A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder

10.1371/journal.pone.0046692PLoS ONE710

An outbreak of Streptococcus pyogenes in a mental health facility : advantage of well-timed whole-genome sequencing over emm typing

Financial support: The outbreak investigation was supported by Institute of Mental Health.OBJECTIVE:  We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing. SETTING:  A 2,000-bed tertiary-care psychiatric hospital. METHODS:  Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)-based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak. RESULTS:  The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1-C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0-5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21-45 and 26-58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology. CONCLUSIONS:  WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.PostprintPeer reviewe

Variations in the visual probe paradigms for attention bias modification for substance use disorders

Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders-that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified for opioid use disorders, three for cannabis use disorders and four for stimulant use disorders. As evident from the synthesis, there is great variability in the paradigm adopted, with most articles including only information about the nature of the stimulus, the number of trials, the timings for the fixation cross and the timings for the stimulus set. Future research examining attentional biases among individuals with substance use disorders should take into consideration the paradigms that are commonly used and evaluate the optimal stimulus and stimulus-onset asynchrony timings.NMRC (Natl Medical Research Council, S’pore)MOH (Min. of Health, S’pore)Published versio

Child psychiatry without psychiatrists : a new model for old problems

Child psychiatry was developed around the turn of the century following an increasing recognition of childhood behavioural and emotional issues. Most child psychiatrists provide care within specialty clinics and tertiary hospitals. Treatment for mental health disorders for children and adolescents has improved considerably with more evidence-based and effective medications, and psychosocial interventions.1 However, the practice of child psychiatry is not cost-effective in its present form. Other professionals can perform some of the functions of child psychiatrists at a fraction of the cost. In addition, there is an urgency to meet the treatment gap of childhood mental health disorders. It is not feasible to train more psychiatrists to address this increased demand due to resource constraints in terms of doctors and time.Published versio

Emotional bias modification in youths with attention deficit hyperactivity disorder (ADHD) : new research vista

Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting emotional biases amongst individuals with ADHD. These studies provide us with preliminary evidence for the effectiveness of modifying emotional biases and how it could help in ameliorating symptoms related to emotional dysregulation. There needs to be future research in this area with further evidence supporting the effectiveness of modifying emotional biases. It is also crucial for future research to determine which of these tools is best at detecting such biases, and which of these tools are versatile enough and non-invasive that they could safely be implemented for both research and clinical needs.Ministry of Health (MOH)National Medical Research Council (NMRC)Published versionMWZ is supported by a grant under the Singapore Ministry of Health’s National Medical Research Council (grant number NMRC/Fellowship/0048/2017) for PhD training. The funding source was not involved in any part of this project. This publication is funded by the ALIVE Serious Games Grant (SGG19/SN06), with the grant project titled “Gamified Emotional Bias Modification Intervention for Children with ADHD”

Addressing aggression in Singapore youths : an evidence based case example

Abstract not available

Co-designing a mobile gamified attention bias modification intervention for substance use disorders : participatory research study

Background: Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective: The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. Methods: The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. Results: Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. Conclusions: The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm.  NMRC (Natl Medical Research Council, S’pore)Published versio

Equine-assisted learning in youths at-risk for school or social failure

This study examined whether a three-month equine-assisted learning program improved measures of character skills in two independent cohorts of Year 1 youths, in a specialized secondary school for youths with difficulties coping with mainstream curriculum. In 2013, 75 students underwent intervention while 82 students did not. In 2014, 58 students underwent intervention and 59 students were waitlisted in semester 1; cross-over was performed in semester 2. The students were rated a week before, mid-way and a week post-intervention. Results from multi-level modeling indicated that the intervention led to progressive improvements in character skills over the school semester, in the majority of the constructs measured in both the 2013 and 2014 cohorts. The rate of change in measures of character skills over the semester correlated with the grade point average of the students at semester-end. Implications and limitations of the findings are discussed