.064T portable MRI and fixed 3T MRI exams in the emergency department. Imaging showed no evidence of acute infarction or intracranial lesions. The 0.064T images were of poor quality relative to 3T sequences, but the results of the portable MRI agreed with the conventional 3T MRI and a computed tomography scan from the same day. The compatible imaging results suggest that portable, low-field MRI can aid in neurological diagnosis without transporting patients to the MRI suite. Further studies should expand this comparison between high- and low-field MRI to better characterize the role and clinical applications of point-of-care MRI.

Objective To investigate the health damage caused by long-term exposure to low-intensity laser among female workers and provide a basis for the development of corresponding preventive measures. Methods Totally 96 female workers exposed to low -intensity laser in a large -scale communication equipment manufacturing company were selected as the exposed group, while another 96 female office staff without any exposure to occupational hazards in the same company were studied as the control group. Occupational health examinations were conducted for all study participants, and the relative results were analyzed. Results The prevalences of self-reported ophthalmic symptoms such as eye pain, foreign body-like irritation of the eye, photophobia, tearing, conjunctival congestion, and decreased visual acuity were higher in the exposed group than in the control group (P < 0.05). The prevalences of abnormalities in cornea, conjunctiva, lens, and fundus examinations were higher in the exposed group than in the control group (P < 0.05). The prevalences of self -reported dizziness, nausea, palpitation, insomnia, appetite loss, muscular stiffness, hypomnesis, hidrosis, feeling fatigued, and dysphoria were all significantly increased in the exposed group compared with the control group (P < 0.05). Rates of sinus arrhythmia and T -wave elevation in the exposed group were higher than those in the control group (P < 0.05). The menstrual abnormality in the exposed group was higher than that in the control group (P < 0.05). There was no statistically significant difference in abnormalities of blood pressure, blood routine examination, liver function, urine routine examination, and blood lipids between the exposed group and the control group (P > 0.05). Conclusions Long-term exposure to lowintensity laser could at least cause damage to the eyes, nervous system, cardiovascular system, and reproductive system of female workers. Workers occupationally exposed to lase should pay attention to strengthening personal eye and skin protection. [ABSTRACT FROM AUTHOR]

Background and Study purpose. Blood flow restriction training is a new training technique that involves lowintensity exercise and can generate physiological changes equivalent to high-intensity exercise. The aim of this study is to assess the impact of blood flow restriction in conjunction with low-intensity resistance exercise on muscle mass and muscle strength among overweight adolescents, in comparison to conventional resistance exercise. Materials and methods. The study involved two randomized groups: an experimental group, which performed 40% of one repetition maximum (1RM) resistance exercise combined with 60% of arterial occlusion pressure (AOP), and a traditional resistance exercise group, which performed 70% of 1RM resistance exercise. All participants underwent pre-test and post-test evaluations for body composition, 1RM, and muscle circumference. The training program lasted for six weeks and consisted of upper and lower body training, including exercises such as leg press, leg curl, arm curl, and arm extension. Results. The group that underwent low-load blood flow restriction (LLBFR) training showed a notable increase in muscle mass (p<0.049) as well as arm and leg circumference (p<0.047 and p<0.046, respectively) compared to before the training program, similar to the results of high-intensity resistance exercise. Conclusions. Combining blood flow restriction with low-intensity resistance training is a potentially effective approach to increase muscle size and strength, especially in overweight adolescents. Moreover, this type of training can decrease the amount of exercise load, making it a feasible option for individuals who may not tolerate high loads due to certain medical conditions or other limitations. [ABSTRACT FROM AUTHOR]

There is a dearth of studies investigating whether the combination of low-intensity statins with ezetimibe can reduce the risk of diabetes in patients requiring statin therapy. Therefore, we aimed to evaluate the effects of combination therapy on the prevention of glycated hemoglobin (HbA1c) elevation in patients without diabetes. Sixty-eight patients were randomly assigned in a 1:1 ratio to receive a combination of low-intensity rosuvastatin (5 mg/day) and ezetimibe (10 mg/day) or high-intensity rosuvastatin (20 mg/day). The primary endpoint was the absolute difference in the HbA1c levels at 12 weeks. The HbA1c level showed an overall elevation of 0.11% at 12 weeks compared to that at baseline (mean ± standard deviation: 5.78 ± 0.3%, 95% confidence interval [CI]: 5.86–6.07, p = 0.044). The HbA1c levels did not differ between the groups at 12 weeks (least square mean difference: 0.001, 95% CI: 0.164–0.16, p = 0.999). Our study found that the combination of low-intensity rosuvastatin and ezetimibe did not yield significant differences in HbA1c levels compared to high-intensity rosuvastatin alone after 12 weeks in patients without diabetes. This suggests that the combination of low-intensity rosuvastatin and ezetimibe may not be an effective strategy for preventing HbA1c elevation in patients without diabetes requiring statins. [ABSTRACT FROM AUTHOR]

