Decisional support for young people who self-harm: protocol for a feasibility trial

Introduction: Self-harm is common in adolescents and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DA) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention, and the ability to recruit and follow-up participants within a school setting. Methods and Analysis: In this parallel arm, single blind feasibility trial, 60 participants aged 12-18 years who have self-harmed in the past 12 months, will be randomised to either: 1) a group receiving the online DA or 2) a control group receiving general information about feelings and emotions. Both groups will complete measures assessing decision-making and help-seeking behaviour. The school counsellor will be notified of any participants who have been randomised to ensure safeguarding for the young person. Participants in both groups will be followed up at 4-weeks and the measures will be repeated. Qualitative interviews will be conducted with a subset of participants to explore their views and experiences of the DA and of participation in the study. Ethics and Dissemination: Ethical approval was granted by King’s College London (KCL) College Research Ethics Committee. Results of this study will help to clarify if we can recruit and administer an online decisional support intervention within a school setting for young people who self-harm. The study will inform the design and implementation of a larger randomised controlled trial to test the effectiveness of the DA. Dissemination of the study findings will target publication in peer-reviewed journals of general and special interest. The funder will be sent a report outlining the major findings of the study

Web-based decision-aid to assist help-seeking choices for young people who self-harm: outcomes from a randomised controlled feasibility trial

Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seeking help for their self-harm. Objective: Our aim was to evaluate the feasibility and acceptability of the DA intervention and the randomised controlled trial (RCT) in a school setting. Methods: We conducted a 2-group, single blind, randomised controlled feasibility trial in a school setting. Participants aged 12-18 years who reported self-harm in the past 12 months were randomised to either a web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomisation and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision-making and help-seeking behaviour. Qualitative interviews were conducted with young people, parents/carers and staff, and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 208 (18%) of the 1,164 parent/guardians contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 82% (n=170) of young people into the study. Of those young people screened, 14% (n=23) had self-harmed in the past year. Ten participants were randomised to receiving the DA and 13 were randomised to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and/or the intervention are needed before generalisable research about DAs can be successfully conducted in a school setting

Habitat complexity affects functional traits and diversity of ant assemblages in urban green spaces (Hymenoptera: Formicidae)

Habitat complexity conferred by vegetation characteristics mediates key processes that govern the assemblage of insect communities. Thus, species within the community should only persist if their functional traits are well-matched to the conditions of their environment. Here, we compared ant assemblages between habitats in terms of species richness and functional-trait distribution at the species and the assemblage level. Ants were collected from 36 sites representing different degrees of habitat complexity mediated by standing vegetation. We found fewer ant species in simpler habitats, supporting the "habitat-heterogeneity" hypothesis. We measured key functional traits of ants that reflect their foraging and dispersal strategies, such as body size, femur length, antenna scape length, and head length / width. Interactions of species traits with measured habitat complexity variables were assessed at the species and the assemblage level using a fourth-corner approach. Ant traits were closely related to environmental complexity. In wooded habitats, ants were larger and had broader heads, while ants with longer antenna scapes prevailed in habitats with a dense herb / grass layer. Our study suggests that vegetation structural complexity can act as an environmental filter, driving ant assemblages in terms of both species numbers and functional traits. Our results can be used to predict turnover patterns in ant assemblages due to changes in management practices

Solution structure of a bacterial microcompartment targeting peptide and its application in the construction of an ethanol bioreactor

Targeting of proteins to bacterial microcompartments (BMCs) is mediated by an 18-amino-acid peptide sequence. Herein, we report the solution structure of the N-terminal targeting peptide (P18) of PduP, the aldehyde dehydrogenase associated with the 1,2-propanediol utilization metabolosome from Citrobacter freundii. The solution structure reveals the peptide to have a well-defined helical conformation along its whole length. Saturation transfer difference and transferred NOE NMR has highlighted the observed interaction surface on the peptide with its main interacting shell protein, PduK. By tagging both a pyruvate decarboxylase and an alcohol dehydrogenase with targeting peptides, it has been possible to direct these enzymes to empty BMCs in vivo and to generate an ethanol bioreactor. Not only are the purified, redesigned BMCs able to transform pyruvate into ethanol efficiently, but the strains containing the modified BMCs produce elevated levels of alcohol

