Practitioner Review: Therapist variability, patient-reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment - a systematic review and meta-analysis

Background: Previous meta-analyses have only found small correlations (r=0.10 to r=0.19) between therapeutic alliance and clinical outcomes in samples of adolescents receiving psychological therapy. Although study-level variables have been found to moderate this, little is known about the impact of therapist variability. The present meta-analysis aimed to address this gap by using patient-therapist ratio as a moderator variable. Methods: Contrary to previous reviews of adolescent alliance, individual effect sizes were extracted using a pre-registered conceptual hierarchy. Controlling for treatment-level confounds, a random effects meta-analysis assessed the moderating effect of patient-therapist ratio on the alliance-outcome relationship in pre-defined single-predictor and multi-predictor meta-regressions.Results: The alliance-outcome relationship was found to be larger than previously thought (k=28, N=2911, r=0.29, 95% Confidence Interval 0.21, 0.37;

Lunar exospheric argon modeling

International audienceArgon is one of the few known constituents of the lunar exosphere. The surface-based mass spectrometer Lunar Atmosphere Composition Experiment (LACE) deployed during the Apollo 17 mission first detected argon, and its study is among the subjects of the Lunar Reconnaissance Orbiter (LRO) Lyman Alpha Mapping Project (LAMP) and Lunar Atmospheric and Dust Environment Explorer (LADEE) mission investigations. We performed a detailed Monte Carlo simulation of neutral atomic argon that we use to better understand its transport and storage across the lunar surface. We took into account several loss processes: ionization by solar photons, charge-exchange with solar protons, and cold trapping as computed by recent LRO/Lunar Orbiter Laser Altimeter (LOLA) mapping of Permanently Shaded Regions (PSRs). Recycling of photo-ions and solar radiation acceleration are also considered. We report that (i) contrary to previous assumptions, charge exchange is a loss process as efficient as photo-ionization, (ii) the PSR cold-trapping flux is comparable to the ionization flux (photo-ionization and charge-exchange), and (iii) solar radiation pressure has negligible effect on the argon density, as expected. We determine that the release of 2.6 × 1028 atoms on top of a pre-existing argon exosphere is required to explain the maximum amount of argon measured by LACE. The total number of atoms (1.0 × 1029) corresponds to ∼6700 kg of argon, 30% of which (∼1900 kg) may be stored in the cold traps after 120 days in the absence of space weathering processes. The required population is consistent with the amount of argon that can be released during a High Frequency Teleseismic (HFT) Event, i.e. a big, rare and localized moonquake, although we show that LACE could not distinguish between a localized and a global event. The density of argon measured at the time of LACE appears to have originated from no less than four such episodic events. Finally, we show that the extent of the PSRs that trap argon, 0.007% of the total lunar surface, is consistent with the presence of adsorbed water in such PSRs

The OARSI "joint effort initiative" repository of online osteoarthritis management programmes: an implementation rapid response during covid-19

