Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial.

BACKGROUND: Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. METHODS: In this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544. FINDINGS: Between Jan 16, 2015, and May 31, 2017, we randomly assigned 368 patients to receive CBT plus standardised medical care (n=186) or standardised medical care alone (n=182); of whom 313 had primary outcome data at 12 months (156 [84%] of 186 patients in the CBT plus standardised medical care group and 157 [86%] of 182 patients in the standardised medical care group). At 12 months, no significant difference in monthly dissociative seizure frequency was identified between the groups (median 4 seizures [IQR 0-20] in the CBT plus standardised medical care group vs 7 seizures [1-35] in the standardised medical care group; estimated incidence rate ratio [IRR] 0·78 [95% CI 0·56-1·09]; p=0·144). Dissociative seizures were rated as less bothersome in the CBT plus standardised medical care group than the standardised medical care group (estimated mean difference -0·53 [95% CI -0·97 to -0·08]; p=0·020). The CBT plus standardised medical care group had a longer period of dissociative seizure freedom in the previous 6 months (estimated IRR 1·64 [95% CI 1·22 to 2·20]; p=0·001), reported better health-related quality of life on the EuroQoL-5 Dimensions-5 Level Health Today visual analogue scale (estimated mean difference 6·16 [95% CI 1·48 to 10·84]; p=0·010), less impairment in psychosocial functioning on the Work and Social Adjustment Scale (estimated mean difference -4·12 [95% CI -6·35 to -1·89]; p<0·001), less overall psychological distress than the standardised medical care group on the Clinical Outcomes in Routine Evaluation-10 scale (estimated mean difference -1·65 [95% CI -2·96 to -0·35]; p=0·013), and fewer somatic symptoms on the modified Patient Health Questionnaire-15 scale (estimated mean difference -1·67 [95% CI -2·90 to -0·44]; p=0·008). Clinical improvement at 12 months was greater in the CBT plus standardised medical care group than the standardised medical care alone group as reported by patients (estimated mean difference 0·66 [95% CI 0·26 to 1·04]; p=0·001) and by clinicians (estimated mean difference 0·47 [95% CI 0·21 to 0·73]; p<0·001), and the CBT plus standardised medical care group had greater satisfaction with treatment than did the standardised medical care group (estimated mean difference 0·90 [95% CI 0·48 to 1·31]; p<0·001). No significant differences in patient-reported seizure severity (estimated mean difference -0·11 [95% CI -0·50 to 0·29]; p=0·593) or seizure freedom in the last 3 months of the study (estimated odds ratio [OR] 1·77 [95% CI 0·93 to 3·37]; p=0·083) were identified between the groups. Furthermore, no significant differences were identified in the proportion of patients who had a more than 50% reduction in dissociative seizure frequency compared with baseline (OR 1·27 [95% CI 0·80 to 2·02]; p=0·313). Additionally, the 12-item Short Form survey-version 2 scores (estimated mean difference for the Physical Component Summary score 1·78 [95% CI -0·37 to 3·92]; p=0·105; estimated mean difference for the Mental Component Summary score 2·22 [95% CI -0·30 to 4·75]; p=0·084), the Generalised Anxiety Disorder-7 scale score (estimated mean difference -1·09 [95% CI -2·27 to 0·09]; p=0·069), and the Patient Health Questionnaire-9 scale depression score (estimated mean difference -1·10 [95% CI -2·41 to 0·21]; p=0·099) did not differ significantly between groups. Changes in dissociative seizures (rated by others) could not be assessed due to insufficient data. During the 12-month period, the number of adverse events was similar between the groups: 57 (31%) of 186 participants in the CBT plus standardised medical care group reported 97 adverse events and 53 (29%) of 182 participants in the standardised medical care group reported 79 adverse events. INTERPRETATION: CBT plus standardised medical care had no statistically significant advantage compared with standardised medical care alone for the reduction of monthly seizures. However, improvements were observed in a number of clinically relevant secondary outcomes following CBT plus standardised medical care when compared with standardised medical care alone. Thus, adults with dissociative seizures might benefit from the addition of dissociative seizure-specific CBT to specialist care from neurologists and psychiatrists. Future work is needed to identify patients who would benefit most from a dissociative seizure-specific CBT approach. FUNDING: National Institute for Health Research, Health Technology Assessment programme