Background and Study purpose. Blood flow restriction training is a new training technique that involves low-intensity exercise and can generate physiological changes equivalent to high-intensity exercise. The aim of this study is to assess the impact of blood flow restriction in conjunction with low-intensity resistance exercise on muscle mass and muscle strength among overweight adolescents, in comparison to conventional resistance exercise. Materials and methods. The study involved two randomized groups: an experimental group, which performed 40% of one repetition maximum (1RM) resistance exercise combined with 60% of arterial occlusion pressure (AOP), and a traditional resistance exercise group, which performed 70% of 1RM resistance exercise. All participants underwent pre-test and post-test evaluations for body composition, 1RM, and muscle circumference. The training program lasted for six weeks and consisted of upper and lower body training, including exercises such as leg press, leg curl, arm curl, and arm extension. Results. The group that underwent low-load blood flow restriction (LLBFR) training showed a notable increase in muscle mass (p

Physical activity (PA) reduces with older age, ill health, and disability. For these groups, guidance recognizes the benefit of small increases in PA and low-intensity PA. This study evaluated a low-threshold intervention that addressed known barriers to older people's participation in PA in residential care and sheltered housing. Ten, competitive sport sessions were delivered by coaches at 49 sites with the aim that they be sustained in-house. Using quasi-experimental methods, participants reported reduced sitting time, increased moderate/vigorous PA, increased participation in sports and improved scores for both health quality of life and fear of falling at 6 months. The program engaged 29% of residents and was sustained at 50% of sites at 8 months. The findings suggest that low-threshold sports programs that overcome known barriers to older people's participation in PA have the potential to provide a gateway to increased PA in group homes and to be sustained in-house. [ABSTRACT FROM AUTHOR]

The Early Start Denver Model is an evidence-based, comprehensive naturalistic developmental behavioral intervention for young and very young children with autism spectrum disorder. This interdisciplinary model is suitable for the Taiwanese public health system. In this study, we evaluated the effectiveness of an Early Start Denver Model program with adaptation, including a lower intensity, shorter duration, and delivery in general hospitals by multidisciplinary professionals. A quasi-experimental study with pre-, post-intervention, and 6-month follow-up was conducted. Forty-five young children with autism spectrum disorder, aged 2–4 years, were grouped into the Early Start Denver Model and control (the usual community treatment) groups. The Early Start Denver Model group received 6 months of one-on-one intervention for approximately 8–9 h per week. Compared with the control group, the Early Start Denver Model group showed greater improvements in overall development quotient and nonverbal development quotient from pre- to post-intervention, but these differences (a Group-by-Time interaction) did not sustain at the 6-month follow-up. Being mindful of some potential threats to internal validity associated with clinical trial designs and implementation, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in regional general hospital settings in the context of Han-Chinese-mainly culture. The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2–4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8–9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries. [ABSTRACT FROM AUTHOR]

• A single-eyer diffraction grating photodetector enabled spectroscopy of low-intensity broadband light. • The grating pitch reduction ensured unique SPR resonance points within the measured wavelength and scanning angle range. • The plasmonic photodetectors with submicron 0.95 µm-pitch-grating presented robust reconstructive spectroscopy. • Transmittance measurements of three different materials, acrylic resin, glass, and COP plates with the proposed photodetector presented distinctive transmission spectrum features. Reconstructive spectroscopy, a spectroscopic method that derives the spectrum of incident light using photodetection elements with various dispersion characteristics, is emerging as a promising approach for constructing compact spectroscopic devices. The generally adopted approach of simultaneously irradiating spatially distributed multiple elements is not suitable for weak light because the elements divide the total incident power spatially. Temporarily tilting a single-eyed diffraction grating photodetector that couples the light with the surface plasmon resonance can utilize the whole incident optical power, which is advantageous when only weak light is available. However, to perform robust spectroscopy, a carefully designed dispersion relation of surface plasmon resonance is required. In this study, we propose a suitable grating structure for reconstructive spectroscopy of low-intensity broadband near-infrared light. Using an optimal sub-micron pitch of 0.95 µm grating, the reconstruction of the light from a halogen lamp light with an intensity density as small as around 10µW/nm is presented in the 1200–1400 nm wavelength range. The reconstructive spectroscopy with the plasmonic photodetector also allows for the identification of materials such as glass, cycloolefin polymer, and acrylic resin within this wavelength band. The potential for integration with microelectromechanical systems technology opens up possibilities for a compact near-infrared spectroscopic device that is compatible with a variety of light sources, offering applications in various scientific fields. [ABSTRACT FROM AUTHOR]