Psychology students’ perception of and engagement with feedback as a function of year of study

Undergraduate students’ perception of feedback and level of engagement with the feedback they receive have gained increasing attention in the educational literature recently to identify areas which require educators’ attention. However, research in this area has generally been based on limited self-selecting samples, and has not considered how students’ relationship with feedback may alter depending on their year of study. To address this, a survey measuring students’ views and practices regarding feedback was completed at a higher education institution by 447 first-, second- and third-year psychology students, representing 77% of the cohort. Findings revealed that third years responded more negatively in both areas than their first- and second-year counterparts, whose ratings on these aspects themselves were far from optimal. These findings highlight the need for early interventions to improve students’ perception of and engagement with feedback in the earlier years, and to prevent the recorded deterioration later on in the degree course

The role of the amygdala during emotional processing in Huntington's disease: from pre-manifest to late stage disease.

BACKGROUND: Deficits in emotional processing can be detected in the pre-manifest stage of Huntington's disease and negative emotion recognition has been identified as a predictor of clinical diagnosis. The underlying neuropathological correlates of such deficits are typically established using correlative structural MRI studies. This approach does not take into consideration the impact of disruption to the complex interactions between multiple brain circuits on emotional processing. Therefore, exploration of the neural substrates of emotional processing in pre-manifest HD using fMRI connectivity analysis may be a useful way of evaluating the way brain regions interrelate in the period prior to diagnosis. METHODS: We investigated the impact of predicted time to disease onset on brain activation when participants were exposed to pictures of faces with angry and neutral expressions, in 20 pre-manifest HD gene carriers and 23 healthy controls. On the basis of the results of this initial study went on to look at amygdala dependent cognitive performance in 79 Huntington's disease patients from a cross-section of disease stages (pre-manifest to late disease) and 26 healthy controls, using a validated theory of mind task: "the Reading the Mind in the Eyes Test" which has been previously been shown to be amygdala dependent. RESULTS: Psychophysiological interaction analysis identified reduced connectivity between the left amygdala and right fusiform facial area in pre-manifest HD gene carriers compared to controls when viewing angry compared to neutral faces. Change in PPI connectivity scores correlated with predicted time to disease onset (r=0.45, p<0.05). Furthermore, performance on the "Reading the Mind in the Eyes Test" correlated negatively with proximity to disease onset and became progressively worse with each stage of disease. CONCLUSION: Abnormalities in the neural networks underlying social cognition and emotional processing can be detected prior to clinical diagnosis in Huntington's disease. Connectivity between the amygdala and other brain regions is impacted by the disease process in pre-manifest HD and may therefore be a useful way of identifying participants who are approaching a clinical diagnosis. Furthermore, the "Reading the Mind in the Eyes Test" is a surrogate measure of amygdala function that is clinically useful across the entire cross-section of disease stages in HD.The work included in this manuscript has been partially funded by financial support from the NIHR Cambridge Biomedical Research Centre and the Cambridge University NHS Foundation Trust. JBR is supported by the Wellcome Trust (088324).This is the final version of the article. It first appeared at http://dx.doi.org/10.1016/j.neuropsychologia.2015.02.01

Microevolution of Group A Streptococci In Vivo: Capturing Regulatory Networks Engaged in Sociomicrobiology, Niche Adaptation, and Hypervirulence

