Adherence therapy for people with Parkinson's disease

Introduction: Medication non-adherence is prevalent in Parkinson’s disease (PD). However, factors associated with non-adherence are unknown. Despite interventions to improve medication adherence being investigated in long-term conditions, few studies have focused on PD. Adherence Therapy (AT) is a novel, patient-centred approach to maximising adherence that has shown benefit in other chronic conditions. Aim: To investigate the efficacy of AT for improving medication adherence and quality of Life (QoL) in people with PD. Methods: To achieve the above aim I conducted a systematic review to identify factors associated with medication non-adherence, followed by a Cochrane systematic review on interventions for improving medication adherence in PD. I then tested the efficacy of AT in PD in a randomised controlled trial (RCT). Semistructured interviews were used to explore patients’ experiences of receiving AT. Results: Mood disorders, cognition, poor symptom control/QoL, younger age/longer disease duration, regimen complexity/polypharmacy, risk taking behaviours, poor knowledge of PD/education, lack of spouse/partner, low income, desire to maintain employment and gender were identified as factors associated with non-adherence in PD. Only one study previously investigated an intervention (didactic educational material) for improving medication adherence in PD, according to my Cochrane systematic review. Seventy-six patients and 46 spouse/carers completed the RCT (CAAT-PARK). At week-12 follow-up the active treatment group significantly improved in adherence and QoL compared to the treatment as usual group. Thematic analysis of interviews from 10 patients and 3 spouse/carers suggested that positive effects and attributes of AT may be important for the success of AT. Furthermore, the findings suggested that the mechanism of AT may be bi-directional and associated with improved confidence and self-efficacy. Conclusions: Adherence Therapy improved medication adherence and QoL in PD. A larger pragmatic trial to test the efficacy and cost effectiveness of Adherence Therapy with a control group placebo intervention is required. ISRCTN0783095

Qualitative evaluation of adherence therapy in Parkinson’s disease: a multidirectional model

Background: Medication can control the symptoms of Parkinson’s disease (PD). Despite this, non-adherence with medication is prevalent in PD. Treatments for improving adherence with medication have been investigated in many chronic conditions, including PD. However, few researchers have evaluated their interventions qualitatively. We investigated the acceptability and potential mechanism of action of adherence therapy (AT) in PD patients and their spouse/carers who received the intervention as part of a randomized controlled trial. Methods: Sixteen participants (ten patients and six spouses/carers) who had recently completed the trial were purposely selected in order to cover a range of ages and disease severity. Semi-structured interviews were conducted in the participants’ homes. Data were transcribed and analyzed using a thematic approach. A second researcher, naïve to PD and AT, analyzed the data independently to limit bias. Results: The trial showed that AT significantly improved both medication adherence and quality of life in people with PD. Specifically, patients who received AT reported improvements in mobility, activities of daily living, emotional wellbeing, cognition, communication, and body discomfort. General beliefs about medication also significantly improved in those who received AT compared with controls. In the current qualitative evaluation, a total of 175 codes were generated, which formed eleven subthemes. These could be grouped under three overarching themes, ie, perceptions prior to AT, positive effects of AT, and attributes of AT. Conclusion: This randomized controlled trial is the first to investigate AT in PD. The acceptability and underlying mechanism of the intervention suggest a new multidirectional model of AT in PD which future research should seek to confirm. The findings provide a deeper understanding of AT and will allow clinicians to modify the delivery of the intervention by acknowledging various pathways to improved outcomes

The needs of mothers of children with autism spectrum disorder (ASD) in the Kingdom of Saudi Arabia (KSA): a qualitative study

The purpose of this qualitative study was to explore the unmet needs and experiences of mothers of ASD children in The Kingdom of Saudi Arabia (KSA). This study employed telephone interviews with eight Saudi mothers raising a child with autism. Questions from a researcher-developed interview guide elicited responses about challenges and unmet needs. Results indicated that the majority of respondents felt they had low to no knowledge of ASD prior to and after their child's diagnosis. Six themes were identified: i) Mothers’ identification of their lack of information about their children with ASD, ii) Mother’s perceptions about their mental and physical well-being, iii) Mothers’ recognition of their constant challenges raising children with ASD,iv) Suggestions to increase public awareness about ASD, v) Mothers’ identification of their training needs, and vi) Mothers’ perceptions of their children’s educational needs . Respondents insisted that cultural issues such as lack of transportation and fathers’ involvement did add to their burden. This study recommended that professionals and academics in KSA should take into consideration the unmet needs of mothers of ASD children when designing interventions and services for children with ASD to ensure they are tailored to the cultural context and needs of mothers

Spin-Flipping Half Vortex in a Macroscopic Polariton Spinor Ring Condensate

We report the observation of vorticity in a macroscopic Bose-Einstein condensate of polaritons in a ring geometry. Because it is a spinor condensate, the elementary excitations are "half vortices" in which there is a phase rotation of $\pi$ in connection with a polarization vector rotation of $\pi$ around a closed path. This is clearly seen in the experimental observations of the polarization rotation around the ring. In the ring geometry, a new type of half vortex is allowed in which the handedness of the spin flips from one side of the ring to the other, in addition to the rotation of the linear polarization component; such a state is not allowed in a simply-connected geometry. Theoretical calculation of the energy of this state shows that when many-body interactions are taken into account, it is lower in energy than a simple half vortex. The direction of circulation of the flow around the ring fluctuates randomly between clockwise and counterclockwise from one shot to the next; this corresponds to spontaneous breaking of time-reversal symmetry in the system. These new, macroscopic polariton ring condensates allow for the possibility of direct control of the vorticity of the condensate.Comment: 21 pages, 10 figures, including supplemental information; Proceedings of the National Academy of Sciences (USA) (2015

