Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment

Background: Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery. Method: We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children. Conclusions: We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access

Issues for computer modelling of room acoustics in non-concert hall settings

The basic principle of common room acoustics computer models is the energy-based geometrical room acoustics theory. The energy-based calculation relies on the averaging effect provided when there are many reflections from many different directions, which is well suited for large concert halls at medium and high frequencies. In recent years computer modelling has become an established tool in architectural acoustics design thanks to the advance in computing power and improved understanding of the modelling accuracy. However concert hall is only one of many types of built environments that require good acoustic design. Increasingly computer models are being sought for non-concert hall applications, such as in small rooms at low frequencies, flat rooms in workplace surroundings, and long enclosures such as underground stations. In these built environments the design issues are substantially difference from that of concert halls and in most cases the common room acoustics models will needed to be modified or totally re-formulated in order to deal with these new issues. This paper looks at some examples of these issues. In workplace environments we look at the issues of directional propagation and volume scattering by furniture and equipment instead of the surface scattering that is common assumed in concert hall models. In small rooms we look at the requirement of using wave models, such as boundary element models, or introducing phase information into geometrical room acoustics models to determine wave behaviours. Of particular interest is the ability of the wave models to provide phase information that is important not only for room modes but for the construction of impulse response for auralisation. Some simulated results using different modelling techniques will be presented to illustrate the problems and potential solutions

Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders.

BACKGROUND: The Bladder cooling reflex (BCR) i.e. uninhibited detrusor contractions evoked by intravesical instillation of cold saline, is a segmental reflex believed to be triggered by menthol sensitive cold receptors in the bladder wall, with the afferent signals transmitted by C fibres. The BCR is a neonatal reflex that becomes suppressed by descending signals from higher centres at approximately the time when the child gains full voluntary control of voiding. It re-emerges in adults with neurogenic detrusor overactivity as a consequence of loss of central descending inhibition, resulting from conditions such as spinal cord injury or multiple sclerosis. We have recently shown an increase of nerve fibres expressing the cool and menthol receptor TRPM8 in both overactive (IDO) and painful bladder syndrome (PBS), but its functional significance is unknown. We have therefore studied the bladder cooling reflex and associated sensory symptoms in patients with PBS and overactivity disorders. METHODS: The BCR, elicited by ice water test (IWT) was performed in patients with painful bladder syndrome (PBS, n = 17), idiopathic detrusor overactivity (IDO, n = 22), neurogenic detrusor overactivity (NDO, n = 4) and stress urinary incontinence (as controls, n = 21). The IWT was performed by intravesical instillation of cold saline (0 - 4 degrees C). A positive IWT was defined as presence of uninhibited detrusor contraction evoked by cold saline, associated with urgency or with fluid expulsion. Patients were asked to report and rate any pain and cold sensation during the test. RESULTS: A positive IWT was observed in IDO (6/22, 27.3%) and NDO (4/4, 100%) patients, but was negative in all control and PBS patients. Thirteen (76.5%) PBS patients reported pain during the IWT, with significantly higher pain scores during ice water instillation compared to the baseline (P = 0.0002), or equivalent amount of bladder filling (100 mls) with saline at room temperature (P = 0.015). None of the control or overactive (NDO/IDO) patients reported any pain during the IWT. CONCLUSION: The BCR in DO may reflect loss of central inhibition, which appears necessary to elicit this reflex; the pain elicited in PBS suggests afferent sensitisation, hence sensory symptoms are evoked but not reflex detrusor contractions. The ice water test may be a useful and simple marker for clinical trials in PBS, particularly for novel selective TRPM8 antagonists

The local governance of Anti-Social Behaviour

The aim of this study is to explore the ‘empirical particulars’ (Garland 2001, p. vii) of policymaking in crime and disorder control, and the ways in which sub national policy actors are able to adapt and exert influence more generally over national level policy decisions as well as resist such wider forces. This research contends that some rethinking is needed away from much existing criminological literature on shifts in crime control policy that has been dominated by the ‘grand narrative’ accounts of writers such as Garland (2001). These narratives have been concerned largely with the provision of general accounts of overall shifts in policymaking at the national and at times global levels. As a result the local dimension to this process has been with a few notable exceptions neglected or downplayed. Instead the primary focus of much existing criminological literature has been upon the role of national policy elites, presenting policymaking as a top down experience that follows a relatively smooth trajectory. In contrast this study suggests that policymaking is instead a more unpredictable and messier process that can be affected by problems of implementation and resistance. In order to examine the role of the ‘local’ within policymaking, this research employed the use of a single ‘exemplifying case study’ of one English city and in turn it examined in depth one particular area of policymaking and implementation, namely the local management of Anti Social Behaviour (henceforth ASB). This sought to bring together documentary analysis and elite interviews in an effort to provide an empirically detailed account of anti social behaviour policy development. This study focused primarily on a series of semi-structured interviews, involving a range of key local policy actors. These were conducted over an extended period of time, which coincided with the rise of the national level ASB agenda. This extended period enabled observations to also be made about the ebb and flow of policy often as it emerged and caused local practitioners to have to develop and adapt policy responses. The resulting empirical findings provide an informed example of the messiness and contingency of public policymaking, whilst also providing a site in which other academic theories can be tested and applied. The intention of this study is to not only make a significant contribution to the field in which it is nested (ASB policy and practice), but also to enhance our understanding of the effects that broader policy change and the impact that key national policy drivers can have upon the formulation of local level policy responses. In brief the thesis suggests that through the interaction of key policy actors at both the national and local levels, policy formulation and implementation is realised