Science Communication in a Digital Age: Social Media and the American Fisheries Society

Social media platforms are effective tools used to help communicate and increase involvement in cultural, political, and scientific circles. In 2012, an ad hoc committee was established to explore online fisheries science communication and how social media platforms can be utilized by the American Fisheries Society (AFS). A survey was disseminated to all AFS units (chapters, sections, divisions) and student subunits to better understand the current use of social media within the AFS. A relatively high response rate (82%) provided some confidence in the survey results—namely, that nearly 69% or more of units and subunits used social media. Facebook was the dominant platform used (59%; all others < 15%) and almost exclusively (97%) for the purpose of communication. Education, outreach, and member recruitment were other reasons for social media use. Finally, whether units currently use social media or not at all, it was recommended that AFS-led workshops and assistance would increase the usefulness of social media

The Critical Turning Points Database : Concept, Methodology and Dataset of an International Transformative Social Innovation Comparison (TRANSIT Working Paper # 10, July 12th 2017)

[Abstract] This working paper presents the TRANSIT open-access online database on Critical Turning Points (CTP) in Transformative Social Innovation. It specifies the contents of the database, comprising qualitative accounts of more than 450 ‘critical’ episodes in the evolution of social innovation initiatives in 27 different countries. Providing the theoretical-methodological context to these data, the paper also describes the theoretical background of the CTP concept and the methodology though which the CTP accounts have been reconstructed through interviews with members of SI initiatives. The paper concludes with reflections on the open access CTP database as a knowledge infrastructure, discussing its significance in terms of mapping, dissemination and framing of social innovation.This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 61316

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Distribution of epipelagic biomass in Puget Sound over the summer

Fishes often utilize multiple habitats over the course of their estuarine residence. Puget Sound, WA, provides epipelagic habitat to a variety of species, including declining populations of (Pacific herring, Clupea pallasi) and Endangered Species Act-listed Pacific salmon (Oncorhynchus spp). Currently, little is known about epipelagic habitat use by the fish community in Puget Sound. We used surface townetting, midwater trawling, and hydroacoustic data to characterize epipelagic fish distribution from April through October, 2011 in four basins of Puget Sound. Seasonal and spatial variability was evident in epipelagic biomass (fish and jellyfish). Biomass generally increased progressively during the summer and shifted to deeper depths. Biomass was observed more often in the offshore zone than in shelf and transition zones. Net catches indicated that herring and juvenile salmon species dominated the epipelagic fish community and exhibited considerable spatial and temporal overlap with one another. Spatial and temporal patterns in fish biomass sampled by surface townets generally reflected the patterns measured below the surface by acoustics. In July and September, when midwater trawl data were also available, acoustics and midwater trawls produced closer relative estimates to one another than to the surface townets. The spatial-temporal overlap among species and increase in biomass over the summer period create increased potential for species interactions, especially in the offshore zone

A new species of Polyipnus (Teleostei: Stomiiformes) from the western Pacific, with comments on the P. triphanos species complex

Harold, Antony S., Kemp, Iris M., Shore, Sarah K. (2016): A new species of Polyipnus (Teleostei: Stomiiformes) from the western Pacific, with comments on the P. triphanos species complex. Zootaxa 4111 (5): 555-564, DOI: http://doi.org/10.11646/zootaxa.4111.5.

