Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness

Background Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Single-cell multi-omics analysis of the immune response in COVID-19

Funder: Lister Institute of Preventive Medicine; doi: https://doi.org/10.13039/501100001255Funder: University College London, Birkbeck MRC Doctoral Training ProgrammeFunder: The Jikei University School of MedicineFunder: Action Medical Research (GN2779)Funder: NIHR Clinical Lectureship (CL-2017-01-004)Funder: NIHR (ACF-2018-01-004) and the BMA FoundationFunder: Chan Zuckerberg Initiative (grant 2017-174169) and from Wellcome (WT211276/Z/18/Z and Sanger core grant WT206194)Funder: UKRI Innovation/Rutherford Fund Fellowship allocated by the MRC and the UK Regenerative Medicine Platform (MR/5005579/1 to M.Z.N.). M.Z.N. and K.B.M. have been funded by the Rosetrees Trust (M944)Funder: Barbour FoundationFunder: ERC Consolidator and EU MRG-Grammar awardsFunder: Versus Arthritis Cure Challenge Research Grant (21777), and an NIHR Research Professorship (RP-2017-08-ST2-002)Funder: European Molecular Biology Laboratory (EMBL)Abstract: Analysis of human blood immune cells provides insights into the coordinated response to viral infections such as severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19). We performed single-cell transcriptome, surface proteome and T and B lymphocyte antigen receptor analyses of over 780,000 peripheral blood mononuclear cells from a cross-sectional cohort of 130 patients with varying severities of COVID-19. We identified expansion of nonclassical monocytes expressing complement transcripts (CD16+C1QA/B/C+) that sequester platelets and were predicted to replenish the alveolar macrophage pool in COVID-19. Early, uncommitted CD34+ hematopoietic stem/progenitor cells were primed toward megakaryopoiesis, accompanied by expanded megakaryocyte-committed progenitors and increased platelet activation. Clonally expanded CD8+ T cells and an increased ratio of CD8+ effector T cells to effector memory T cells characterized severe disease, while circulating follicular helper T cells accompanied mild disease. We observed a relative loss of IgA2 in symptomatic disease despite an overall expansion of plasmablasts and plasma cells. Our study highlights the coordinated immune response that contributes to COVID-19 pathogenesis and reveals discrete cellular components that can be targeted for therapy

Evaluation of a tube feeding decision aid for substitute decision makers

Substitute decision makers may be in a position to make preference-sensitive decisions for their patient, including whether to approve tube feeding. The present study evaluated the only known tube feeding decision aid for substitute decision makers (Mitchell, Tetroe, & O\u27Conner, 2001). Sixty adults completed a pre-questionnaire, read an active control brochure (control group) or decision aid (experimental group), and completed a post-questionnaire. Both groups demonstrated increased knowledge and decisional conflict at post-test, although the experimental group had higher scores in both. Participants who were either in favor or against tube feeding at pre-test rarely changed their decision at post-test. Control group participants did not report less satisfaction with their decision than the experimental group, and the decision aid was highly acceptable. More research is needed to determine why decisional conflict may increase following the use of a decision aid, and what factors might promote decreased decisional conflict

End -of -life care training in medical school: An examination of medical students\u27 knowledge, attitudes, preparedness to provide care, and the hidden curriculum.

End-of-life (EOL) care discussions between physicians and patients promote positive patient health outcomes (Stewart, 1995). However, medical students receive limited training in EOL care (Sullivan, Lakoma, & Block, 2003). To be able to improve curricula, it is important to understand the current training experience and its effects on student attitudes and behavior. The purpose of the current study was twofold: (1) to examine predictors of self-rated preparation to provide EOL care, and (2) to examine predictors of attitudes about EOL care in a medical student population. Additionally, the moderating effect of “hidden†or informal curriculum on the relation between learning experiences and attitudes about EOL was examined. Medical students across all four years of training (n = 169) completed measures about their preparation to provide EOL care, attitudes, knowledge, “learning experiences†(knowledge and didactic education, i.e., formal curriculum), and perception of a hidden curriculum about EOL care. Results regarding the first aim of the study revealed that self-rated preparation to provide care was predicted by more didactic education, perception of less hidden curriculum, and greater confidence in communication skills. Results regarding the second aim revealed that positive attitudes pertaining to beliefs about clinician responsibility for providing EOL care was predicted by greater knowledge. A perception of less hidden curriculum moderated the relation between learning experiences and positive attitudes pertaining to beliefs about clinician responsibility (i.e., an interaction with knowledge and didactic education). Further, attitudes regarding beliefs about patient reactions to EOL care discussions were predicted by greater knowledge. In contrast, learning experiences did not predict attitudes about practical barriers to an EOL care discussion or beliefs about physician emotions associated with EOL care. The results highlight the value of further examining formal education, in particular, as a predictor of attitudes about EOL care. Clarification of the relations between variables could inform targets for educational intervention. To this end, future research should examine how the EOL care learning experiences-attitude relation influences student communication behavior. Such advances would facilitate a thorough understanding of how students learn and apply knowledge, develop beliefs about professional responsibility, and build sensitivity for patients’ concerns regarding end-of-life care. Distally, strengthening the EOL care training curriculum would promote meaningful improvements in patients’ health outcomes

Utilization of the Center for the Advancement of Pharmaceutical Education Educational Outcomes, Revised Version 2004: Report of the 2005 American College of Clinical Pharmacy Educational Affairs Committee

In response to the release of the Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes1 revised version in May 2004, the 2004–2005 American College of Clinical Pharmacy (ACCP) Educational Affairs Committee was charged by then-president Barbara G. Wells, PharmD, with reviewing the updated document and recommending strategies for pharmacy educators to apply the information. The recommendations contained in this document focus on guiding curricular development, helping students connect what they learn in the classroom and experiential setting to the practice of pharmacy, educating external audiences about the role of the pharmacist, assessing the new outcomes, and determining the impact on pharmacy education. Recommendations are the result of a review of background information, listed references, and discussion of experiences with implementing the 1998 revised version of the CAPE Educational Outcomes2 (ie, curricular mapping) in new or existing pharmacy programs

Annihilation electrogenerated chemiluminescence of mixed metal chelates in solution : Modulating emission colour by manipulating the energetics

We demonstrate the mixed annihilation electrogenerated chemiluminescence of tris(2,2′-bipyridine)ruthenium(ii) with various cyclometalated iridium(iii) chelates. Compared to mixed ECL systems comprising organic luminophores, the absence of T-route pathways enables effective predictions of the observed ECL based on simple estimations of the exergonicity of the reactions leading to excited state production. Moreover, the multiple, closely spaced reductions and oxidations of the metal chelates provide the ability to finely tune the energetics and therefore the observed emission colour. Distinct emissions from multiple luminophores in the same solution are observed in numerous systems. The relative intensity of these emissions and the overall emission colour are dependent on the particular oxidized and reduced species selected by the applied electrochemical potentials. Finally, these studies offer insights into the importance of electronic factors in the question of whether the reduced or oxidized partner becomes excited in annihilation ECL. This journal i