Developing a psychologically-informed pain management course for use in osteopathic practice: The OsteoMAP cohort study

Background: Multidisciplinary healthcare programmes which include psychosocial interventions for persistent musculoskeletal pain demonstrate better patient outcomes than separate physical therapies. This paper reports outcomes from the OsteoMAP study, which combined psychological and mindfulness-informed interventions from Acceptance and Commitment Therapy (ACT) with manual treatment to create a multimodal pain self-management course for delivery by osteopaths working with patients with long-term musculoskeletal conditions. Method: A single cohort of 256 patients participated in a new persistent pain self-management course. Self-report data was collected at baseline (n = 180) and after six months (n = 79) using the European Quality of Life, Bournemouth and Revised Action and Acceptance Questionnaires and the Freiburg Mindfulness Inventory. Results: There were significant improvements in all four outcome measures (p < 0.001). Changes in quality of life and coping with pain showed significant correlations with increased psychological flexibility (r = 0.69–0.71) and slightly weaker associations with mindfulness (r = 0.50–0.51). Conclusions: This psychologically-informed self-management course was feasible for delivery in an osteopathic educational clinic and patient outcomes supported proof of concept. A pragmatic randomised controlled trial is now recommended to compare course effects with other management approaches and to continue developing multimodal care for patients with persistent pain presenting in general osteopathic practice. © 2020 Elsevier Lt

Upper trapezius muscle tonicity, assessed by palpation, relates to change in tissue oxygenation and structure as measured by Time-Domain Near Infrared Spectroscopy

Palpation is a diagnostic tool widely used by manual therapists despite its disputed reliability and validity. Previous studies have usually focused on the detection of Myofascial Trigger Points (MTrPs), i.e., the points within muscles thought to have undergone molecular composition, oxygenation and structural changes, altering their tonicity. Time-domain near-infrared spectroscopy (TD-NIRS) could provide new insights into soft tissue oxygenation and structure, in order to objectively assess the validity and reliability of palpation. This pilot study aims at (1) assessing the ability of TD-NIRS to detect a difference between palpably normal and hypertonic upper trapezius (UT) muscles, and (2) to estimate the reproducibility of the TD-NIRS measurement on UT muscles. TD-NIRS measurements were performed on 4 points of the UT muscles in 18 healthy participants (10F, mean age: 27.6 yrs), after a physical examination by a student osteopath to locate these points and identify the most and least hypertonic. From TD-NIRS, the most hypertonic points had a higher concentration in deoxy- ([HHb]) (0.887 ± 0.253 μM, p<0.001) and total haemoglobin ([HbT]) (1.447 ± 0.772 μM, p<0.001), a lower tissue oxygen saturation (StO2) (-0.575 ± 0.286 %, p<0.001), and a greater scattering amplitude factor (AF) (0.2238 ± 0.1343 cm-1, p=0.001) than the least hypertonic points. Moreover, the intraclass correlation coefficient one-way random-effects model (ICC (1,1)) calculated for each TD-NIRS parameter and for each point revealed an excellent reliability of the measurement (Mean ± SD, 0.9253 ± 0.0678). These initial results, showing that changes in TD-NIRS parameters correlate with changes in muscle tonicity as assessed by palpation, are encouraging and show that TD-NIRS could help to further assess the validity of palpation as a diagnostic tool in manual therapy

OSCAR (Osteopathic Single CAse Research) – assessing the effect of standard and biopsychosocial osteopathic management for patients with non-specific low back pain: protocol for a Single Case Experimental Design (SCED)

