Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial).

Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. ClinicalTrials.gov : NCT03595098, registered July 23, 2018

Progress in simulating turbulent electron thermal transport in NSTX

Nonlinear simulations based on multiple NSTX discharge scenarios have progressed to help differentiate unique instability mechanisms and to validate with experimental turbulence and transport data. First nonlinear gyrokinetic simulations of microtearing (MT) turbulence in a high-beta NSTX H-mode discharge predict experimental levels of electron thermal transport that are dominated by magnetic flutter and increase with collisionality, roughly consistent with energy confinement times in dimensionless collisionality scaling experiments. Electron temperature gradient (ETG) simulations predict significant electron thermal transport in some low and high beta discharges when ion scales are suppressed by E x B shear. Although the predicted transport in H-modes is insensitive to variation in collisionality (inconsistent with confinement scaling), it is sensitive to variations in other parameters, particularly density gradient stabilization. In reversed shear (RS) Lmode discharges that exhibit electron internal transport barriers, ETG transport has also been shown to be suppressed nonlinearly by strong negative magnetic shear, s<<0. In many high beta plasmas, instabilities which exhibit a stiff beta dependence characteristic of kinetic ballooning modes (KBM) are sometimes found in the core region. However, they do not have a distinct finite beta threshold, instead transitioning gradually to a trapped electron mode (TEM) as beta is reduced to zero. Nonlinear simulations of this "hybrid" TEM/KBM predict significant transport in all channels, with substantial contributions from compressional magnetic perturbations. As multiple instabilities are often unstable simultaneously in the same plasma discharge, even on the same flux surface, unique parametric dependencies are discussed which may be useful for distinguishing the different mechanisms experimentally