Background: Recent national policy and strategic workforce commissioning has created quality-monitored low intensity working in children and young people's mental health (CYP-MH), that follows a stepped care model seen in adult services. This study explored the experiences of members of this new workforce to better understand factors that might support the effectiveness and sustainability of the role from a practitioner perspective. Methods: Interpretive Phenomenological Analysis was used to analyse (N=12) semi-structured interview transcripts from CYP Wellbeing Practitioners (CWPs) in London and the Southeast. Results: Five main themes emerged from analysis, suggesting practitioners value their role and its place within the workforce, but have concerns about the low intensity remit meeting high intensity demands, their professional identity and career progression within the speciality. Conclusions: Low-intensity services provide a welcome addition to CYP-MH services with encouraging outcomes so far. Themes that emerged from practitioner experience highlighted clearly defined service remits, careful integration into existing service provision, and professional recognition with career progression as factors that might support the sustainability of the low intensity CYP-MH workforce. [ABSTRACT FROM AUTHOR]

Background: With rising demand for non-invasive body contouring, this study aimed to evaluate the efficacy and safety of non-focused, low-intensity ultrasound for lower abdominal lipolysis., Methods: The enrolled subjects prospectively received 6 weekly sessions of well-setting ultrasound treatment with frequency of 1 MHz and an intensity of 2.2 W/cm2, to target the subcutaneous fat of lower abdomen with three regions (left, middle, and right). Evaluations included ultrasound measurements and blood biochemical analyses at the baseline, pre-4th session, and at 1 and 2-month post-treatment points to confirm the efficacy and safety., Results: A total of 17 subjects completed the whole treatment. Significant reductions in superficial abdominal fat layer thickness of all three regions were observed (all P-values of ANOVA <0.001), without severe adverse events reported. Post-hoc analysis showed the superficial fat layers of all the three regions at 1-month post-treatment significant reductions comparing the baseline (all adjusted P < 0.05). The reduction effects for superficial fat layers were still available at the 2-month post-treatment follow-up at the left and middle regions. Conversely, there was no significant improvements among the deep fat layers at the three regions., Conclusion: Non-focused, low-intensity ultrasound demonstrate its potential of efficacy and safety for reducing superficial abdominal fat, and may maintain the capability for at least two months. Further studies are needed to confirm long-term efficacy and optimize treatment parameters.   What is already known on this topic? Non-focused ultrasound with low-intensity is recognized for its potential in non-invasive body contouring, but detailed efficacy and safety data were limited, especially for lower abdominal lipolysis. What this study adds? Our research demonstrated the efficacy and safety of non-focused ultrasound with low-intensity in reducing superficial abdominal fat, with sustained effects for at least two months. How this study might affect research, practice, or policy? This study could guide future researches toward long-term effects and optimization of ultrasound treatments, and influence clinical practice by providing a validated method for non-invasive fat reduction., (© The Author(s) 2025. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aim: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. Methods: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with

Bilateral brain stimulation is an important modality used to investigate brain circuits and treat neurological conditions. Recently, low-intensity pulsed ultrasound (LIPUS) received significant attention as a novel non-invasive neurostimulation technique with high spatial specificity. Despite the growing interest, the typical ultrasound brain stimulation study, especially for small animals, is limited to a single target of sonication. The constraint is associated with the complexity and the cost of the hardware system required to achieve multi-regional sonication. This work presented the development of a low-cost LIPUS system with a pair of single-element ultrasound transducers to address the above problem. The system was built with a multicore processor with an RF amplifier circuit. In addition, LIPUS device was incorporated with a wireless module (bluetooth low energy) and powered by a single 3.7 V battery. As a result, we achieved an ultrasound transmission with a central frequency of 380 kHz and a peak-to-peak pressure of 480 kPa from each ultrasound transducer. The developed system was further applied to anesthetized rats to investigate the difference between uni- and bilateral stimulation. A significant difference in cortical power density extracted from electroencephalogram signals was observed between uni- and bilateral LIPUS stimulation. The developed device provides an affordable solution to investigate the effects of LIPUS on functional interhemispheric connection. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) is an effective treatment for child anxiety disorders. Low-intensity forms of CBT, such as guided parent-delivered CBT (GPD-CBT), have been developed to increase access; however, it is unclear why some children benefit from this treatment and others do not. This qualitative study aimed to increase understanding of parents' experiences of GPD-CBT and what facilitates and creates barriers to good outcomes. The sample was derived from a sample of families who took part in long-term follow-up assessments (reported in). Data were analyzed using thematic analysis. Two themes containing five subthemes were developed from the data. Theme 1 described factors influencing the experience of GPD-CBT. Theme 2 described perceived outcomes in the child and wider changes within the family. The identification of facilitators and barriers to the success of GPD-CBT could inform and improve future treatment delivery. [ABSTRACT FROM AUTHOR]

This paper critically examines the characteristics of low-intensity, small-scale family farming and related aspects of farming sustainability, in a marginally productive peri-urban landscape, that of the capital town of Lesvos Island, Mytilini, Greece. These aspects and characteristics are explored on the basis of farmers’-landowners’ perceptions and visions of local landscape/land use change, through a questionnaire survey. Our findings indicate that production is basically aimed for self-consumption; such practices yield low incomes but bear high cultural values, mostly run by hobby and part-time farmers-landowners, lacking agricultural education. Olive crops are the dominant, but decreasing, form of production, while some other less-water-reliant cultivations are increasing. Peri-urban small family farming remains significant, but in need of new policies/strategies further promoting its value and role.

