Fidelity of delivery and contextual factors influencing children’s level of engagement: Process evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) Trial (Preprint)

BACKGROUND: The Online Remote Behavioural Intervention for Tics (ORBIT) study was a multicentre randomized controlled trial of a complex intervention that consisted of an online behavioural intervention for children and young people (CYP) with tic disorders. In this first part of a two-stage process evaluation, we conducted a mixed-methods study exploring reach, dose, and fidelity of the intervention and contextual factors influencing engagement with the intervention. OBJECTIVE: This study aims to explore the fidelity of delivery and the contextual factors underpinning the ORBIT intervention. METHODS: Baseline study data and intervention usage metrics from participants in the intervention arm were used as quantitative implementation data (n=112). The experiences of being in the intervention were explored by semi-structured interviews with children (n=20) and parent (n=20) participants, therapists (n=4), and referring clinicians (n=6). A principal components analysis was used to create a comprehensive, composite measure of CYP’s engagement with the intervention. Engagement factor scores reflected relative uptake as assessed by a range of usage indices including chapters accessed, number of pages visited and number of logins. RESULTS: The intervention was implemented with high fidelity, and participants deemed the intervention acceptable and satisfactory. Engagement and adherence were high with child participants completing an average of 7.5/10 chapters and 100/112 (89.3%) participants completed a minimum of 4 chapters: the pre-defined threshold for effective dose. Compared to the total population of children with tic disorders, the sample tended to have more educated parents and live in more economically advantaged areas but socioeconomic factors were not related to engagement factor scores. Factors associated with higher engagement factor scores included participants enrolled at the London site vs. the Nottingham site (P=.011), self-referred vs. clinic-referred (P=.041), higher parental engagement as evidenced by number of parental chapters completed (ρ=0.73, n=111, P<.001) and more therapist time for parent (ρ=0.46, n=111, P<.001). A multiple linear regression indicated that parents’ chapter completion (β=.69, t110=10.18, P<.001) and therapist time for parent (β=.19, t110=2.95, P=.004) were the only significant independent predictors of engagement factor scores. CONCLUSIONS: Overall, the intervention had high fidelity of delivery and was evaluated positively by participants, although reach may have been constrained by the nature of the randomized controlled trial. Parental engagement and therapist time for parent were strong predictors of intervention implementation which has important implications for the design and implementation of digital therapeutic interventions into Child and Adolescent Mental Health Services. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN) 70758207; https://doi.org/10.1186/ISRCTN70758207 and ClinicalTrials.gov NCT03483493; https://clinicaltrials.gov/ct2/show/NCT0348349

Factors influencing the efficacy of an online behavioural intervention for children and young people with tics: Process evaluation of a randomised controlled trial

The Online Remote Behavioural Intervention for Tics (ORBIT) trial found that an internet-delivered, therapist-supported, and parent-assisted Exposure and Response Prevention (ERP) intervention reduced tic severity and improved clinical outcomes. This process evaluation aimed to explore mechanisms of impact and factors influencing efficacy. Participants were 112 children with a tic disorder and their parents randomised to the active intervention arm of the ORBIT trial. Child engagement was assessed by usage metrics and parent engagement by chapter completion. Experiences of the digital intervention were explored by semi-structured interviews. Outcomes (3-months post randomisation) were change in tic severity and overall clinical improvement. Tic severity reduced from baseline to 3-month follow-up and 36% were rated as much improved clinically. Greater tic severity at baseline predicted reduction in tic severity. Parental engagement was the only independent predictor of clinical improvement. There were no statistically significant mediators or moderators of the relationship between level of child engagement and outcome. From the qualitative findings, child participants appreciated working together with parents on the intervention and participants found the intervention engaging. ORBIT may be an effective and acceptable intervention for children and young people with tic disorders, with parental engagement being a key factor in successful outcomes

R-mode oscillations and rocket effect in rotating superfluid neutron stars. I. Formalism

We derive the hydrodynamical equations of r-mode oscillations in neutron stars in presence of a novel damping mechanism related to particle number changing processes. The change in the number densities of the various species leads to new dissipative terms in the equations which are responsible of the {\it rocket effect}. We employ a two-fluid model, with one fluid consisting of the charged components, while the second fluid consists of superfluid neutrons. We consider two different kind of r-mode oscillations, one associated with comoving displacements, and the second one associated with countermoving, out of phase, displacements.Comment: 10 page

Soft eSkin:distributed touch sensing with harmonized energy and computing

Inspired by biology, significant advances have been made in the field of electronic skin (eSkin) or tactile skin. Many of these advances have come through mimicking the morphology of human skin and by distributing few touch sensors in an area. However, the complexity of human skin goes beyond mimicking few morphological features or using few sensors. For example, embedded computing (e.g. processing of tactile data at the point of contact) is centric to the human skin as some neuroscience studies show. Likewise, distributed cell or molecular energy is a key feature of human skin. The eSkin with such features, along with distributed and embedded sensors/electronics on soft substrates, is an interesting topic to explore. These features also make eSkin significantly different from conventional computing. For example, unlike conventional centralized computing enabled by miniaturized chips, the eSkin could be seen as a flexible and wearable large area computer with distributed sensors and harmonized energy. This paper discusses these advanced features in eSkin, particularly the distributed sensing harmoniously integrated with energy harvesters, storage devices and distributed computing to read and locally process the tactile sensory data. Rapid advances in neuromorphic hardware, flexible energy generation, energy-conscious electronics, flexible and printed electronics are also discussed. This article is part of the theme issue ‘Harmonizing energy-autonomous computing and intelligence’

