Psilocybin-assisted therapy and HIV-related shame

As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of - 5.5 (- 6.5, - 3.5) points from baseline to 3-months follow-up (Z = - 2.6, p = 0.009, r = - 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care

The 'Antiretrovirals, Sexual Transmission Risk and Attitudes' (ASTRA) study. Design, methods and participant characteristics.

Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV

A pilot randomised controlled trial of a preconsultation web-based intervention to improve the care quality and clinical outcomes of diabetes outpatients (DIAT)

notes: PMCID: PMC3731775This article was published in BMJ Open following peer review and can also be viewed on the journal’s website at http://bmjopen.bmj.com.Diabetes is a chronic condition associated with many long-term complications. People with diabetes need to actively manage their condition, which can be complex. In consultations with healthcare professionals, patients receive advice about their diabetes but do not always discuss things which concern them, perhaps because of the perceived limited time or embarrassment. We want to test a 'preconsultation' intervention in which the patient is supported by a healthcare assistant to complete a web-based intervention aimed at producing an agenda to help them identify important areas for discussion in the consultation. Use of this agenda may enable the patient to play a more active role in that consultation and consequently become more confident, and hence more successful, in managing their condition

A preconsultation web-based tool to generate an agenda for discussion in diabetes outpatient clinics to improve patient outcomes (DIAT): a feasibility study

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this record.OBJECTIVE: To test the feasibility of running a randomised controlled trial of a preconsultation web-based intervention (Presenting Asking Checking Expressing (PACE-D)) to improve the quality of care and clinical outcomes in patients with diabetes. DESIGN AND SETTING: A feasibility study (with randomisation) conducted at outpatient diabetes clinics at two secondary care hospitals in Devon, UK. PARTICIPANTS: People with diabetes (type 1 and type 2) attending secondary care general diabetes outpatient clinics. INTERVENTION: The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist. OUTCOMES: The percentage of eligible patients who were recruited and the percentage of participants for whom routine glycosylated haemoglobin (HbA1c) data (the putative primary outcome) could be extracted from medical notes and who completed secondary outcome assessments via questionnaire at follow-up were reported. RESULTS: In contrast with the planned recruitment of 120 participants, only 71 participants were randomised during the 7-month recruitment period. This comprised 18.7% (95% CI 14.9% to 23.0%) of those who were eligible. Mean (SD) age of the participants was 56.5 (12.4) years and 66.2% had type 1 diabetes. Thirty-eight patients were randomised to the intervention arm and 33 to the control arm. HbA1c data were available for only 73% (95% CI 61% to 83%) of participants at the 6 months follow-up. The questionnaire-based data were collected for 66% (95% CI 54% to 77%) of the participants at 6 months follow-up. Participants reported that the PACE-D tool was easy to use. CONCLUSIONS: A randomised controlled trial of the preconsultation web-based intervention as set out in our current protocol is not feasible without significant modification to improve recruitment and follow-up of participants. The study also provides insights into the feasibility and challenges of conducting complex intervention trials in everyday clinical practice. TRIAL REGISTRATION: ISRCTN75070242.The research question was generated from a research prioritisation exercise undertaken by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC) and the Patient and Public Involvement Group (PenPIG). The authors are grateful to Andy Barton (Research Design Service South West) for advice provided when developing the proposal. The authors would like to thank the study sponsor: Royal Devon and Exeter NHS Foundation Trust. They are grateful to Donald Cegala (Emeritus Professor of Communication and Family Medicine, Ohio State University) for supporting their use and modification of the PACE intervention. They are grateful to Cosmo White for formatting images for the paper

A preconsultation web-based tool to generate an agenda for discussion in diabetes outpatient clinics to improve patient outcomes (DIAT): A feasibility study

© 2016 Published by the BMJ Publishing Group Limited. Objective To test the feasibility of running a randomised controlled trial of a preconsultation web-based intervention (Presenting Asking Checking Expressing (PACE-D)) to improve the quality of care and clinical outcomes in patients with diabetes. Design and setting A feasibility study (with randomisation) conducted at outpatient diabetes clinics at two secondary care hospitals in Devon, UK. Participants People with diabetes (type 1 and type 2) attending secondary care general diabetes outpatient clinics. Intervention The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist. Outcomes The percentage of eligible patients who were recruited and the percentage of participants for whom routine glycosylated haemoglobin (HbA1c) data (the putative primary outcome) could be extracted from medical notes and who completed secondary outcome assessments via questionnaire at follow-up were reported. Results In contrast with the planned recruitment of 120 participants, only 71 participants were randomised during the 7-month recruitment period. This comprised 18.7% (95% CI 14.9% to 23.0%) of those who were eligible. Mean (SD) age of the participants was 56.5 (12.4) years and 66.2% had type 1 diabetes. Thirty-eight patients were randomised to the intervention arm and 33 to the control arm. HbA1c data were available for only 73% (95% CI 61% to 83%) of participants at the 6 months follow-up. The questionnaire-based data were collected for 66% (95% CI 54% to 77%) of the participants at 6 months follow-up. Participants reported that the PACE-D tool was easy to use. Conclusions A randomised controlled trial of the preconsultation web-based intervention as set out in our current protocol is not feasible without significant modification to improve recruitment and follow-up of participants. The study also provides insights into the feasibility and challenges of conducting complex intervention trials in everyday clinical practice. Trial registration ISRCTN75070242