The prognosis of newly diagnosed patients with acute myeloid leukemia is still unfavorable in the majority of cases within the intermediate and mainly adverse genetic risk group but also in a considerable fraction of favorable-risk patients, mainly due to recurrence of disease after complete remission achievement or, less frequently, primary refractoriness. Besides genetic classification at diagnosis, post-treatment prognostic factors include measurable residual disease evaluation in patients in complete remission and in most cases measurable residual disease (MRD) positivity predicts hematologic relapse potentially allowing early therapeutic intervention. Currently, the most commonly used methods for detection of minimal residual disease are multiparameter flow cytometry and quantitative PCR, applicable to around 90% and 50% of patients, respectively. In addition, in > 90% of acute myeloid leukemia (AML) patients, molecular aberrations can be identified by next-generation sequencing, a technology that is widely used in clinical practice for the initial mutational screening at the time of diagnosis but more often, for MRD detection because its flexibility allows almost every mutated gene to be used as an MRD marker. Threshold levels of residual disease and correlation with outcome have been thoroughly studied and established in younger patients treated with intensive induction and consolidation chemotherapy as well as after allogeneic transplantation. Yet, experience on MRD monitoring and interpretation in patients treated with low-intensity regimens, including new agents, is still limited. The updated armamentarium of anti-leukemic agents includes the BCL-2 inhibitor venetoclax, which demonstrated good tolerability, high response rates, and prolonged overall survival when combined with hypomethylating agents or low dose cytarabine in patients considered elderly/”unfit” to tolerate intensive regimens. Although remissions with negative minimal residual disease clearly translated into improved outcomes after intensive treatments, data supporting the same evidence in patients receiving low-intensity venetoclax-based treatments are not still consolidated. We here review and discuss more recent data on the minimal residual disease interpretation and role in AML patients treated with venetoclax-based combinations.

Background and Aims: Low-intensity psychological interventions are effective for children and young people (CYP) with mental health difficulties and can help bridge the demand-capacity gap. Despite increasing awareness, training and use of low-intensity psychological interventions, it is not yet understood what is being implemented in clinical practice in the UK and the associated evidence base., Method: This paper presents two studies; first, a national survey ( n =102) of practitioners to identify low-intensity psychological interventions currently delivered in practice and second, an exploration of the availability and the strength of empirical support (characterised as 'gold', 'silver' and 'bronze') of low-intensity CBT interventions for CYP., Results: The first study found a wide variety of interventions being used across different services; 101/102 respondents reported using routine outcome measures. The second study identified 44 different low-intensity interventions, 28 of which were rated as having gold empirical support. However, only 13 of the gold interventions were considered accessible for practitioners and only two were reported being used in routine practice., Conclusion: These findings highlight that these interventions have been developed and empirically tested, but many are not easily accessible, highlighting the 'research-practice' gap in the provision of low-intensity interventions. There is a need for an increase in standardisation of care and accessibility of gold interventions. This paper hopes to begin the process of creating a hub of low-intensity interventions that are accessible and empirically supported to improve equity of access and outcomes of low-intensity psychological interventions for CYP.

Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence., Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting., Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants' enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05., Results: As for experts' consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision-based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user's perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001)., Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults' enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions., (© Teerawat Kamnardsiri, Sirintip Kumfu, Peeraya Munkhetvit, Sirinun Boripuntakul, Somporn Sungkarat. Originally published in JMIR Serious Games (https://games.jmir.org).)

Objective: The neuromodulatory effects of focused ultrasound (FUS) have been demonstrated in animal epilepsy models; however, the safety and efficacy of FUS in humans with epilepsy have not been well established. Patients with drug‐resistant epilepsy (DRE) undergoing stereo‐electroencephalography (SEEG) provide an opportunity to investigate the neuromodulatory effects of FUS in humans. Methods: Patients with DRE undergoing SEEG for localization of the seizure onset zone (SOZ) were prospectively enrolled. FUS was delivered to the SOZ using a neuronavigation‐guided FUS system (ceiling spatial‐peak temporal‐average intensity level = 2.8 W/cm2, duty cycle = 30%, modulating duration = 10 min). Simultaneous SEEG recordings were obtained during sonication and for 3 days after treatment. Seizures, interictal epileptiform discharges, and adverse events after FUS were monitored. Results: Six patients met the eligibility criteria and completed FUS treatment. A decrease in seizure frequency was observed in two patients within the 3‐day follow‐up; however, one patient presented an increase in the frequency of subclinical seizures. Posttreatment magnetic resonance imaging revealed neither lesion nor brain edema. Significant changes in spectral power of SEEG were noted at the targeted electrodes during FUS treatment. One patient reported subjective scalp heating during FUS, and one patient developed transient naming and memory impairment that resolved within 3 weeks after FUS. Significance: FUS can be safely delivered to the SOZ of patients with DRE, resulting in significant changes in spectral power of SEEG. A larger sample cohort and pursuing optimal sonication parameters will be required to elucidate the neuromodulatory effects of FUS when used for seizure control. [ABSTRACT FROM AUTHOR]