Neural development features: Spatio-temporal development of the Caenorhabditis elegans neuronal network

The nematode Caenorhabditis elegans, with information on neural connectivity, three-dimensional position and cell linage provides a unique system for understanding the development of neural networks. Although C. elegans has been widely studied in the past, we present the first statistical study from a developmental perspective, with findings that raise interesting suggestions on the establishment of long-distance connections and network hubs. Here, we analyze the neuro-development for temporal and spatial features, using birth times of neurons and their three-dimensional positions. Comparisons of growth in C. elegans with random spatial network growth highlight two findings relevant to neural network development. First, most neurons which are linked by long-distance connections are born around the same time and early on, suggesting the possibility of early contact or interaction between connected neurons during development. Second, early-born neurons are more highly connected (tendency to form hubs) than later born neurons. This indicates that the longer time frame available to them might underlie high connectivity. Both outcomes are not observed for random connection formation. The study finds that around one-third of electrically coupled long-range connections are late forming, raising the question of what mechanisms are involved in ensuring their accuracy, particularly in light of the extremely invariant connectivity observed in C. elegans. In conclusion, the sequence of neural network development highlights the possibility of early contact or interaction in securing long-distance and high-degree connectivity

Diversity of Zoanthids (Anthozoa: Hexacorallia) on Hawaiian Seamounts: Description of the Hawaiian Gold Coral and Additional Zoanthids

The Hawaiian gold coral has a history of exploitation from the deep slopes and seamounts of the Hawaiian Islands as one of the precious corals commercialised in the jewellery industry. Due to its peculiar characteristic of building a scleroproteic skeleton, this zoanthid has been referred as Gerardia sp. (a junior synonym of Savalia Nardo, 1844) but never formally described or examined by taxonomists despite its commercial interest. While collection of Hawaiian gold coral is now regulated, globally seamounts habitats are increasingly threatened by a variety of anthropogenic impacts. However, impact assessment studies and conservation measures cannot be taken without consistent knowledge of the biodiversity of such environments. Recently, multiple samples of octocoral-associated zoanthids were collected from the deep slopes of the islands and seamounts of the Hawaiian Archipelago. The molecular and morphological examination of these zoanthids revealed the presence of at least five different species including the gold coral. Among these only the gold coral appeared to create its own skeleton, two other species are simply using the octocoral as substrate, and the situation is not clear for the final two species. Phylogenetically, all these species appear related to zoanthids of the genus Savalia as well as to the octocoral-associated zoanthid Corallizoanthus tsukaharai, suggesting a common ancestor to all octocoral-associated zoanthids. The diversity of zoanthids described or observed during this study is comparable to levels of diversity found in shallow water tropical coral reefs. Such unexpected species diversity is symptomatic of the lack of biological exploration and taxonomic studies of the diversity of seamount hexacorals

Cross validation of bi-modal health-related stress assessment

This study explores the feasibility of objective and ubiquitous stress assessment. 25 post-traumatic stress disorder patients participated in a controlled storytelling (ST) study and an ecologically valid reliving (RL) study. The two studies were meant to represent an early and a late therapy session, and each consisted of a "happy" and a "stress triggering" part. Two instruments were chosen to assess the stress level of the patients at various point in time during therapy: (i) speech, used as an objective and ubiquitous stress indicator and (ii) the subjective unit of distress (SUD), a clinically validated Likert scale. In total, 13 statistical parameters were derived from each of five speech features: amplitude, zero-crossings, power, high-frequency power, and pitch. To model the emotional state of the patients, 28 parameters were selected from this set by means of a linear regression model and, subsequently, compressed into 11 principal components. The SUD and speech model were cross-validated, using 3 machine learning algorithms. Between 90% (2 SUD levels) and 39% (10 SUD levels) correct classification was achieved. The two sessions could be discriminated in 89% (for ST) and 77% (for RL) of the cases. This report fills a gap between laboratory and clinical studies, and its results emphasize the usefulness of Computer Aided Diagnostics (CAD) for mental health care

The Molecular Clockwork of the Fire Ant Solenopsis invicta

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication

Surface and Temporal Biosignatures

Recent discoveries of potentially habitable exoplanets have ignited the prospect of spectroscopic investigations of exoplanet surfaces and atmospheres for signs of life. This chapter provides an overview of potential surface and temporal exoplanet biosignatures, reviewing Earth analogues and proposed applications based on observations and models. The vegetation red-edge (VRE) remains the most well-studied surface biosignature. Extensions of the VRE, spectral "edges" produced in part by photosynthetic or nonphotosynthetic pigments, may likewise present potential evidence of life. Polarization signatures have the capacity to discriminate between biotic and abiotic "edge" features in the face of false positives from band-gap generating material. Temporal biosignatures -- modulations in measurable quantities such as gas abundances (e.g., CO2), surface features, or emission of light (e.g., fluorescence, bioluminescence) that can be directly linked to the actions of a biosphere -- are in general less well studied than surface or gaseous biosignatures. However, remote observations of Earth's biosphere nonetheless provide proofs of concept for these techniques and are reviewed here. Surface and temporal biosignatures provide complementary information to gaseous biosignatures, and while likely more challenging to observe, would contribute information inaccessible from study of the time-averaged atmospheric composition alone.Comment: 26 pages, 9 figures, review to appear in Handbook of Exoplanets. Fixed figure conversion error