Are parenting interventions effective in improving parental functioning in parents of children with ASD?: a meta-analysis

This meta-analysis (M-A) evaluated the effectiveness of parenting interventions on parental functioning in parents of children with autism spectrum disorder (ASD). Electronic searches of Pub Med, Psyc INFO, and Web of Knowledge databases identified controlled and pre to post trials evaluating the effectiveness of parenting interventions on parental functioning, Eleven studies that met the inclusion criteria were included in this M-A. A random effect M-A estimated pooled standard mean difference (SMD) for parenting interventions on measures of stress, sense of competence, parenting practices, depression and anxiety. Analyses revealed medium but significant effects of interventions on parents’ stress pre-post intervention. This effect remained medium and significant when controlled studies were analysed and also following sensitivity analyses removing non-randomised trials. Moreover, the analyses showed a large and significant effect of interventions on parental sense of competence pre-post intervention. The effect decreased to medium and significant for sense of competence when controlled studies were analysed and remained medium and significant after sensitivity analyses removing non-randomised trials

The effectiveness of a psychoeducation intervention delivered via WhatsApp for mothers of children with autism spectrum disorder (ASD) in the Kingdom of Saudi Arabia: a randomized controlled trial

BackgroundMothers of children with autism spectrum disorder (ASD) report high levels of stress and lower levels of well-being than parents of typically developing children. Current interventions for ASD typically focus on working with the child rather than delivering strategies to help support parents.ObjectiveTo evaluate the effectiveness of a psychoeducation intervention developed to support mothers of children with ASD in Saudi Arabia.MethodSixty-two mothers (23–52 years) of children (26–78 months) were recruited to a multisite randomized controlled trials of the intervention. The intervention consisted of one face-to-face session (60 min) and four virtual sessions (30 min each) delivered using WhatsApp. Parenting stress was the primary outcome, with secondary outcomes focusing on maternal depression, anxiety, and happiness, and child behaviour problems and ASD symptoms. Data were collected at baseline T1, immediately postintervention T2 and 8-week follow-up T3.ResultsOne-way analysis of covariance was used at T2 and T3 with T1 scores entered as a covariate. Improvements were found at T2 for stress (F = 234.34, p = .00, and d = −1.52) and depression (F = 195.70, p = .00, and d = −2.14) but not anxiety, and these results were maintained at T3. Changes in child behaviour problems were limited to improvements in hyperactivity at T2 (F = 133.66, p = .00, and d = −1.54). Although changes in stress and depression were statistically significant, change to clinically normal levels was limited to depression. None of the participants had recovered after the intervention (Parent Stress Index Short Form stress scores), whereas 23 mothers (71.87%) in the intervention group had recovered at T2 and 22 (68.75%) at T3 (Hospital Anxiety and Depression Scale depression scores).ConclusionThis intervention with WhatsApp support is beneficial but may need to be augmented with other forms of support for mothers of children with ASD including more condensed sessions on stress and interventions targeting anxiety

Bacterial recovery and recycling of tellurium from tellurium-containing compounds by Pseudoalteromonas sp. EPR3

Aims: Tellurium-based devices, such as photovoltaic (PV) modules and thermoelectric generators, are expected to play an increasing role in renewable energy technologies. Tellurium, however, is one of the scarcest elements in the earth's crust, and current production and recycling methods are inefficient and use toxic chemicals. This study demonstrates an alternative, bacterially mediated tellurium recovery process. Methods and Results: We show that the hydrothermal vent microbe Pseudoalteromonas sp. strain EPR3 can convert tellurium from a wide variety of compounds, industrial sources and devices into metallic tellurium and a gaseous tellurium species. These compounds include metallic tellurium (Te0), tellurite (TeO32−), copper autoclave slime, tellurium dioxide (TeO2), tellurium-based PV material (cadmium telluride, CdTe) and tellurium-based thermoelectric material (bismuth telluride, Bi2Te3). Experimentally, this was achieved by incubating these tellurium sources with the EPR3 in both solid and liquid media. Conclusions: Despite the fact that many of these tellurium compounds are considered insoluble in aqueous solution, they can nonetheless be transformed by EPR3, suggesting the existence of a steady state soluble tellurium concentration during tellurium transformation. Significance and Impact of the Study These experiments provide insights into the processes of tellurium precipitation and volatilization by bacteria, and their implications on tellurium production and recycling.Engineering and Applied Science

Prospects for Stem Cell-Based Therapy

Resident pools of somatic stem cells in many organs are responsible for tissue maintenance and repair. The goal of regenerative medicine is to exploit these cells either by transplanting them from an exogenous source or by activating endogenous stem cells pharmacologically. For diseases caused by mutations in a single gene, the therapeutic goal is tissue replacement using stem cells engineered to correct the genetic defect. However, a number of technical hurdles must be overcome before therapies based on pluripotent human stem cells can enter the clinic