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings. Key learning aims: (1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions. (2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties. (3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care. [ABSTRACT FROM AUTHOR]

Guided CBT self-help represents a low-intensity intervention to deliver evidence-based psychological therapy within the Improving Access to Psychological Therapies (IAPT) programme. Best practice guidance highlighting characteristics associated with CBT self-help is available to help services reach decisions regarding which interventions to adopt. However, at present a single process to evaluate written CBT self-help interventions informed by guidance is lacking. This study reports on the development of a standardised criteria-driven process that can be used to determine the extent written CBT self-help interventions are consistent with guidance regarding the fundamental characteristics of low-intensity CBT and high-quality written patient information. Following development, the process was piloted on 51 IAPT services, with 23 interventions identified as representing free-to-use written CBT self-help interventions. Overall, inter-rater reliability was acceptable. Following application of the criteria framework, 14 (61%) were considered suitable to be recommended for use within the IAPT programme. This pilot supports the development and potential utility of an independent criteria-driven process to appraise the suitability of written workbook-based CBT self-help interventions for use within the IAPT programme. Key learning aims: (1) To recognise the range of written low-intensity CBT self-help interventions currently used within IAPT services. (2) To identify separate criteria associated with high-quality written CBT self-help interventions. (3) To use identified criteria to develop a framework to evaluate written workbook based low-intensity CBT self-help interventions for use within the IAPT programme. (4) To evaluate inter-rater reliability of the criteria framework to evaluate the quality and appropriateness of written workbook based low-intensity CBT self-help interventions used within IAPT services. [ABSTRACT FROM AUTHOR]

Background: To prevent or reduce the risk of strain injury, various approaches, including stretching techniques are currently being used. The effect of proprioceptive neuromuscular facilitation (PNF) and static stretching on flexibility has been demonstrated; however, it is not clear which one is superior. Objects: This study aimed to evaluate the differences between the effects of PNF and static stretching performed at various intensities on muscle flexibility. Methods: The maximum voluntary isometric contraction (MVIC) of the hamstrings using the PNF stretching technique was performed in the P100 group, while 70% of the MVIC was performed in the P70 group. The MVIC value obtained during the PNF stretching in both groups was used as a reference for setting the intensity of static stretching. Static stretching was performed at 130% (S130), 100% (S100), and 70% of the MVIC (S70). The active knee extension (AKE) values, defined as the knee flexion angle were measured before stretching (baseline), immediately after stretching (post), and at 3 minutes, 6 minutes, and 15 minutes. Results: PNF stretching produce a greater improvement in flexibility compared with static stretching. Specifically, the AKE was significantly higher in the S100 and S70 groups than in the P100 group at Post. In the comparison of AKE over time in each group, the AKE at Post showed a significant decrease compared to the value at Baseline in the S130 group; however, no significant difference was observed at 6 minutes while a significant increase was noted at 15 minutes. Conclusion: This study found that PNF stretching is more effective than static stretching with respect to increasing and maintaining the flexibility of muscles. In addition, the increase in flexibility at maximal intensity was similar to that observed at submaximal intensity during both PNF and static stretching.

Abstract Background Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats – a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet – to a control group that will receive PC medical treatment as usual. Methods A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: “face-to-face MBI + TAU”, “Internet-delivered MBI + TAU”, and “TAU alone”. The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. Discussion This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. Trial registration Clinical Trials.gov NCT03034343. Trial Registration date 24 January 2017, retrospectively registered.

Background: Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. Methods: We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. Results: We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety (p

Considering that the squat exercise requires flexion and extension of the knee and hip joints, a resistance training program based on squat exercises should efficiently increase the flexion and extension strength of both the knee and hip. To our knowledge, however, no study has simultaneously investigated the effects of squat training on both flexion and extension strength in both the knee and hip. Low-intensity squat exercises at slow speeds can be expected to effectively and safely improve knee and hip flexion and extension strength in a wide range of individuals. This study aimed to clarify whether knee and hip flexion and extension strength improved after an 8-week low-intensity squat training program at slow speed. Twenty-four untrained young men were randomly assigned to a training or control group. Participants in the training group performed 40% one-repetition maximum parallel squats at slow speed (4 s for concentric/eccentric actions), 3 days per week for 8 weeks. Before and after the intervention, isometric peak torque of the knee and hip flexors and extensors during maximal voluntary contraction (MVC) was determined. For the knee flexors and extensors, muscle volume was also measured. There were significant training-induced increases in peak torque (P < 0.05). The training effects on knee and hip extension torque (effect size = 0.36–0.38) were higher than those on knee and hip flexion torque (effect size = 0.09–0.13). The squat training used here increased both knee and hip flexion and extension strength, but the training effects on the flexion strength were less than those on the extension strength. Regarding the knee extensors, a significant training-related increase in muscle volume was found (P < 0.05) without neuromuscular adaptations. In addition, there were significant correlations between the training-induced increases in muscle volume and peak torque of KE. These results suggest that muscle hypertrophy may be responsible for increased muscle strength of the knee extensors after an 8-week low-intensity squat training program at slow speed.

Abstract Background Despite the positive outcomes of the use of noninvasive positive pressure ventilation (NPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), NPPV fails in approximately 15% of patients with AECOPD, possibly because the inspiratory pressure delivered by conventional low-intensity NPPV is insufficient to improve ventilatory status for these patients. High-intensity NPPV, a novel form that delivers high inspiratory pressure, is believed to more efficiently augment alveolar ventilation than low-intensity NPPV, and it has been shown to improve ventilatory status more than low-intensity NPPV in stable AECOPD patients. Whether the application of high-intensity NPPV has therapeutic advantages over low-intensity NPPV in patients with AECOPD remains to be determined. The high-intensity versus low-intensity NPPV in patients with AECOPD (HAPPEN) study will examine whether high-intensity NPPV is more effective for correcting hypercapnia than low-intensity NPPV, hence reducing the need for intubation and improving survival. Methods/design The HAPPEN study is a multicenter, two-arm, single-blind, prospective, randomized controlled trial. In total, 600 AECOPD patients with low to moderate hypercapnic respiratory failure will be included and randomized to receive high-intensity or low-intensity NPPV, with randomization stratified by study center. The primary endpoint is NPPV failure rate, defined as the need for endotracheal intubation and invasive ventilation. Secondary endpoints include the decrement of arterial carbon dioxide tension from baseline to 2 h after randomization, in-hospital and 28-day mortality, and 90-day survival. Patients will be followed up for 90 days after randomization. Discussion The HAPPEN study will be the first randomized controlled study to investigate whether high-intensity NPPV better corrects hypercapnia and reduces the need for intubation and mortality in AECOPD patients than low-intensity NPPV. The results will help critical care physicians decide the intensity of NPPV delivery to patients with AECOPD. Trial registration ClinicalTrials.gov, NCT02985918. Registered on 7 December 2016.

Anxiety and depression affect a significant number of children and young people (CYP) and can have a far reaching and long-lasting impact. Cognitive behavioural (CB) interventions can be effective for treating anxiety and depression in CYP but are difficult to access. Recent government policy in England seeks to train a non-traditional graduate workforce to deliver a range of CB interventions for mild to moderate anxiety and depression to CYP, in community settings. This practice-based evaluation aimed to estimate the effectiveness of CB interventions delivered by postgraduate trainees undertaking training in a range of CB interventions for mild to moderate anxiety and depression whilst on placement in schools or community Child and Adolescent Mental Health Services (CAMHS). Self- and parent-reported routine outcome measures (ROMS) were completed pre- and post-intervention, including measures of symptom severity, symptom impact and goal achievement. Significant improvements were demonstrated across all self and parent-reported measures post-intervention, with mean scores falling firmly in the non-clinical range, a significant reduction in the proportion of CYP in the clinical range on measures, and predominantly medium to large effect sizes. Results are promising in terms of the capacity to train a graduate workforce to deliver a range of low-intensity CB interventions to CYP experiencing mild to moderate depression or anxiety-based difficulties in either CAMHS or school settings, increasing capacity across the system. The current practice-based evaluation also supports the potential effectiveness of current training models/programmes. Further research is needed in terms of long-term outcomes and to compare outcomes between settings, interventions, and demographic groups. Key learning aims: (1) To understand the potential prevalence rates of mental health difficulties in children and young people in England, and their wider impact. (2) Critical awareness of the evidence base for cognitive and behavioural interventions for depression and anxiety in children and young people. (3) Awareness of gaps in access to evidence-based psychological interventions for children and young people in England. (4) Knowledge of emerging graduate-level low-intensity psychological practitioner roles in England. (5) Awareness of the emerging evidence base for the estimated effectiveness of low-intensity cognitive and behavioural interventions delivered to children and young people by graduate-level practitioners in schools and community mental health settings. [ABSTRACT FROM AUTHOR]

Proprioceptive neuromuscular facilitation (PNF) stretching at low intensities has been rarely investigated. Previous studies have shown that hamstring flexibility after stretching is only temporary. The aim of this study was to assess the effect of low intensities (40% and 10% of maximum voluntary isometric contraction, MVIC) of PNF stretching on hamstring muscles and to assess the effect of standing toe touch on the duration of hamstring flexibility. This was a single-blind randomized controlled trial. Sixty-four healthy adults (age, 22.67 ± 1.73 years) were selected and divided into four groups: 40% intensity PNF stretching (P40), 10% intensity PNF stretching (P10), 40% intensity PNF stretching with toe touch (P40 with TT), and 10% intensity PNF stretching with toe touch (P10 with TT). Hamstring flexibility was measured using the active knee extension test (pre-stretching, post-stretching, and 3, 6, 9, 12, and 15 min after PNF stretching). In the P40, P40 with TT, and P10 with TT groups, significant changes were observed at all time points after stretching (p < 0.05). In the P10 group, significant changes were only observed immediately post stretching (p = 0.006) and at 3 min (p = 0.029) after stretching. In terms of maintaining the duration of flexibility, the P40 with TT and P10 with TT groups were superior to the P40 and P10 groups. PNF stretching at low intensity, approaching 40% of MVIC, led to more flexibility than 10% MVIC. Additionally, standing toe touch after PNF stretching is recommended to develop and maintain hamstring flexibility. [ABSTRACT FROM AUTHOR]

Considering that the squat exercise requires flexion and extension of the knee and hip joints, a resistance training program based on squat exercises should efficiently increase the flexion and extension strength of both the knee and hip. To our knowledge, however, no study has simultaneously investigated the effects of squat training on both flexion and extension strength in both the knee and hip. Low-intensity squat exercises at slow speeds can be expected to effectively and safely improve knee and hip flexion and extension strength in a wide range of individuals. This study aimed to clarify whether knee and hip flexion and extension strength improved after an 8-week low-intensity squat training program at slow speed. Twenty-four untrained young men were randomly assigned to a training or control group. Participants in the training group performed 40% one-repetition maximum parallel squats at slow speed (4 s for concentric/eccentric actions), 3 days per week for 8 weeks. Before and after the intervention, isometric peak torque of the knee and hip flexors and extensors during maximal voluntary contraction (MVC) was determined. For the knee flexors and extensors, muscle volume was also measured. There were significant training-induced increases in peak torque (P < 0.05). The training effects on knee and hip extension torque (effect size = 0.36–0.38) were higher than those on knee and hip flexion torque (effect size = 0.09–0.13). The squat training used here increased both knee and hip flexion and extension strength, but the training effects on the flexion strength were less than those on the extension strength. Regarding the knee extensors, a significant training-related increase in muscle volume was found (P < 0.05) without neuromuscular adaptations. In addition, there were significant correlations between the training-induced increases in muscle volume and peak torque of KE. These results suggest that muscle hypertrophy may be responsible for increased muscle strength of the knee extensors after an 8-week low-intensity squat training program at slow speed. [ABSTRACT FROM AUTHOR]

The Early Start Denver Model is an evidence-based, comprehensive naturalistic developmental behavioral intervention. Randomized controlled studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can positively impact the clinical outcomes of young children with autism spectrum disorder. However, it is difficult to deliver high-intensity early intervention in an under-resourced country such as Taiwan. This study evaluated the effects of implementing the Early Start Denver Model with adaptations (including low intensity, shorter duration, and delivery in general hospitals by multidisciplinary professionals) within the Taiwanese public health system. A pre- and post-intervention study was conducted. Sixteen children with autism spectrum disorder (mean age of 33.5 months) received 6 months of one-on-one Early Start Denver Model intervention (approximately 8 h per week). The children showed significant post-intervention improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, with a wider reach, for young children with autism spectrum disorder in Taiwan. The next steps in Taiwan are to incorporate a control group and assess the long-term effects of the adapted Taiwanese Early Start Denver Model program. The Early Start Denver Model is a comprehensive naturalistic developmental behavioral intervention for young children with autism spectrum disorder. Rigorous studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can help young children with autism spectrum disorder have great progress in language, cognitive development, and adaptive skills and reduce overall symptom severity. In accordance with the current limitations in resourcing for early intervention in Taiwan, this study evaluated the effects of implementing the Early Start Denver Model in the Taiwanese public health system with some adaptations, including lower intensity, shorter duration, and delivery in general hospitals. A total of 16 children with autism spectrum disorder, aged between 25 and 46 months, received approximately 8 h per week one-on-one Early Start Denver Model intervention. After 6 months of intervention, the children showed great improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that directly delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, which can make more young children with autism spectrum disorder in Taiwan access the Early Start Denver Model service. [ABSTRACT FROM AUTHOR]

We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose–response relationship between ABA intervention hours and outcomes. [ABSTRACT FROM AUTHOR]

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes. [ABSTRACT FROM AUTHOR]