Purpose: 1) To collate into a repository, best-evidence online osteoarthritis management programmes (OAMPS), and 2) facilitate their implementation, in the context of the COVID-19 pandemic.The Osteoarthritis Research Society International Joint Effort Initiative (OARSI JEI) is a collaboration between international researchers, clinicians and knowledge brokers with an interest in the implementation of OAMPS. OAMPs are defined by the OARSI JEI as “models of evidence-based, non-surgical care that have been implemented in a real world setting and include the following four components: personalised OA care; delivered as a package of care with longitudinal reassessment and progression; comprising two or more elements of the core non-surgical, non-pharmacological interventions (education, exercise and weight loss); with optional adjunct treatments as required (e.g. assistive devices and psychosocial support)”. In 2020, COVID-19 presented a major barrier to the clinical delivery of traditional “in-person” OAMPS. In response, the OARSI JEI implementation group sought to create a repository resource for healthcare professionals (HCPs) seeking to access and signpost patients with OA to online, high-quality OAMPS. The resource also provided access to online HCP training.Methods: An existing community of practice (OARSI JEI implementation group) with access to patient and public involvement, was utilised to create and share an evidence-informed online OAMP repository via social media and OARSI networks. The project involved 5 key stages. Online OAMPS resource investigation: International research, implementation and HCP experts from the JEI implementation group (n=32) were invited to send all online OAMP resources that they were aware of to the reviewers (LS, JQ). These were captured in a spreadsheet with data extracted on programme name; country of origin; whether the resource targeted patients or HCPs; access details relating to required technology, sign in and any access costs; weblink; brief programme content summary; OARSI expert advocating for the programme quality (including whether the content is evidence informed). Screening for repository inclusion: Two reviewers (JQ, LS) screened the resources received against inclusion criteria (matching the OAMP definition, remotely deliverable via the internet, OARSI expert endorsed). Disagreements were resolved through discussion. Creating the online OA repository resource: Academics (JQ, LS, KD) provided content and feedback for a knowledge broker (LC) to create a pdf repository containing included online OAMP information, weblinks and summary information in the form of an infographic. Rapid social media knowledge mobilisation: The repository resource was initially hosted on the Keele Impact Accelerator Unit website and shared on completion with existing OARSI member JEI networks via social media (Twitter)(LC). Owners of online OAMPS also promoted their own programmes via social media. Reflection and learning: Project method strengths and limitations were discussed, critiqued and captured during an OARSI JEI community of practice meeting.Results: The final OARSI online repository included 7 OAMPS and linked training resources. The online repository is available at: https://www.keele.ac.uk/pcsc/research/impactacceleratorunit/oamps/JEI%20COVID-19%20repository.pdf with ongoing plans for hosting on the OARSI website. Fig. 1 illustrates the repository cover and Fig. 2 is the infographic repository summary. A relative dearth of online OAMPS meeting our prespecified criteria were identified which included: ESCAPE pain; The Joint Academy; JIGSAW-E (for pharmacists and physiotherapists); PEAK: Join2Move; Osteoarthritis Management Healthy Weight for life. Only JIGSAW-E, PEAK and the Join2Move app were widely available free resources for HCPs at the early stage of the COVID-19 pandemic. All online OAMPs were in English except the Join2Move app which is in Dutch. Content details of the included online OAMPs and online OAMP HCP training packages are summarised in Table 1. The initial Twitter launch tweet sharing the repository infographic and repository link has had 5,679 impressions and 334 engagements to date and has been shared globally. Reflections and limitations: There is an urgent requirement for more high-quality OAMPs to be freely available for remote delivery and in a wider range of languages. This has relevance both during the COVID pandemic and more generally for rural, geographically isolated populations and low- and middle-income countries. In reacting to an emergency, rapidly evolving, time-pressured clinical pandemic context, there was a tension in matching the highest quality methods for searching, evaluating and synthesising online OAMPs in the shortest possible time. For example, full systematic review methods were deemed inappropriate and the project was not explicitly informed a-priori by a protocol or knowledge mobilisation theory, however, members of the team had knowledge mobilisation expertise. It is possible that we did not identify all online OAMPs. For example, no online OAMPS from South America, Africa or Asia were identified which may, in part, be explained by the geographical representation within the community of practice, with participants mostly from Europe, North America and Australasia. It is acknowledged that the pragmatic and rapid OAMP resource identification, screening and knowledge mobilisation from this project does not guarantee implementation into clinical practice. The existence of the OARSI JEI implementation group facilitated the timely execution of this project whilst the use of social media allowed the repository to be shared rapidly with many stakeholders. Future plans include the hosting of the repository and future JEI work on the OARSI website (to increase resource access); the formal synthesis of knowledge mobilisation metrics relating to the online repository and included OAMPS, and; the ongoing review of repository content in the light of new OAMPS.Conclusions: The OARSI-endorsed JEI implementation group facilitated the creation of an online OAMP repository in response to the COVID-19 pandemic and need for remotely delivered care. There is a dearth of widely available and remotely deliverable OAMPs internationally. This is likely to present a significant barrier to the delivery of best OA care, especially during COVID-19. OARSI can have a key role in supporting the implementation of best OA care. There is a need to actively broaden the diversity and national representation within the JEI implementation group and increase patient and public involvement to best serve the international OA populations, particularly from low- and middle-income countries, it seeks to inform