Guided self-help cognitive behavioral intervention for VoicEs (GiVE): study protocol for a pilot randomized controlled trial

Background: Cognitive behavior therapy for psychosis (CBTp) is an effective intervention for people who hear distressing voices (auditory hallucinations). However, there continues to be a problem of poor access to CBTp. Constraints on health care funding require this problem to be addressed without a substantial increase in funding. One solution is to develop guided self-help forms of CBTp to improve access, and a symptom-specific focus on, for example, distressing voices (auditory verbal hallucinations) has the potential to enhance effectiveness. We term this cognitive behavior therapy for distressing voices (CBTv). Methods/design: This trial is an external pilot randomized controlled trial comparing the effects of 12 week guided self-help CBTv (with eight therapist support sessions) with a wait list control condition. Informed consent will be obtained from each participant. Half of the 30 participants will be randomized to receive guided self-help CBTv immediately; the remaining half will receive the intervention after a 12-week delay. All participants will continue with their usual treatment throughout the study. Outcomes will be assessed using questionnaires completed at baseline and 12 weeks postrandomization. Interviews will be offered to all those who receive therapy immediately to explore their experiences with the intervention. Discussion: The outcomes of this trial, both quantitative and qualitative, will inform the design of a definitive randomized controlled trial of guided self-help CBTv. If this intervention is effective, it could help to increase access to CBT for those who hear distressing voices

Time-optimal Unitary Operations in Ising Chains II: Unequal Couplings and Fixed Fidelity

We analytically determine the minimal time and the optimal control laws required for the realization, up to an assigned fidelity and with a fixed energy available, of entangling quantum gates ($\mathrm{CNOT}$) between indirectly coupled qubits of a trilinear Ising chain. The control is coherent and open loop, and it is represented by a local and continuous magnetic field acting on the intermediate qubit. The time cost of this local quantum operation is not restricted to be zero. When the matching with the target gate is perfect (fidelity equal to one) we provide exact solutions for the case of equal Ising coupling. For the more general case when some error is tolerated (fidelity smaller than one) we give perturbative solutions for unequal couplings. Comparison with previous numerical solutions for the minimal time to generate the same gates with the same Ising Hamiltonian but with instantaneous local controls shows that the latter are not time-optimal.Comment: 11 pages, no figure

The utility of the irap star rating system in assessing (and potentially changing) the safety level of rural road intersections

This study explores the effectiveness of the iRAP (international Road Assessment Programme) Star Rating System in assessing and improving rural road intersections, and specifically whether the simplest version of iRAP is of value in the South African context. iRAP assessments were compared with assessments and observations made at some length on site, to see whether the iRAP system sufficiently captured the most salient problems. Overall, the study showed that iRAP is a practical and effective tool which can be put to good use both to test the safety of intersections or road segments and, also, to experiment with potential interventions to see how safety can be improved most effectively.Papers presented virtually at the 39th International Southern African Transport Conference on 05 -07 July 202

Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

Background: Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest the therapy is both acceptable and beneficial. Aims: The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. Method: We interviewed 9 trial participants using the Change Interview and a mixed methods approach. Results: Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. Conclusions: The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE

Inadequate Loading Stimulus on ISS Results in Bone and Muscle Loss

INTRODUCTION Exercise has been the primary countermeasure to combat musculoskeletal changes during International Space Station (ISS) missions. However, these countermeasures have not been successful in preventing loss of bone mineral density (BMD) or muscle volume in crew members. METHODS We examined lower extremity loading during typical days on-orbit and on Earth for four ISS crew members. In-shoe forces were monitored using force-measuring insoles placed inside the shoes. BMD (by DXA), muscle volumes (by MRI), and strength were measured before and after long-duration spaceflight (181 +/- 15 days). RESULTS The peak forces measured during ISS activity were significantly less than those measured in 1g for the same activities. Typical single-leg loads on-orbit during walking and running were 0.89 +/- 0.17 body weights (BW) and 1.28 +/- 0.18 BW compared to 1.18 +/- 0.11 BW and 2.36 +/- .22 BW in 1g, respectively [2]. Crew members were only loaded for an average of 43.17 +/- 14.96 min a day while performing exercise on-orbit even though 146.8 min were assigned for exercise each day. Areal BMD decreased in the femoral neck and total hip by 0.71 +/- 0.34% and 0.81 +/- 0.21% per month, respectively. Changes in muscle volume were observed in the lower extremity (-10 to -16% calf; -4 to -7% thigh) but there were no changes in the upper extremity (+0.4 to -0.8%). Decrements in isometric and isokinetic strength at the knee (range: -10.4 to -24.1%), ankle (range: -4 to -22.3%), and elbow (range: -7.5 to - 16.7%) were also observed. Knee extension endurance tests showed an overall decline in total work (-14%) but an increased resistance to fatigue post-flight. DISCUSSION AND CONCLUSIONS Our findings support the conclusion that the measured exercise durations and/or loading stimuli were insufficient to protect bone and muscle health

Foot Reaction Forces during Long Duration Space Flight

Musculoskeletal changes, particularly in the lower extremities, are an established consequence of long-duration space flight despite exercise countermeasures. It is widely believed that disuse and reduction in load bearing are key to these physiological changes, but no quantitative data characterizing the on-orbit movement environments currently exist. Here we present data from the Foot Experiment (E318) regarding astronaut activity on the ground and on-orbit during typical days from 4 International Space Station (ISS) crew members who flew during increments 6, 8, 11, and 12

Using the Enhanced Daily Load Stimulus Model to Quantify the Mechanical Load and Bone Mineral Density Changes Experienced by Crew Members on the International Space Station

Despite the use of exercise countermeasures during long-duration space missions, bone mineral density (BMD) and predicted bone strength of astronauts continue to show decreases in the lower extremities and spine. This site-specific bone adaptation is most likely caused by the effects of microgravity on the mechanical loading environment of the crew member. There is, therefore, a need to quantify the mechanical loading experienced on Earth and on-orbit to define the effect of a given "dose" of loading on bone homeostasis. Gene et al. recently proposed an enhanced DLS (EDLS) model that, when used with entire days of in-shoe forces, takes into account recently developed theories on the importance of factors such as saturation, recovery, and standing and their effects on the osteogenic response of bone to daily physical activity. This algorithm can also quantify the tinting and type of activity (sit/unload, stand, walk, run or other loaded activity) performed throughout the day. The purpose of the current study was to use in-shoe force measurements from entire typical work days on Earth and on-orbit in order to quantify the type and amount of loading experienced by crew members. The specific aim was to use these measurements as inputs into the EDLS model to determine activity timing/type and the mechanical "dose" imparted on the musculoskeletal system of crew members and relate this dose to changes in bone homeostasis