Investigating the Influences of Language Delay and/or Familial Risk for Dyslexia on Brain Structure in 5-Year-Olds

Early language delay has often been associated with atypical language/literacy development. Neuroimaging studies further indicate functional disruptions during language and print processing in school-age children with a retrospective report of early language delay. Behavioral data of 114 5-year-olds with a retrospective report of early language delay in infancy (N = 34) and those without (N = 80) and with a familial risk for dyslexia and those without are presented. Behaviorally, children with a retrospective report of early language delay exhibited reduced performance in language/reading-related measures. A voxel-based morphometry analysis in a subset (N = 46) demonstrated an association between reduced gray matter volume and early language delay in left-hemispheric middle temporal, occipital, and frontal regions. Alterations in middle temporal cortex in children with a retrospective report of early language delay were observed regardless of familial risk for dyslexia. Additionally, while children with isolated familial risk for dyslexia showed gray matter reductions in temporoparietal and occipitotemporal regions, these effects were most profound in children with both risk factors. An interaction effect of early language delay and familial risk was revealed in temporoparietal, occipital, and frontal cortex. Our findings support a cumulative effect of early behavioral and genetic risk factors on brain development and may ultimately inform diagnosis/treatment

Non-invasive mechanical joint loading as an alternative model for osteoarthritic pain

OBJECTIVE: Mechanisms responsible for osteoarthritic pain remain poorly understood and current analgesic therapies are often insufficient. We have characterized and pharmacologically tested the pain phenotype of a non-invasive mechanical joint loading (MJL) model of osteoarthritis thus providing an alternative murine model for osteoarthritic pain. METHODS: The right knees of male mice (12-week-old, C57BL/6) were loaded at 9N or 11N (40 cycles, three times/week for two weeks). Behavioural measurements of limb disuse, mechanical and thermal hypersensitivity were acquired before MJL and monitored for six weeks post-loading. The severity of articular cartilage lesions was determined post-mortem with the OARSI grading scheme. Furthermore, 9N-loaded mice were treated for four weeks with diclofenac (10mg/kg), gabapentin (100mg/kg) or anti-Nerve Growth Factor (3mg/kg). RESULTS: Mechanical hypersensitivity and weight-bearing worsened significantly in 9N- and 11N-loaded mice two weeks post-loading compared to baseline values and non-loaded controls. Maximum OA scores of ipsilateral knees confirmed increased cartilage lesions in 9N- (2.8±0.2) and 11N-loaded (5.3±0.3) mice compared to non-loaded controls (1.0±0.0). Gabapentin and diclofenac restored pain behaviours to baseline values after two weeks of daily treatment, with gabapentin being more effective than diclofenac. A single injection of anti-NGF alleviated nociception two days after treatment and remained effective for two weeks with a second dose inducing stronger and more prolonged analgesia. CONCLUSION: Our results show that MJL induces OA lesions and a robust pain phenotype that can be reversed using analgesics known to alleviate OA pain in patients. This establishes the use of MJL as an alternative model for osteoarthritic pain

Genetic background strongly influences the bone phenotype of P2X7 receptor knockout mice

The purinergic P2X7 receptor is expressed by bone cells and has been shown to be important in both bone formation and bone resorption. In this study we investigated the importance of the genetic background of the mouse strains on which the P2X7 knock-out models were based by comparing bone status of a new BALB/cJ P2X7-/- strain with a previous one based on the C57BL/6 strain. Female four-month-old mice from both strains were DXA scanned on a PIXImus densitometer; femurs were collected for bone strength measurements and serum for bone marker analysis. Bone-related parameters that were altered only slightly in the B6 P2X7-/- became significantly altered in the BALB/cJ P2X7-/- when compared to their wild type littermates. The BALB/cJ P2X7-/- showed reduced levels of serum C-telopeptide fragment (s-CTX), higher bone mineral density, and increased bone strength compared to the wild type littermates. In conclusion, we have shown that the genetic background of P2X7-/- mice strongly influences the bone phenotype of the P2X7-/- mice and that P2X7 has a more significant regulatory role in bone remodeling than found in previous studies