The employment of migrant nannies in the UK: negotiating social class in an open market for commoditised in-home care

Migrant women are important sources of labour in the commoditised in-home childcare sector in many regions of the UK. Jobs in this sector, which include nannies as well as au pairs, babysitters, housekeepers and mothers' helps, are often low paid and low status with pay and conditions being determined by employers' circumstances and whims. This article draws on primary data and secondary sources to illustrate the ways in which employers compare migrant nannies with British nannies and other childcare workers in terms of the social class and formal education levels of different groups, with the aim of explaining why migrants are perceived as high-quality candidates for what are often low-paid, low-status jobs. I argue that employers negotiate inter-class relations in this gendered form of employment by understanding their relationship with the migrant nannies they have employed in the context of broader global inequalities—these inequalities are then reproduced and reaffirmed in private homes and across UK culture and society

International forum. an investigation of iron status in blood donors

No abstract availabl

Does the anticipatory behaviour of chickens communicate reward quality?

The anticipatory behaviour of animals has been credited with enabling scientists to more closely infer what an animal wants. From a welfare perspective, this knowledge could improve how we care for animals under our management, as information about how animals prioritise rewarding items may guide how we allocate resources effectively. Our goal was to determine if behaviour in anticipation of different types of reward was differentially expressed. We investigated whether certain behaviours were characteristic of anticipation of both food and non-food rewards, and whether signals indicating rewards led to increased activity levels. Twelve laying hens experienced a Pavlovian conditioning paradigm using sound cues to signal the availability of two different food rewards (mealworms, normal food), one non-food reward (a container of mixed soil and sand substrate suitable for foraging and dust bathing (Dusty substrate)) and a sound-neutral event, which was signalled by a sound, but no reward was given. A muted-neutral treatment (no reward and no sound cue) controlled for any specific behaviour as a result of the sound cues.Behavioural responses and the number of transitions between behaviours were measured during a 15 s anticipatory period, before birds accessed rewards in an adjoining compartment by pushing through a door. These responses and latency to access the rewards were analysed using linear and generalised linear mixed models. Differences in pushing and pecking at the door (frequency: Dusty substrate 4.87a, Meal-worm 3.18b, Normal Food 2.23b, Sound Neutral 0.30c, Muted Neutral 0.03d, �2(4) = 228.99, p < 0.001),standing (not walking) (duration (s): Sound Neutral 9.92c, Muted Neutral 7.49bc, Normal Food 7.39bc, Mealworm 7.05b, Dusty substrate 3.06a, �2(4) = 36.28, p < 0.001), reflected the perceived value of the rewards, with birds appearing to be more motivated to access the Dusty substrate compared with the food rewards. Rewarded sound cues elicited increased transitions between behaviours, compared with neutral events (Dusty substrate 10.16a, Mealworm 10.13a, Normal Food 9.22ab, Sound Neutral 7.89bc, Muted Neutral 6.43c, �2(4) = 72.05, p < 0.001). The sound-neutral treatment induced increased head movements,previously associated with anticipation of rewards (duration (s): Sound Neutral 1.58b, Muted Neutral 0.58ab, Normal Food 0.48a, Mealworm 0.27a, Dusty substrate 0.00a, �2(4) = 25.56, p < 0.001). Latency to access rewards conveyed the relative value of rewards (Dusty substrate 7.30a, Mealworm 10.06ab,Normal Food 16.53b, �2(2) = 10.88, p = 0.004). Our experiment indicates that, under certain conditions,hens increase their activity levels (behavioural responses and transitions) in anticipation of rewards.Importantly, we demonstrate that this response is not food specific, but rather a general response to both food and non-food rewards. This outcome extends our knowledge of reward-related anticipatory behaviour, and of how hens rank rewards of contrasting incentive value, which may have implications for the methods and environments applied to improve the welfare of laying hens in managed systems

Antibiotic research and development: business as usual?

This article contends that poor economic incentives are an important reason for the lack of new drugs and explains how the DRIVE-AB intends to change the landscape by harnessing the expertise, motivation and diversity of its partner

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707