The Herts and Minds study: feasibility of a randomised controlled trial of Mentalizationbased Treatment versus usual care to support the wellbeing of children in foster care

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background: There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK. Method: Herts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5-16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT (n = 15) or Usual Clinical Care (UCC) (n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility. Results: Feasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size. Conclusion: With modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care. Trial registration: ISRCTN 90349442. The trial was retrospectively registered on 6 May 2016.Peer reviewedFinal Published versio

Spectral Analysis of a Four Mode Cluster State

We theoretically evaluate the squeezed joint operators produced in a single optical parametric oscillator which generates quadripartite entangled outputs, as demonstrated experimentally by Pysher et al. \cite{pysher}[Phys. Rev. Lett. 107, 030505 (2011)]. Using a linearized fluctuation analysis we calculate the squeezing of the joint quadrature operators below threshold for a range of local oscillator phases and frequencies. These results add to the existing theoretical understanding of this potentially important system.Comment: 4 pages, 6 figure

The floristics of Sand Forest in northern KwaZulu-Natal, South Africa

We use multivariate analyses (ordination and classification) to assess both the floristic uniqueness of the woody vegeation of Sand Forest in relation to a range of other forest types in the region, and the range of variation within Sand Forest. Two broad Sand Forest subtypes and related Ecotonal Forests are described and grouped under the term Tropical Dry Forest, distinct from all evergreen forests in South Africa. Sand Forest, a dry semi-deciduous type in northeastern KwaZulu-Natals defined by the presence of the canopy dominant Cleistanthus schlechteri as well as Hymenocardia ulmoides, Psydrax fragrantissima, Croton pseudopulchellus and  Drypetes arguta. Sand Forests form a cohesive group in both DCA and TWINSPAN analyses, with similar composition of canopy dominants at sampled sites. This implies that ecological funcioning is similar across the geographical range in northeastern KwaZulu-Natal. However, turnover of subdominant species between recognisable Sand Forest types emphasizes the need to conserve the full range of extant forests

Evaluation of a fuel-efficient urban delivery vehicle

A novel, fuel-efficient, articulated urban delivery vehicle is developed and tested. The vehicle has a path-following steering system on the semitrailer which improves its manoeuvrability in narrow city streets. This enables the payload to be increased from 39.4m3 of freight on a conventional rigid delivery vehicle to 84.2m3 on this articulated counterpart: leading directly to up to 33% fuel saving per unit of freight task. The vehicle is also equipped with a hydraulic regenerative braking system which stores energy in hydraulic accumulators during braking events and releases this energy back to accelerate the vehicle in subsequent motion. The design of this system and the field testing programme are described. The experimental tests are used to determine hydraulic losses and to validate a mathematical model of the vehicle and regenerative braking system. Finally, the validated mathematical model is used to perform a parametric study for the vehicle operating on various standard driving cycles. It is found that operating the regenerative braking system with engine stop-start and optimized accumulator pre-charge pressures can reduce fuel consumption by 9 to 18% compared with the baseline vehicle, depending on the drive cycle. When combined with the performance improvements due to the trailer steering system and additional payload, this gives an overall reduction in fuel consumption of 35-42%

Knowledge management: Philosophy, process, and pitfalls

According to a leading scholar of management James Brian Quinn,' "The capacity to manage human intellectand to transform intellectual output into a service or a group of services embodied in a product is fast becoming the critical executive skill of this era." Contrast that with the assertion by the pointy-haired boss of the Dilbert cartoon that his company's success will be driven by "redesigning processes to enable enterprise integration of knowledge resources and tools." The first is a serious, thoughtful, and eminently reasonable statement of a belief in the transformation of management. The second is a caricature of that belief, subsequently doused by Wally's response, "Is it okay if I do nothing?" Leave it to Scott Adams and his alter egos to gut the sanctity from the latest management fad

The experience of adolescents participating in a randomised clinical trial in the field of mental health: a qualitative study

Background This descriptive study aimed to investigate adolescents’ motivations for participating in a randomised controlled trial (RCT), to explore the understanding that the young people had regarding a number of aspects of the trial design, to examine whether or not they found participation in the trial to be acceptable and what affected this, and to identify whether and how the young people felt that their participation in the RCT impacted on their experience of therapy and on therapeutic change. Methods Seventy-six adolescents who were taking part in a large-scale RCT to evaluate the clinical and cost effectiveness of psychological therapies for depression were interviewed at two time-points after completing therapy. The semi-structured interviews, which included a focus on the young people’s experience of the research study, were analysed using framework analysis. Results The vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of ‘conditional altruism’. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process. Although the adolescents were largely positive about their experiences from taking part, the study raises questions about whether clinical outcomes may be influenced by participation in the research elements of the trial. Conclusions Although adolescents are under-represented in clinical trials, those who do participate are generally positive about the experience; however, careful thought needs to be given to key elements of the trial design and the potential impact of the research participation on clinical outcomes