Milk and dairy products have a major role in human nutrition, as they contribute essential nutrients for child development. The nutritional properties of dairy products are maintained despite applying traditional processing techniques. Nowadays, so-called emerging technologies have also been implemented for food manufacture and preservation purposes. Low- and high-intensity ultrasounds are among these technologies. Low-intensity ultrasounds have been used to determine, analyze and characterize the physical characteristics of foods, while high-intensity ultrasounds are applied to accelerate particular biological, physical and chemical processes during food product handling and transformation. The objective of this review is to explain the phenomenology of ultrasounds and to detail the differences between low and high-intensity ultrasounds, as well as to present the advantages and disadvantages of each one in terms of the processing, quality and preservation of milk and dairy products. Additionally, it reviews the rheological, physicochemical and microbiological applications in dairy products, such as raw milk, cream, yogurt, butter, ice cream and cheese. Finally, it explains some methodologies for the generation of emulsions, homogenates, crystallization, etc. Currently, low and high-intensity ultrasounds are an active field of study, and they might be promising tools in the dairy industry.

Background: Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent., Objective: This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety., Methods: Log data were examined with respect to a sample of "engaged" users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the "minimum dose." Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety., Results: There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t 53 =5.5; P<.001; 95% CI 2.4-5.2) and low mood (t 53 =2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder-7 (F 2,51 =6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire-8 did not reach significance (F 2,51 =2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving., Conclusions: Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement., (©Paul Farrand, Patrick J Raue, Earlise Ward, Dean Repper, Patricia Areán. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 10.01.2024.)

The purpose of this study was to examine the effect of low-intensity exercise on neuroplasticity and memory performance in young Wistar adult rats. Neuroplasticity was determined by altering the expression of proteins such as synaptophysin, neuroligin-1, AMPAR, NMDAR, and PSD-95 in the rat hippocampus. Six-month-old rats were randomly divided into Sedentary (Sed) and Exercise (Ex) Groups. Exercise rats had better spatial memory compared to sedentary rats. This result was shown by a reduction in both the time travelled and the total error in the Water-E Maze task (P<0.05). Immunohistochemistry staining showed that exercise rats had higher optical density scores of both pre- and postsynaptic proteins compared to sedentary rats (P<0.05). In conclusion, the findings indicate that the low-intensity exercise improves spatial learning and memory, as shown by increased neuroplasticity and synaptic maturation in young Wistar adult rats. [ABSTRACT FROM AUTHOR]

Difficulties falling asleep are common among adolescents, especially during times of stress. Adolescents may thus benefit from brief techniques (15 min) that decrease pre-sleep cognitive-emotional arousal and sleep-onset latency. The present study used a 3 (intervention: mindfulness bodyscan mp3, constructive worry, control) by 3 (time: baseline, week 1, week 2) mixed-model design on a school-based sample of adolescents (N = 232; Mage = 15.9 ± 0.8 years, range = 14-18 years; 19% male), and a sub-sample of adolescents with prolonged sleep-onset latency (i.e. ≥30 min; N = 119; Mage = 16.9 ± 0.9 years; 21% male). It was expected that the 15-min prerecorded breath-based mindfulness bodyscan, and constructive worry, would decrease sleep-onset latency and pre-sleep arousal similarly over time, relative to the control condition. A significant interaction was observed among adolescents with prolonged sleep-onset latency, who completed >3 days for at least 1 week (p = .001), where mindfulness decreased sleep-onset latency relative to constructive worry and the control. Neither technique changed pre-sleep worry or cognitiveemotional arousal, or associated daytime functioning (both the whole sample and sub-sample). A pre-recorded mp3 breath-based mindfulness bodyscan technique is a promising means by which adolescents with prolonged sleep-onset latency can decrease sleep-onset latency. This simple tool has potential for scalable dissemination by stakeholders (e.g. teachers), unqualified to treat adolescent sleep difficulties. Future studies are needed to determine whether benefits may extend to academic performance and mental health, if performed for a longer time period with increased compliance. [ABSTRACT FROM AUTHOR]

Background.An estimated 19–25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings.Methods.The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch.Results.Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017.Conclusions.THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients' symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed. [ABSTRACT FROM AUTHOR]

Background. An estimated 19-25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings. Methods. The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch. Results. Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017. Conclusions. THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings. [ABSTRACT FROM AUTHOR]

The aim of the research was to examine the clinical significance of a low intensity cognitive-behavioural guided self-help programme for a community sample of individuals experiencing depression and low mood. The intervention was provided either face-to-face or over the telephone depending on the participant's preference. The study used a two-group repeated measures naturalistic design. Participants were assessed weekly during the six-week programme, with follow-up assessments at six and twelve weeks. Thirteen participants completed the programme. Low mood was measured by the nineitem Patient Health Questionnaire (PHQ-9), and quality of life was measured by the short form Quality of Life and Enjoyment Questionnaire (QLES-SF). Results showed a clinically significant reduction in depressive symptoms and increase in quality of life ratings. The results provide preliminary support that a cognitive-behavioural guided self-help programme can benefit people experiencing low to moderate levels of depression. [ABSTRACT FROM AUTHOR]