Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis

Whilst cognitive behavioural therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherence to CBT for OCD in terms of: (1) treatment refusal, (2) treatment dropout, (3) session at- tendance/module completion, and (4) between-session CBT task adherence. Sociodemographic and clinical variables, treatment and study design characteristics were examined as moderators of adherence. The systematic search identified 123 studies including 5627 participants taking part in CBT or control conditions. A pooled rate of 15.6% of eligible patients refused CBT and a further 15.9% of treatment starters dropped out from treatment. Group CBT had significantly lower dropout rates than individually-delivered CBT. No other significant moderators were found. Most studies reported moderate to good adherence to between-session CBT tasks, which had a significant medium to large association with post-treatment OCD symptom reduction. Recommendations for enhanced measurement and re- porting of patient adherence to CBT for OCD are made along with clinical implications of findings

The envirome and the connectome: exploring the structural noise in the human brain associated with socioeconomic deprivation

Complex cognitive functions are widely recognized to be the result of a number of brain regions working together as large-scale networks. Recently, complex network analysis has been used to characterize various structural properties of the large scale network organization of the brain. For example, the human brain has been found to have a modular architecture i.e. regions within the network form communities (modules) with more connections between regions within the community compared to regions outside it. The aim of this study was to examine the modular and overlapping modular architecture of the brain networks using complex network analysis. We also examined the association between neighborhood level deprivation and brain network structure – modularity and grey nodes. We compared network structure derived from anatomical MRI scans of 42 middle-aged neurologically healthy men from the least (LD) and the most deprived (MD) neighborhoods of Glasgow with their corresponding random networks. Cortical morphological covariance networks were constructed from the cortical thickness derived from the MRI scans of the brain. For a given modularity threshold, networks derived from the MD group showed similar number of modules compared to their corresponding random networks, while networks derived from the LD group had more modules compared to their corresponding random networks. The MD group also had fewer grey nodes – a measure of overlapping modular structure. These results suggest that apparent structural difference in brain networks may be driven by differences in cortical thicknesses between groups. This demonstrates a structural organization that is consistent with a system that is less robust and less efficient in information processing. These findings provide some evidence of the relationship between socioeconomic deprivation and brain network topology

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

A morphological segmentation approach to determining bar lengths

Bars are important drivers of galaxy evolution, influencing many physical processes and properties. Characterising bars is a difficult task, especially in large-scale surveys. In this work, we propose a novel morphological segmentation technique for determining bar lengths based on deep learning. We develop U-Nets capable of decomposing galaxy images into pixel masks highlighting the regions corresponding to bars and spiral arms. We demonstrate the versatility of this technique through applying our models to galaxy images from two different observational datasets with different source imagery, and to RGB colour and monochromatic galaxy imaging. We apply our models to analyse SDSS and Subaru HSC imaging of barred galaxies from the NA10 and SAMI catalogues in order to determine the dependence of bar length on stellar mass, morphology, redshift and the spin parameter proxy $\lambda_{R_e}$. Based on the predicted bar masks, we show that the relative bar scale length varies with morphology, with early type galaxies hosting longer bars. While bars are longer in more massive galaxies in absolute terms, relative to the galaxy disc they are actually shorter. We also find that the normalised bar length decreases with increasing redshift, with bars in early-type galaxies exhibiting the strongest rate of decline. We show that it is possible to distinguish spiral arms and bars in monochrome imaging, although for a given galaxy the estimated length in monochrome tends to be longer than in colour imaging. Our morphological segmentation technique can be efficiently applied to study bars in large-scale surveys and even in cosmological simulations.Comment: 22 pages, 18 figures, submitted to MNRA

Headspace for parents: qualitative report investigating the use of a mindfulness-based app for managing parents' stress during COVID-19

Background: Stress can compromise parental well-being and may contribute to harsh and critical parenting styles, which are in turn associated with children's conduct problems. Coronavirus disease 2019 (COVID-19)-related restrictions are likely to have exacerbated parental stress as, for many, UK-based family life was altered considerably. Mindfulness has been demonstrated to improve stress management and emotion regulation when delivered to parents in person, however, more accessible online interventions are under-researched. / Aims: To provide preliminary data on family well-being and parent–child relationships as well as the acceptability and usability of the Headspace app – a self-delivered mindfulness-based intervention – for parents in low-risk families during the early days of the COVID-19 pandemic. / Method: We provided 12 parents with access to Headspace, and collected qualitative data (semi-structured interviews and 5 minute speech samples) immediately following the initial COVID-19 lockdown in the UK. The resulting transcripts were thematically analysed. / Results: Most parents reported Headspace to be acceptable and useful – improvements in parents’ own sleep were particularly noted – and there was high adherence to the intervention. However, difficulties related to family well-being and parent–child relationships following the lockdown were also reported. / Conclusions: As a result of the confounding impact of COVID-19 restrictions, and varied access to app content, we were unable to determine any outcomes to be a result of practising mindfulness specifically. However, COVID-19 has had a profound impact on many UK-based families, including those previously at low risk, and our results demonstrate that Headspace may have beneficial effects for parents. There is a need to more rigorously test this tool with a broader range of families

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

Plasma-sprayed dual density ceramic turbine seal system

Dual density, plasma sprayed ceramic coating systems were investigated for possible application as abradable turbine tip seal systems in small gas turbine engines. Abradability, erosion resistance, internal leakage, and microstructural characterization were investigated for polyester and cenosphere filled zirconium oxide composites. Results indicate the polyester system is more abradable but displays significantly less erosion resistance than the cenosphere system. It is also stated that the absence of significant blade tip damage during abradability testing of both systems suggests additional effort may result in a more nearly optimum balance of abradability and erosion resistance

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

An alternative splicing program promotes adipose tissue thermogenesis

Alternative pre-mRNA splicing expands the complexity of the transcriptome and controls isoform-specific gene expression. Whether alternative splicing contributes to metabolic regulation is largely unknown. Here we investigated the contribution of alternative splicing to the development of diet-induced obesity. We found that obesity-induced changes in adipocyte gene expression include alternative pre-mRNA splicing. Bioinformatics analysis associated part of this alternative splicing program with sequence specific NOVA splicing factors. This conclusion was confirmed by studies of mice with NOVA deficiency in adipocytes. Phenotypic analysis of the NOVA-deficient mice demonstrated increased adipose tissue thermogenesis and improved glycemia. We show that NOVA proteins mediate a splicing program that suppresses adipose tissue thermogenesis. Together, these data provide quantitative analysis of gene expression at exon-level resolution in obesity and identify a novel mechanism that contributes to the regulation of adipose tissue function and the maintenance of normal glycemia