Nearshore and offshore feeding of juvenile salmon and forage fish in the Salish Sea

The Salish Sea provides essential early marine growth environment for several pelagic fish species, including Pacific salmon (Oncorhynchus spp), Pacific herring (Clupea pallasi), and other forage fish (e.g., surf smelt, Hypomesus pretiosus; sand lance, Ammodytes hexapterus). Early marine feeding and growth can be important to survival to adulthood for these species. Early marine growth of Endangered Species Act-listed Puget Sound Chinook salmon (O. tshawytscha) is tightly correlated with smolt to adult returns. Variability in early growth is linked to variation in feeding rate. Therefore, factors which affect feeding success, such as competition, during this life stage could have important influences on marine survival. Recent work has shown spatial-temporal and dietary overlap among juvenile salmon and herring and suggested that potential for competitive interactions exists. However, the extent and strength of potential interactions remain poorly understood and little is known about the feeding of other pelagic planktivores. We describe feeding habits of juvenile salmon, herring, and surf smelt in the Salish Sea to quantify variation in diet composition and characterize dietary overlap. Monthly, yearly, and regional variation was evident, but consistent patterns were distinguishable. During the critical summer growing season, Pacific herring dominated the biomass of the shallow pelagic planktivorous fish community and exhibited extensive diet and spatial overlap with juvenile Chinook salmon and coho salmon (O. kisutch). Crab larvae and amphipods were important prey items. Diet compositions of chum salmon (O. keta) and surf smelt differed from those of the other species, including greater amounts of gelatinous organisms (ctenophores, larvaceans). Our results suggest that assessments of basin carrying capacity and potential species interactions need to account for the population and feeding dynamics of all major daylight planktivores, especially herring

Oncolytic Reovirus Infection Is Facilitated by the Autophagic Machinery

Mammalian reovirus is a double-stranded RNA virus that selectively infects and lyses transformed cells, making it an attractive oncolytic agent. Despite clinical evidence for anti-tumor activity, its efficacy as a stand-alone therapy remains to be improved. The success of future trials can be greatly influenced by the identification and the regulation of the cellular pathways that are important for reovirus replication and oncolysis. Here, we demonstrate that reovirus induces autophagy in several cell lines, evident from the formation of Atg5-Atg12 complexes, microtubule-associated protein 1 light chain 3 (LC3) lipidation, p62 degradation, the appearance of acidic vesicular organelles, and LC3 puncta. Furthermore, in electron microscopic images of reovirus-infected cells, autophagosomes were observed without evident association with viral factories. Using UV-inactivated reovirus, we demonstrate that a productive reovirus infection facilitates the induction of autophagy. Importantly, knock-out cell lines for specific autophagy-related genes revealed that the expression of Atg3 and Atg5 but not Atg13 facilitates reovirus replication. These findings highlight a central and Atg13-independent role for the autophagy machinery in facilitating reovirus infection and contribute to a better understanding of reovirus-host interactions

Oncolytic Reovirus Infection Is Facilitated by the Autophagic Machinery

Mammalian reovirus is a double-stranded RNA virus that selectively infects and lyses transformed cells, making it an attractive oncolytic agent. Despite clinical evidence for anti-tumor activity, its efficacy as a stand-alone therapy remains to be improved. The success of future trials can be greatly influenced by the identification and the regulation of the cellular pathways that are important for reovirus replication and oncolysis. Here, we demonstrate that reovirus induces autophagy in several cell lines, evident from the formation of Atg5-Atg12 complexes, microtubule-associated protein 1 light chain 3 (LC3) lipidation, p62 degradation, the appearance of acidic vesicular organelles, and LC3 puncta. Furthermore, in electron microscopic images of reovirus-infected cells, autophagosomes were observed without evident association with viral factories. Using UV-inactivated reovirus, we demonstrate that a productive reovirus infection facilitates the induction of autophagy. Importantly, knock-out cell lines for specific autophagy-related genes revealed that the expression of Atg3 and Atg5 but not Atg13 facilitates reovirus replication. These findings highlight a central and Atg13-independent role for the autophagy machinery in facilitating reovirus infection and contribute to a better understanding of reovirus-host interactions