Background Osteopathy has been shown to be effective in the management of chronic low back pain (LBP). Guidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific LBP. Objectives This study has four aims: 1/to assess how patients with LBP improve after osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management course; 2/to assess if it is feasible and acceptable for osteopaths to receive weekly SCED data and use it to guide patient management; 3/to assess if it is acceptable for patients to submit daily data and discuss weekly summary with their osteopaths; and 4/to test feasibility for researchers in collecting, managing and storing large quantities of individual patient data. Methods A multiple baseline single case experimental design trial with up to 10 UK osteopaths with more than 15 years in practice and 60 patients will assess how change occurs as a result of osteopathic treatment for patients with non-specific LBP of more than 12 weeks’ duration. Statistical analysis will assess the degree and rate of change between baseline, intervention and follow-up periods, and whether differences in effect are observed after the osteopaths have completed the biopsychosocial patient management training course. Primary outcomes will be the Numeric Pain Rating and Patient Specific Function Scales, measured daily at baseline and for 6 weeks during the intervention stage, and weekly or fortnightly during a 12-week follow-up period. Ethics This research was approved by the XXX Research Ethics Committee

Estimation of Cell Cycle States of Human Melanoma Cells with Quantitative Phase Imaging and Deep Learning

Visualization and classification of cell cycle stages in live cells requires the introduction of transient or stably expressing fluorescent markers. This is not feasible for all cell types, and can be time consuming to implement. Labelling of living cells also has the potential to perturb normal cellular function. Here we describe a computational strategy to estimate core cell cycle stages without markers by taking advantage of features extracted from information-rich ptychographic time-lapse movies. We show that a deep-learning approach can estimate the cell cycle trajectories of individual human melanoma cells from short 3-frame (~23 minute) snapshots, and can identify cell cycle arrest induced by chemotherapeutic agents targeting melanoma driver mutations

How men step back – and recover – from suicide attempts: A relational and gendered account

Men account for three-quarters of suicide deaths in the UK, yet we know little about how at-risk men construct their experiences of moving towards - and then subsequently stepping back from - suicide, nor the part played by relational factors therein. An inductive thematic analysis was used to examine narrative interviews with eleven UK men who self-reported serious thoughts, plans and up-to and including suicide attempts in progress, but who consciously decided against carrying out an attempt. Their accounts suggest a highly social process of movements towards and away from suicide (e.g. frustrated help-seeking). Stepping back from suicide represents not a discrete issue, but a linked process in suicidality and wider recovery. Here, the use of military metaphors in particular (e.g. waging war, fighting back) highlights the gendered nature of the issue. Additionally, our article illuminates a range of social relations and forces that circulate in and around suicidality, which itself is embedded in varying forms of relationality, normativity and gendered practices. [Abstract copyright: © 2020 Foundation for the Sociology of Health & Illness.

Under-representation of males in the early years: the challenges leaders face

This article investigates why there appears to be an under-representation of males in comparison to their female colleagues in the Early Years (EY) sector, and the perception of male teachers progressing more quickly to leadership positions when they do enter this context. Using case studies of final year male students on an Initial Teacher Training (ITT) undergraduate degree course at one university, we attempt to analyse data on male under-representation in Early Years against contemporary theories of identity, power and leadership. Questionnaires and interviews were conducted with the male sample group and male senior leaders in primary schools to gain an overview as to the leadership support they needed and provided. Our tentative findings suggested that male trainees are happy to work in an Early Years context and take leadership positions, but the challenge for leaders is that male trainees require strong leadership mentoring processes to help overcome perceived contextual barriers

Exploring men's and women's experiences of depression and engagement with health professionals: more similarities than differences? A qualitative interview study

<p>Abstract</p> <p>Background</p> <p>It is argued that the ways in which women express emotional distress mean that they are more likely to be diagnosed with depression, while men's relative lack of articulacy means their depression is hidden. This may have consequences for communicating with health professionals. The purpose of this analysis was to explore how men and women with depression articulate their emotional distress, and examine whether there are gender differences or similarities in the strategies that respondents found useful when engaging with health professionals.</p> <p>Methods</p> <p>In-depth qualitative interviews with 22 women and 16 men in the UK who identified themselves as having had depression, recruited through general practitioners, psychiatrists and support groups.</p> <p>Results</p> <p>We found gender similarities and gender differences in our sample. Both men and women found it difficult to recognise and articulate mental health problems and this had consequences for their ability to communicate with health professionals. Key gender differences noted were that men tended to value skills which helped them to talk while women valued listening skills in health professionals, and that men emphasised the importance of getting practical results from talking therapies in their narratives, as opposed to other forms of therapy which they conceptualised as 'just talking'. We also found diversity among women and among men; some respondents valued a close personal relationship with health professionals, while others felt that this personal relationship was a barrier to communication and preferred 'talking to a stranger'.</p> <p>Conclusion</p> <p>Our findings suggest that there is not a straightforward relationship between gender and engagement with health professionals for people with depression. Health professionals need to be sensitive to patients who have difficulties in expressing emotional distress and critical of gender stereotypes which suggest that women invariably find it easy to express emotional distress and men invariably find it difficult. In addition it is important to recognise that, for a minority of patients, a personal relationship with health professionals can act as a barrier to the disclosure of emotional distress.</p

