19 research outputs found
Clinical effectiveness of the psychological therapy Mental Health Intervention for Children with Epilepsy in addition to usual care compared with assessment-enhanced usual care alone: a multicentre, randomised controlled clinical trial in the UK
Background
Mental health difficulties are common in children and young people with chronic health conditions, but many of those in need do not access evidence-based psychological treatments. The study aim was to evaluate the clinical effectiveness of integrated mental health treatment for children and young people with epilepsy, a common chronic health condition known to be associated with a particularly high rate of co-occurring mental health difficulties.
Methods
We conducted a parallel group, multicentre, open-label, randomised controlled trial of participants aged 3–18 years, attending epilepsy clinics across England and Northern Ireland who met diagnostic criteria for a common mental health disorder. Participants were randomised (1:1; using an independent web-based system) to receive the Mental Health Intervention for Children with Epilepsy (MICE) in addition to usual care, or assessment-enhanced usual care alone (control). Children and young people in both groups received a full diagnostic mental health assessment. MICE was a modular psychological intervention designed to treat common mental health conditions in children and young people using evidence-based approaches such as cognitive behaviour therapy and behavioural parenting strategies. Usual care for mental health disorders varied by site but typically included referral to appropriate services. Participants, along with their caregivers, and clinicians were not masked to treatment allocation but statisticians were masked until the point of analysis. The primary outcome, analysed by modified intention-to-treat, was the parent-report Strengths and Difficulties Questionnaire (SDQ) at 6 months post-randomisation. The study is complete and registered with ISRCTN (57823197).
Findings
1401 young people were potentially deemed eligible for study inclusion. Following the exclusion of 531 young people, 870 participants were assessed for eligibility and completed the SDQ, and 480 caregivers provided consent for study inclusion between May 20, 2019, and Jan 31, 2022. Between Aug 28, 2019, and Feb 21, 2022, 334 participants (mean ages 10·5 years [SD 3·6] in the MICE group vs 10·3 [4·0] in control group at baseline) were randomly assigned to an intervention using minimisation balanced by age, primary mental health disorder, diagnosis of intellectual disability, and autistic spectrum disorder at baseline. 168 (50%) of the participants were female and 166 (50%) were male. 166 participants were randomly assigned to the MICE group and 168 were randomly assigned to the control group. At 6 months, the mean SDQ difficulties for the 148 participants in the MICE group was 17·6 (SD 6·3) and 19·6 (6·1) for the 148 participants in the control group. The adjusted effect of MICE was –1·7 (95% CI –2·8 to –0·5; p=0·0040; Cohen's d, 0·3). 14 (8%) patients in the MICE group experienced at least one serious adverse event compared with 24 (14%) in the control group. 68% percent of serious adverse events (50 events) were admission due to seizures.
Interpretation
MICE was superior to assessment-enhanced usual care in improving symptoms of emotional and behavioural difficulties in young people with epilepsy and common mental health disorders. The trial therefore shows that mental health comorbidities can be effectively and safely treated by a variety of clinicians, utilising an integrated intervention across ages and in the context of intellectual disability and autism. The evidence from this trial suggests that such a model should be fully embedded in epilepsy services and serves as a model for other chronic health conditions in young people
Sarcasm Used by Couples in the U.K. and U.S.: A Cultural Comparison
Components of communication are key in romantic relationships and vary dependent on the dyad. A sense of humor facilitates playfulness; sarcasm use, while more ambiguous in meaning, might also serve to enhance relationship quality. For those who are less comfortable with direct communication (i.e., sharing their feelings), sarcasm might serve as a useful tool in sharing their thoughts without being too vulnerable. Such sharing might produce individual and dyadic benefits (i.e., laughter, closeness) or bolster fundamental aspects of relationship functioning (i.e., trust, comfort). Sarcasm is a particular communication strategy likely influenced by individual (i.e., gender) and situational factors (i.e., culture). The purpose of the current study was to investigate the effects of (a) culture (U.K. vs. U.S.), (b) gender (male vs. female), and the interaction between culture and gender on the use of sarcasm and humor, while considering openness to emotional expression as a potential explanation for these differences. Participants in romantic relationships completed an online survey examining their use of sarcasm, humor, and emotional expression with their partner (N=88). Moderated mediation analyses revealed a significant negative association between openness to express emotion and sarcasm use for individuals in romantic relationships. Existing literature on the use of sarcasm as an alternative for more direct and literal expression of emotions supports these findings. The findings also indicated that gender and culture interact in unexpected, complex ways to predict sarcasm use, noting the importance of openness to expression of emotion as part of the process. Furthermore, the current investigation demonstrated that the pattern of findings for sarcasm use did not generalize to humor more broadly in a dyadic context. Findings indicate the importance of understanding nuanced communication processes, particularly with regard to their use based on unique societal and cross-cultural factors.Bachelor of Art
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Measuring chemicals with biology : engineering genetic biosensors for chemical analysis
Nature has evolved incredibly efficient and sustainable technology over millions of years, and we are just now learning how to reprogram it for our needs. In the past century this has been manifested in our ability to create proteins for breaking down and building up chemicals. Common laundry detergents contain a cocktail of enzymes for removing lipids, starches, and sugars from textiles. The pharmaceutical industry is embracing enzymes for more efficient drug synthesis. We are already adopting nature’s solution for chemical manipulation. The next frontier will involve adopting nature’s solution to chemical measurement.
All living organisms use proteins, or genetic biosensors, to sense and respond to chemical cues. In the past two decades these natural biosensors have been repurposed for monitoring biomarkers, detecting chemical threats, and screening for improved catalysts. However, just as with enzymes, biosensors from nature oftentimes must be tailored for a desired application.
This thesis describes novel methods for engineering genetic biosensors, as well as demonstrations of applications enabled by them, over three independent studies. In the
first study, a new evolutionary approach to genetic biosensor design is described and subsequently used to create a series of highly specific sensors for five therapeutic alkaloids. One of these sensors is then used to rapidly evolve a plant methyltransferase enzyme capable of producing tetrahydropapaverine, an immediate precursor to four FDA-approved drugs. Next, the same evolutionary approach is used to create a generalist biosensor
responsive to a wide range of otherwise intractable monoterpenes that are commonly used in the fragrance, flavor, cosmetic, and pharmaceutical industries. Finally, the last study describes two separate genetic biosensors engineered to monitor the incorporation of the
noncanonical amino acids selenocysteine and L-DOPA. The utility of these sensors is then demonstrated by measuring the incorporation efficiency of thousands of seleno-competent bacterial strains and hundreds of L-DOPA aminoacyl-tRNA synthetases in hours, which would otherwise require months using traditional equipment. Scaling the approaches described herein will facilitate the industrialization of genetic biosensors for next- generation chemical analysis.Cellular and Molecular Biolog