Investigation of the relationship between depression, rumination, metacognitive beliefs and cognitive fusion

Background It has been found that both depressed patients and patients who have recovered from depression report more rumination and hold more meta-cognitive beliefs about the benefits of rumination than never-depressed controls. Furthermore, it is suggested that a ruminative cognitive style predicts the onset, length and severity of depressive episodes. Within an ACT (Acceptance and Commitment Therapy) perspective on depression, it is suggested that rumination in depression is a verbal reason-giving behaviour used to „solve‟ the problem of depressed mood. However, it is proposed that an individual‟s fusion with these verbal reasons (i.e. cognitive fusion) perpetuates rumination and impedes the adoption of more functional behaviours. The aim of this study is to investigate the relationships between depression, rumination, cognitive fusion and positive beliefs about rumination. Method A between-groups design was used comparing currently depressed adults (n = 26), recovered depressed adults (n = 21) and never depressed adults (n = 27) on a battery of self-report measures for depressive symptomatology, rumination, positive beliefs about rumination and cognitive fusion. Data were analysed using ANOVAs, post hoc comparisons, and path analysis: an extension of multiple regression. Results Significant differences were found in rumination and cognitive fusion between all three groups, with higher levels of rumination and cognitive fusion found in both the currently depressed and recovered depressed groups compared to never depressed controls. Significant differences in positive beliefs about rumination were found only between the currently depressed group and the never depressed group. Results also indicated that depression severity was best predicted by rumination and cognitive fusion rather than positive beliefs about rumination. Furthermore, the relationships between the variables of cognitive fusion and rumination (β = 0.76, p < .001), and cognitive fusion and depression (β = 0.66, p < .001), were stronger than the relationships between any of the other variables included in this study. Discussion Overall, the findings support the suggestion that cognitive fusion be considered in the conceptualisation of ruminative processes and depression. The results suggest that in individuals who have recovered from depression and are no longer clinically depressed, a difference in cognitive processes such as rumination and cognitive fusion remains. This may indicate that cognitive fusion is not secondary to depression and does appear to be implicated in the ruminative process

Spatiotemporal variability of dissolved inorganic macronutrients along the northern Antarctic Peninsula (1996–2019)

The northern Antarctic Peninsula is a key region of the Southern Ocean due to its complex ocean dynamics, distinct water mass sources, and the climate-driven changes taking place in the region. Despite the importance of macronutrients in supporting strong biological carbon uptake and storage, little is known about their spatiotemporal variability along the northern Antarctic Peninsula. Hence, we explored for the first time a 24-year time series (1996–2019) in this region to understand the processes involved in the spatial and interannual variability of macronutrients. We found high macronutrient concentrations, even in surface waters and during strong phytoplankton blooms. Minimum concentrations of dissolved inorganic nitrogen (DIN; 16 μmol kg−1), phosphate (0.7 μmol kg−1), and silicic acid (40 μmol kg−1) in surface waters are higher than those recorded in surrounding regions. The main source of macronutrients is the intrusions of Circumpolar Deep Water and its modified variety, while local sources (organic matter remineralization, water mass mixing, and mesoscale structures) can enhance their spatiotemporal variability. However, we identified a depletion in silicic acid due to the influence of Dense Shelf Water from the Weddell Sea. Macronutrient concentrations show substantial interannual variability driven by the balance between the intrusions of modified Circumpolar Deep Water and advection of Dense Shelf Water, which is largely modulated by the Southern Annular Mode (SAM) and to some extent by El Niño-Southern Oscillation (ENSO). These findings are critical to improving our understanding of the natural variability of this Southern Ocean ecosystem and how it is responding to climate changes

PIRRIST: Patient and public involvement (PPI) to enhance recruitment and retention in surgical trials

Meeting abstract from the 5th International Clinical Trials Methodology Conference (ICTMC 2019) https://ictmc2019.com

To promote or not to promote fundamental British values? Teachers' standards, diversity and teacher education

In this article we seek to problematize the presence of the requirement within the teachers’ standards (DfE, 2012), that they ‘should not undermine fundamental British values’ in the context of initial teacher education in England. The inclusion of this statement within the teachers’ code of conduct has made its way from the counter-terrorism strategy, Prevent and raises questions about Britishness, values and the relationship between the state and the profession more generally. We argue that the inclusion of the phrase within a statutory document that regulates the profession is de facto a politicization of the profession by the state thereby instilling the expectation that teachers are state instruments of surveillance. The absence of any wider debate around the inclusion of the statement is also problematic as is the lack of training for pre-service and inservice teachers since it means this concept of fundamental British values is unchallenged and its insidious racialising implications are unrecognised by most teachers

TReatIng Urinary symptoms in Men in Primary Healthcare using non-pharmacological and non-surgical interventions (TRIUMPH) compared with usual care: Study protocol for a cluster randomised controlled trial

Background: Lower urinary tract symptoms (LUTS) can relate to urinary storage or voiding. In men, the prevalence and severity of LUTS increases with age, with a significant impact on quality of life. The majority of men presenting with LUTS are managed by their general practitioner (GP) in the first instance, with conservative therapies recommended as the initial treatment. However, the provision of conservative therapies in primary care is variable and can be time and resource limited. GPs require practical resources to enhance patient engagement with such interventions. TRIUMPH aims to determine whether a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for LUTS versus usual care.Methods/design: TRIUMPH is a two-arm, cluster randomised controlled trial (RCT) being conducted in 30 National Health Service (NHS) general practices in England. The TRIUMPH intervention comprises a standardised LUTS advice booklet developed for the trial with patient and healthcare professional (HCP) consultation. The booklet is delivered to patients by nurses/healthcare assistants following assessment of their urinary symptoms. Patients are directed to relevant sections of the booklet, providing the manualised element of the intervention. To encourage adherence, HCPs provide follow-up contacts over 12 weeks. Practices are randomised 1:1 to either deliver the TRIUMPH intervention or a usual care pathway. The patient-reported International Prostate Symptom Score (IPSS) at 12 months post consent is the primary outcome. Secondary outcomes include cost-effectiveness, patient-reported outcomes on LUTS, quality of life, and patient and HCP acceptability and experience of the intervention. Primary analyses will be conducted on an intention-to-treat basis.Discussion: It is unclear whether conservative therapies for male LUTS are effectively delivered in primary care using current approaches. This can lead to men being inappropriately referred to secondary care or experiencing persistent symptoms. Primary care, therefore, holds the key to effective treatment for these men. The TRIUMPH intervention, through its standardised and manualised approach, has been developed to support GP practices in delivering effective conservative care. This pragmatic, cluster RCT should provide robust evidence in a primary-care setting to inform future guidelines

Pathogenic copy number variants and SCN1A mutations in patients with intellectual disability and childhood-onset epilepsy

Background Copy number variants (CNVs) have been linked to neurodevelopmental disorders such as intellectual disability (ID), autism, epilepsy and psychiatric disease. There are few studies of CNVs in patients with both ID and epilepsy. Methods We evaluated the range of rare CNVs found in 80 Welsh patients with ID or developmental delay (DD), and childhood-onset epilepsy. We performed molecular cytogenetic testing by single nucleotide polymorphism array or microarray-based comparative genome hybridisation. Results 8.8 % (7/80) of the patients had at least one rare CNVs that was considered to be pathogenic or likely pathogenic. The CNVs involved known disease genes (EHMT1, MBD5 and SCN1A) and imbalances in genomic regions associated with neurodevelopmental disorders (16p11.2, 16p13.11 and 2q13). Prompted by the observation of two deletions disrupting SCN1A we undertook further testing of this gene in selected patients. This led to the identification of four pathogenic SCN1A mutations in our cohort. Conclusions We identified five rare de novo deletions and confirmed the clinical utility of array analysis in patients with ID/DD and childhood-onset epilepsy. This report adds to our clinical understanding of these rare genomic disorders and highlights SCN1A mutations as a cause of ID and epilepsy, which can easily be overlooked in adults

Typing myalgic encephalomyelitis by infection at onset: A DecodeME study [version 4; peer review: 2 approved]

Background: People with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) experience core symptoms of post-exertional malaise, unrefreshing sleep, and cognitive impairment. Despite numbering 0.2-0.4% of the population, no laboratory test is available for their diagnosis, no effective therapy exists for their treatment, and no scientific breakthrough regarding pathogenesis has been made. It remains unknown, despite decades of small-scale studies, whether individuals experience different types of ME/CFS separated by onset-type, sex or age. Methods: DecodeME is a large population-based study of ME/CFS that recruited 17,074 participants in the first 3 months following full launch. Detailed questionnaire responses from UK-based participants who all reported being diagnosed with ME/CFS by a health professional provided an unparalleled opportunity to investigate, using logistic regression, whether ME/CFS severity or onset type is significantly associated with sex, age, illness duration, comorbid conditions or symptoms. Results: The well-established sex-bias among ME/CFS patients is evident in the initial DecodeME cohort: 83.5% of participants were females. What was not known previously was that females tend to have more comorbidities than males. Moreover, being female, being older and being over 10 years from ME/CFS onset are significantly associated with greater severity.  Five different ME/CFS onset types were examined in the self-reported data: those with ME/CFS onset (i) after glandular fever (infectious mononucleosis); (ii) after COVID-19 infection; (iii) after other infections; (iv) without an infection at onset; and, (v) where the occurrence of an infection at or preceding onset is not known. Among other findings, ME/CFS onset with unknown infection status was significantly associated with active fibromyalgia. Conclusions: DecodeME participants differ in symptoms, comorbid conditions and/or illness severity when stratified by their sex-at-birth and/or infection around the time of ME/CFS onset

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

52 Genetic Loci Influencing Myocardial Mass.

BACKGROUND: Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect changes in myocardial mass and conduction, and are associated with increased risk of heart failure and death. OBJECTIVES: This meta-analysis sought to gain insights into the genetic determinants of myocardial mass. METHODS: We carried out a genome-wide association meta-analysis of 4 QRS traits in up to 73,518 individuals of European ancestry, followed by extensive biological and functional assessment. RESULTS: We identified 52 genomic loci, of which 32 are novel, that are reliably associated with 1 or more QRS phenotypes at p < 1 × 10(-8). These loci are enriched in regions of open chromatin, histone modifications, and transcription factor binding, suggesting that they represent regions of the genome that are actively transcribed in the human heart. Pathway analyses provided evidence that these loci play a role in cardiac hypertrophy. We further highlighted 67 candidate genes at the identified loci that are preferentially expressed in cardiac tissue and associated with cardiac abnormalities in Drosophila melanogaster and Mus musculus. We validated the regulatory function of a novel variant in the SCN5A/SCN10A locus in vitro and in vivo. CONCLUSIONS: Taken together, our findings provide new insights into genes and biological pathways controlling myocardial mass and may help identify novel therapeutic targets