The onset of infection and the switch from primary to secondary niches are dramatic environmental changes that not only alter bacterial transcriptional programs, but also perturb their sociomicrobiology, often driving minor subpopulations with mutant phenotypes to prevail in specific niches. Having previously reported that M1T1 Streptococcus pyogenes become hypervirulent in mice due to selection of mutants in the covRS regulatory genes, we set out to dissect the impact of these mutations in vitro and in vivo from the impact of other adaptive events. Using a murine subcutaneous chamber model to sample the bacteria prior to selection or expansion of mutants, we compared gene expression dynamics of wild type (WT) and previously isolated animal-passaged (AP) covS mutant bacteria both in vitro and in vivo, and we found extensive transcriptional alterations of pathoadaptive and metabolic gene sets associated with invasion, immune evasion, tissue-dissemination, and metabolic reprogramming. In contrast to the virulence-associated differences between WT and AP bacteria, Phenotype Microarray analysis showed minor in vitro phenotypic differences between the two isogenic variants. Additionally, our results reflect that WT bacteria's rapid host-adaptive transcriptional reprogramming was not sufficient for their survival, and they were outnumbered by hypervirulent covS mutants with SpeB−/Sdahigh phenotype, which survived up to 14 days in mice chambers. Our findings demonstrate the engagement of unique regulatory modules in niche adaptation, implicate a critical role for bacterial genetic heterogeneity that surpasses transcriptional in vivo adaptation, and portray the dynamics underlying the selection of hypervirulent covS mutants over their parental WT cells

Studying the atmosphere of the exoplanet HAT-P-7b via secondary eclipse measurements with EPOXI, Spitzer and Kepler

The highly irradiated transiting exoplanet, HAT-P-7b, currently provides one of the best opportunities for studying planetary emission in the optical and infrared wavelengths. We observe six near-consecutive secondary eclipses of HAT-P-7b at optical wavelengths with the EPOXI spacecraft. We place an upper limit on the relative eclipse depth of 0.055% (95% confidence). We also analyze Spitzer observations of the same target in the infrared, obtaining secondary eclipse depths of 0.098+/-0.017%, 0.159+/-0.022%, 0.245+/-0.031% and 0.225+/-0.052% in the 3.6, 4.5, 5.8 and 8.0 micron IRAC bands respectively. We combine these measurements with the recently published Kepler secondary eclipse measurement, and generate atmospheric models for the day-side of the planet that are consistent with both the optical and infrared measurements. The data are best fit by models with a temperature inversion, as expected from the high incident flux. The models predict a low optical albedo of ~< 0.13, with subsolar abundances of Na, K, TiO and VO. We also find that the best fitting models predict that 10% of the absorbed stellar flux is redistributed to the night side of the planet, which is qualitatively consistent with the inefficient day-night redistribution apparent in the Kepler phase curve. Models without thermal inversions fit the data only at the 1.25 sigma level, and also require an overabundance of methane, which is not expected in the very hot atmosphere of HAT-P-7b. We also analyze the eight transits of HAT-P-7b present in the EPOXI dataset and improve the constraints on the system parameters, finding a period of P = 2.2047308+/-0.0000025 days, a stellar radius of R* = 1.824+/-0.089Rsun, a planetary radius of Rp = 1.342+/-0.068RJup and an inclination of i = 85.7+3.5-2.2 deg.Comment: 21 pages, 8 figures, accepted by the Astrophysical Journa

Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial (Preprint)

BACKGROUND Adolescents who self-harm are often unsure how or where to get help. We developed a Web-based personalized decision aid (DA) designed to support young people in decision making about seeking help for their self-harm. OBJECTIVE The aim of this study was to evaluate the feasibility and acceptability of the DA intervention and the randomized controlled trial (RCT) in a school setting. METHODS We conducted a two-group, single blind, randomized controlled feasibility trial in a school setting. Participants aged 12 to 18 years who reported self-harm in the past 12 months were randomized to either a Web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomization, and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision making and help-seeking behavior. Qualitative interviews were conducted with young people, parents or carers, and staff and subjected to thematic analysis to explore their views of the DA and study processes. RESULTS Parental consent was a significant barrier to young people participating in the trial, with only 17.87% (208/1164) of parents or guardians who were contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 81.7% (170/208) of young people into the study. Of those young people screened, 13.5% (23/170) had self-harmed in the past year. Ten participants were randomized to receiving the DA, and 13 were randomized to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability, but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety, and self-harm may be more beneficial. CONCLUSIONS A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and the intervention are needed before generalizable research about DAs can be successfully conducted in a school setting. CLINICALTRIAL International Standard Randomized Controlled Trial registry: ISRCTN11230559; http://www.isrctn.com/ISRCTN11230559 (Archived by WebCite at http://www.webcitation.org/6wqErsYWG) </sec