Absent fathers’, and children’s social and emotional learning: an exploration of the perceptions of ‘positive male role models’ in the primary school sector

This paper focuses on the testimonies of three male primary school staff members who utilised social and emotional learning (SEL) in their everyday practice within their respective schools. The data, collected through individual interviews, illustrate how these three men interpreted SEL, and their role in the development of children’s social, emotional and behavioural (SEB) skills, in response to their perceptions of pupils’ home-life. In particular, the sample identified the children’s fathers’ perceived ability/inability as a main cause of pupils’ SEB deficiencies. Consequently, the three male staff members maintained that in order to advocate and encourage alternative, appropriate behaviours, they should act as ‘replacement fathers’ and become ‘role models’. The findings contribute to existing debates relating to the notion of ‘positive male role models’ in primary schools and the propensity for staff to engage in parental blame. The implications of these findings are discussed, and suggestions that call for a more democratic and cooperative exchange of knowledge between parents and teachers are made

How do we improve men’s mental health via primary care? An evaluation of the Atlas Men’s Well-being Pilot Programme for stressed/distressed men

Background Over three-quarters of all suicides are men (England and Wales), this is despite higher levels of anxiety and depression being reported by women. This disparity may in part be explained by atypical presentations of distress in men, and gendered issues around help-seeking. Consequently, the Atlas Men’s Well-being Programme was designed to engage stressed/distressed men who were patients at a London-based GP surgery. Atlas encouraged GPs to identify and refer men for counselling and/or acupuncture by raising their awareness of men’s distress. The aim of this pilot study was to evaluate Atlas in terms of patients’ characteristics, service utilisation, patient outcomes and cost implications. Methods All patients using the Programme were asked to complete a questionnaire before and after their Atlas sessions. Outcome measures included the Hospital Anxiety and Depression scale, Perceived Stress Scale, Warwick-Edinburgh Mental Well-being Scale, a 11-point scale measuring physical health, and the Psychological Outcome Profiles (PSYCHLOPS), a patient-generated outcome measure. Additionally, for cost calculations, participants were asked about their employment, number of days off work due to illness, and their health and social care service use. Results 102 participants were recruited, 82 completed pre- and post-treatment questionnaires. Comparisons pre- and post-treatment revealed a statistically significant improvement in anxious mood (p <0.001), perceived stress (p < 0.001), positive well-being (p = <0.001), PSYCHLOPS (p = <0.001) and physical health (p = 0.001), though not depressed mood (p = 0.660). Additionally, reductions in costs related to lost employment and health and social care use, exceeded the cost of Atlas counselling and acupuncture sessions, with an average saving of nearly £700 per patient. Conclusions Atlas attendance was associated with improvements in patients’ mental and physical health, and demonstrated likely cost savings. It is now important to understand patient and stakeholder perspectives. Further research could compare usual care with the Atlas approach, and investigate full cost-effectiveness

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety

Background: Anxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the CLIMATE Schools Combined intervention, a universal approach to preventing substance use and mental health problems among adolescents. Methods/design: Participants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i) CLIMATE Schools Combined intervention; (ii) CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health, or (iv) Control (Health and Physical Education as usual). The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.Discussion: Compared to students who receive the universal CLIMATE Schools - Substance Use, or CLIMATE Schools - Mental Health or the Control condition (who received usual Health and Physical Education), we expect students who receive the CLIMATE Schools Combined intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge