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There are limited empirically supported interventions that target three outcomes—behavior of children with ASD (instead of using adjectives such as “disruptive,” “interfering,” “problem,” or “challenging” behavior, we use “behavior” to avoid ableist language), parent stress, and parenting sense of competence. To help address this need, we tested a hybrid telehealth adaptation of COMPASS for Hope (C-HOPE), an 8-week parent-mediated program originally offered via face-to-face or synchronous telehealth delivery. The present study incorporated asynchronous group discussion board sessions hosted on a learning-management platform together with synchronous individual coaching sessions by telephone. Using a pre-post design, 10 caregivers completed the intervention. Effect sizes were calculated for three treatment outcomes of child behavior, parent stress, and parenting sense of competence. There was a statistically significant difference in the scores for child behavior, with a large effect size (d = 0.73) and a statistically significant difference in parent stress, with a medium effect size (d = 0.50). No difference was observed for parenting sense of competence. Treatment adherence and caregiver satisfaction for the intervention were acceptable. Findings support the feasibility and promise of combining asynchronous and synchronous telehealth elements to increase access to evidence-based parent-mediated interventions for ASD.

Asynchronous pacing itself does not directly lead to the development of malignant ventricular arrhythmias. However, acute myocardial ischemia caused by acute reduction in coronary blood flow can result in a “vulnerable myocardium” and simultaneously impair pacemaker sensing function. Such a scenario may give rise to unintended asynchronous pacing, which can act as a trigger for malignant ventricular arrhythmias. We present a case illustrating how ischemia‐induced pacemaker sensing failure contributed to life‐threatening ventricular arrhythmias, highlighting the critical interplay between myocardial perfusion status and pacemaker behavior. We present a case involving pacemaker sensing dysfunction caused by acute reduction in blood flow in the right coronary artery. The pacing spikes occurred progressively earlier on the T waves, eventually resulting in R‐on‐T pacing that triggered VF.

Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.

As the prevalence of autism spectrum disorder continues to rise, there is a growing demand for well-trained service providers to provide behavior analytic interventions. With this increased service need comes the necessity to develop new and efficient training methods as an alternative to traditional face-to-face training. This paper provides a review of research focusing on the use of asynchronous training methods to train service providers to implement interventions and strategies based on the principles of behavior analysis with individuals with developmental disabilities. Twenty-two studies were included and divided into five asynchronous training modalities: self-instructional manuals, self-instructional manual packages, video modeling, video modeling with voiceover instructions, and computer-based instructions. Clinical implications and future directions for research are proposed.

ObjectivesThe US opioid epidemic contributes to a growing population of children experiencing neonatal abstinence syndrome (NAS) and adverse childhood experiences (ACEs). A review of the developmental impacts of the opioid crisis highlights that both prenatal exposure to teratogens and ACEs can result in developmental delay and disabilities. Training for the early intervention/early childhood (EI) systems is needed to enable them to meet the needs of this growing population.MethodsTo address this, an IRB-approved online training on best practices for NAS, developmental monitoring and referral, and trauma-informed care was created for Ohio EI providers who provided informed consent to participate. The feasibility of utilizing an online training was assessed. Knowledge on opioid addiction, NAS, ACEs, and early intervention provider characteristics were collected for 2973 participants.ResultsWithin 6 months, the training reached providers in all Ohio counties and seventeen other states. 57% of providers reported caring for one or more children with a caregiver who has confirmed opioid use. 31% reported these children had experienced four or more ACEs. Providers’ ACEs awareness was moderately associated with their experiences with prenatally-exposed youth. There was a significant increase in knowledge following training. Differences in post-training knowledge differed only by county-level opioid death rates, where those providers with low-medium opioid death rates reported more awareness of children with prenatal opioid exposure compared to participants who lived in a county with medium and medium-high opioid death rates.ConclusionsOnline-training is feasible for closing gaps in the early intervention system.SignificanceWhat is already known on this subject? The opioid epidemic in the United States has claimed millions of lives in the past two decades. The epidemic is associated with neonatal abstinence syndrome and traumatic event exposure to young children, which has detrimental effects on children’s development. Young children affected by the opioid epidemic are being referred at high rates to early intervention services.What this study adds? We consolidated the evidence-based research on the topics and provided them in an asynchronous web-based training to the early childhood workforce. We then examined the feasibility and significance of the training on early childhood workforce knowledge.

In asynchronous online video-based learning, learners experience various affective states, which may make them disengaged and negatively influence learning outcomes. This study aimed to examine the effect of the utility value (UV) intervention to help learners emotionally and behaviorally engage in online learning. The UV intervention includes pre-learning writing activity and UV feedback messages to help learners perceive the relevance between the lecture topic and their lives. In particular, we examined the effects of the UV intervention on learners’ negative emotions (i.e., confusion, frustration, and boredom) and conceptual understanding. For the experiment, 30 Korean adult learners were randomly assigned to the control, feedback-only, and writing-feedback groups. The control group did not receive any UV intervention strategy. The feedback-only group received UV feedback messages when detected to experience negative emotions during learning. The writing-feedback group performed a pre-learning activity to write about the usefulness of the lecture topic and then received UV feedback messages during learning. We used Ekman’s Facial Action Coding System (FACS) to analyze learners’ facial expressions associated with negative emotions. Pre-test and post-test were administered to measure conceptual understanding. The findings revealed that the UV feedback messages significantly reduced the occurrence of boredom while the UV writing did not significantly improve conceptual understanding. Overall, this study suggests that additional strategies and longer timing in UV interventions are necessary to intervene in online learners’ confusion and frustration. Implications are discussed regarding the design of affective feedback mechanisms in online video-based learning environments.

Online education has long been suffering from high dropout rate and low achievement. However, both asynchronous and synchronous online instructions have to become effective to serve as a quick response to maintain undisrupted learning during the COVID-19 outbreak. The purpose of the present study was to examine student engagement, learning outcome, and students' perceptions of an online course featured with frequent tasks, quizzes, and tests as formative assessment. Data were collected from the first five weeks of a course that was temporarily converted from blended learning to be fully online in time of school closure. Analysis of students' learning records and scores indicated that students engaged themselves actively in all of the online learning activities and had gained high scores in all tasks, quizzes, and tests. In addition, students held positive perceptions towards the formative assessment.

The cardiopulmonary resuscitation (CPR) compression to ventilation strategy remains controversial. We conducted a meta-analysis to compare the outcomes between continuous chest compressions CPR with asynchronous ventilation (CCC-CPR) and interrupted chest compressions CPR with synchronous ventilation (ICC-CPR) in cardiac arrest. PubMed, Web of Science, Embase, MEDLINE (Ovid/LWW) and the Cochrane Libraries were searched up from inception to July 31, 2022. Human and animal studies comparing CCC-CPR versus ICC-CPR were included. Outcome variables were return of spontaneous circulation (ROSC), time to ROSC, survival to discharge, 1-month survival, survival at 4 h, good neurological function, mean arterial pressure (MAP) and other clinical parameters. Jadad Scale and Newcastle-Ottawa Scale were used to assess the study quality and risk of bias. The systematic search identified eight studies on humans and twelve studies on animal trials. There were no significant differences in ROSC (odd ratios [OR] 1.07; 95% confidence interval [CI]: 0.86–1.32; P = 0.55), survival to hospital discharge (OR 1.04; 95%CI 0.77–1.42; P = 0.79), 1-month survival (OR 1.07; 95%CI 0.84–1.36; P = 0.57), and good neurological outcome (OR 0.92; 95%CI 0.84–1.01, P = 0.09) between CCC-CPR and ICC-CPR in human studies. In animal trials, CCC-CPR had significantly higher rate of ROSC (OR = 1.81; 95% CI: 0.94–3.49; P = 0.07), survival at 4 h (OR 2.57; 95% CI: 1.16–5.72; P = 0.02) and MAP (mean difference [MD] 0.79, 95% CI: 0.04–1.53; P = 0.04), even though no significant differences in ROSC time, arterial potential of hydrogen (pH) and partial tension of carbon dioxide (PaCO2). CCC-CPR did not show superiority in human outcomes compared with ICC-CPR, but its effect value was significantly increased in animal experiments. We should take the positive outcomes from animals and apply them to human models, and more physiological mechanisms need to be confirmed in CPR patients with different compression-ventilation strategies to improve the prognosis of cardiac arrest.

Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear. This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis. A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE. This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t =-3, P=.004), pain (t =-3.6, P<.001), social support (t =-2.7, P=.009), and social activities (t =2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t =-2.1, P=.04) and pain (t =-2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F =1.5, P=.24), social support (F =2.5, P=.09), and social activity (F =0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F =0.1, P=.90), and performance restriction (F =1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale's least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire's physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week. CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain. Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943.

Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many \"online\" or \"digital mindfulness\" programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful's One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=-0.32, 95% CI -0.35 to -0.30, SE=0.01, t =-24.99, P<.001, Cohen d=-1.02). Participation in live programs drove the decrease in stress (B=-0.03, SE=0.01, t =-3.03, P=.002, d=-0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels.