Couple and family therapies for post-traumatic stress disorder (PTSD)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objectives of this review will be to: assess the efficacy of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non‐specific individual psychological therapies; examine the clinical characteristics of studies that influence the relative efficacy of these therapies; and critically evaluate methodological features of studies that bias research findings

Developing person-centred analysis of harm in a paediatric hospital: a quality improvement report.

The provision of safe care is complex and difficult to achieve. Awareness of what happens in real time is one of the ways to develop a safe system within a culture of safety. At Great Ormond Street Hospital, we developed and tested a tool specifically designed for patients and families to report harm, with the aim of raising awareness and opportunities for staff to continually improve and provide safe care. Over a 10-month period, we developed processes to report harm. We used the Model for Improvement and multiple Plan, Do, Study, Act cycles for testing. We measured changes using culture surveys as well as analysis of the reports. The tool was tested in different formats and moved from a provider centric to a person-centred tool analysed in real time. An independent person working with the families was best placed to support reporting. Immediate feedback to families was managed by senior staff, and provided the opportunity for clarification, transparency and apologies. Feedback to staff provided learning opportunities. Improvements in culture climate and staff reporting were noted in the short term. The integration of patient involvement in safety monitoring systems is essential to achieve safety. The high number of newly identified 'near-misses' and 'critical incidents' by families demonstrated an underestimation of potentially harmful events. This testing and introduction of a self-reporting, real-time bedside tool has led to active engagement with families and patients and raised situation awareness. We believe that this will lead to improved and safer care in the longer term

Couple and family therapies for post-traumatic stress disorder (PTSD)

Background Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include diGiculties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD. Objectives The objectives of this review were to: (1) assess the eGects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative eGects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings. Search methods We searchedMEDLINE (1950-), Embase (1980-) andPsycINFO(1967-) via theCochraneCommonMentalDisordersControlledTrialsRegister (CCMDCTR) to 2014, then directly via Ovid aIer this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018. Selection criteria Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems. Data collection and analysis We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the eGects of interventions for dichotomous outcomes, and standardised mean diGerences (SMD) to summarise posttreatment between-group diGerences on continuous measures. Main results We included four trials in the review. Two studies examined the eGects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the eGects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the eGects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in suGicient detail — we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more eGective than wait list control in reducing PTSD severity (SMD −1.12, 95% CI −1.79 to −0.45; low-quality evidence), anxiety (SMD −0.93, 95% CI −1.58 to −0.27; very low-quality evidence) and depression (SMD −0.66, 95% CI −1.30 to −0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not diGer significantly according to relationship satisfaction (SMD 1.07, 95% CI −0.17 to 2.31; very low-quality evidence); and one study showed no significant diGerences regarding depression (SMD 0.28, 95% CI −0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI −0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more eGective than PFE in reducing PTSD severity for the primary patient (SMD −1.32, 95% CI −1.90 to −0.74; low-quality evidence) at post-treatment. There was no evidence of diGerences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI −0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI −0.31 to 0.73; very low-quality evidence) and anxiety (SMD −0.16, 95% CI −0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD −0.28, 95% CI −0.81 to 0.24; very low-quality evidence) or anxiety (SMD −0.34, 95% CI −0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant diGerences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated ‘high’. Two studies had significant amounts of missing information resulting in 'unclear'risk of bias. There were too few studies available to conduct subgroup analyses. Authors' conclusions There are few trials of couple-based therapies for PTSD and evidence is insuGicient to determine whether these oGer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and standalone interventions with couples orfamilies which targetreduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality

Inflammatory stress of pancreatic beta cells drives release of extracellular heat-shock protein 90α

A major obstacle in predicting and preventing the development of autoimmune type 1 diabetes (T1D) in at-risk individuals is the lack of well-established early biomarkers indicative of ongoing beta cell stress during the pre-clinical phase of disease. Recently, serum levels of the α cytoplasmic isoform of heat-shock protein 90 (hsp90) were shown to be elevated in individuals with new-onset T1D. We therefore hypothesized that hsp90α could be released from beta cells in response to cellular stress and inflammation associated with the earliest stages of T1D. Here, human beta cell lines and cadaveric islets released hsp90α in response to stress induced by treatment with a combination of pro-inflammatory cytokines including interleukin-1β, tumour necrosis factor-α and interferon-γ. Mechanistically, hsp90α release was found to be driven by cytokine-induced endoplasmic reticulum stress mediated by c-Jun N-terminal kinase (JNK), a pathway that can eventually lead to beta cell apoptosis. Cytokine-induced beta cell hsp90α release and JNK activation were significantly reduced by pre-treating cells with the endoplasmic reticulum stress-mitigating chemical chaperone tauroursodeoxycholic acid. The hsp90α release by cells may therefore be a sensitive indicator of stress during inflammation and a useful tool in assessing therapeutic mitigation of cytokine-induced cell damage linked to autoimmunity

Understanding the Relationship between Intention and Cat Containment Behaviour: A Case Study of Kitten and Cat Adopters from RSPCA Queensland

In Australia, cat owners are encouraged to keep their pet cats contained on their property at all times. This study explores the relationship between the intentions and behaviours of 72 kitten and cat adopters from a RSPCA Queensland animal shelter, to provide a more in-depth understanding of the factors influencing the adoption of cat containment behaviours. At the time of adoption, 64 participants (89%) indicated they were intending to keep their cat fully contained. Eight weeks after adoption, 63 participants (87%) reported they were doing so (59 who had stated their intention at the time of adoption, and 4 who had not). We found cat owner containment behaviour was moderately correlated with containment intentions. For some of the participants when it came to enacting this behaviour, their intentions and the provided education information was not enough to overcome the more compelling capability, opportunity and motivational factors which presented themselves once they got home. We were able to identify these factors and suggest additional behaviour change strategies that would assist. Although it is important to provide cat adopters with advice about how to contain their cats properly, these results also highlight the importance of focusing attention on other behaviour change strategies that address the particular barriers faced by some cat-owners who are unsuccessful in keeping their cat contained on their property

Proinsulin and heat shock protein 90 as biomarkers of beta-cell stress in the early period after onset of type 1 diabetes

Rapid evaluation of therapies designed to preserve β cells in persons with type 1 diabetes (T1D) is hampered by limited availability of sensitive β-cell health biomarkers. In particular, biomarkers elucidating the presence and degree of β-cell stress are needed. We characterized β-cell secretory activity and stress in 29 new-onset T1D subjects (10.6 ± 3.0 years, 55% male) at diagnosis and then 8.2 ± 1.2 weeks later at first clinic follow-up. We did comparisons with 16 matched healthy controls. We evaluated hemoglobin A1c (HbA1c), β-cell function (random C-peptide [C] and proinsulin [PI]), β-cell stress (PI:C ratio), and the β-cell stress marker heat shock protein (HSP)90 and examined these parameters' relationships with clinical and laboratory characteristics at diagnosis. Mean diagnosis HbA1c was 11.3% (100 mmol/mol) and 7.6% (60 mmol/mol) at follow-up. C-peptide was low at diagnosis (P < 0.001 vs controls) and increased at follow-up (P < 0.001) to comparable with controls. PI did not differ from controls at diagnosis but increased at follow-up (P = 0.003) signifying increased release of PI alongside improved insulin secretion. PI:C ratios and HSP90 concentrations were elevated at both time points. Younger subjects had lower C-peptide and greater PI, PI:C, and HSP90. We also examined islets isolated from prediabetic nonobese diabetic mice and found that HSP90 levels were increased ∼4-fold compared with those in islets isolated from matched CD1 controls, further substantiating HSP90 as a marker of β-cell stress in T1D. Our data indicate that β-cell stress can be assessed using PI:C and HSP90. This stress persists after T1D diagnosis. Therapeutic approaches to reduce β-cell stress in new-onset T1D should be considered

Secondary metabolites of the sponge-derived fungus Acremonium persicinum

This study reports the isolation and characterization of six new acremine metabolites, 5-chloroacremine A (4), 5-chloroacremine H (5), and acremines 0 (6), P (7), Q(8), and R (9), together with the known acremines A (1), F (2), and N (3) from the fungus Acremonium persicinum cultured from the marine sponge Anomoianthella rubra. The relative configuration of acremine F (2) was determined by analyses of proton coupling constant values and NOESY data, and the absolute configuration confirmed as (IS, 4S, 6R) by X-ray crystallographic analysis of the borate ester derivative 15. Acremines O, P, and R were each shown to be of 8R configuration by H-1 NMR analyses of MPA esters. The relative configurations suggested for acremines P and Q were each deduced by molecular modeling together with NOESY and coupling constant data. The (3)J(H-C) values in acremine P were measured using the pulse sequence EXSIDE, and the observed (3)J(H8-C4) of 5.4 Hz and small (3)J(H-C) values

A dual-process psychobiological model of temperament predicts liking and wanting for food and trait disinhibition

A dual-process model of temperament, incorporating the Behavioural Inhibition System (BIS), Behavioural Activation System (BAS) and effortful control (EC), may help to predict hedonic responses to palatable food and trait disinhibition. Purpose This study aimed to determine if the BIS, BAS and EC predicted liking and wanting for high-fat, sweet foods in adults with overweight and obesity, and if collectively, these variables predicted the eating behaviour trait of Disinhibition. Methods 168 adults (104 females, mean BMI = 33.3 kg/m2) completed the Three Factor Eating Questionnaire, the Carver and White BIS/BAS scales, the Adult Temperament Questionnaire-Effortful Control Scale – Short Form and the Leeds Food Preference Questionnaire. The strength of the BIS, BAS and EC in predicting wanting and liking for high-fat sweet foods, and trait Disinhibition was assessed using hierarchical multiple regression. Results Both the BIS and EC predicted liking, F (6, 161) = 5.05, p < .001, R2 = 0.16, and EC inversely predicted wanting, F (6, 161) = 3.28, p = .005, R2 = 0.11. The BIS, EC and liking predicted, F (8, 159) = 11.0, p < .001, R2 = 0.36, and explained 36% of Disinhibition. The BAS did not predict wanting, liking or Disinhibition. Conclusions These results demonstrate that a sensitive BIS and a lower level of effortful control predicts food reward and Disinhibition in overweight and obese adults. Consequently, interventions that aim to increase effortful control and reduce BIS reactivity may be beneficial for reducing hedonically motivated, disinhibited eating behaviour

Structure-Function Analysis of STRUBBELIG, an Arabidopsis Atypical Receptor-Like Kinase Involved in Tissue Morphogenesis

Tissue morphogenesis in plants requires the coordination of cellular behavior across clonally distinct histogenic layers. The underlying signaling mechanisms are presently being unraveled and are known to include the cell surface leucine-rich repeat receptor-like kinase STRUBBELIG in Arabidopsis. To understand better its mode of action an extensive structure-function analysis of STRUBBELIG was performed. The phenotypes of 20 EMS and T-DNA-induced strubbelig alleles were assessed and homology modeling was applied to rationalize their possible effects on STRUBBELIG protein structure. The analysis was complemented by phenotypic, cell biological, and pharmacological investigations of a strubbelig null allele carrying genomic rescue constructs encoding fusions between various mutated STRUBBELIG proteins and GFP. The results indicate that STRUBBELIG accepts quite some sequence variation, reveal the biological importance for the STRUBBELIG N-capping domain, and reinforce the notion that kinase activity is not essential for its function in vivo. Furthermore, individual protein domains of STRUBBELIG cannot be related to specific STRUBBELIG-dependent biological processes suggesting that process specificity is mediated by factors acting together with or downstream of STRUBBELIG. In addition, the evidence indicates that biogenesis of a functional STRUBBELIG receptor is subject to endoplasmic reticulum-mediated quality control, and that an MG132-sensitive process regulates its stability. Finally, STRUBBELIG and the receptor-like kinase gene ERECTA interact synergistically in the control of internode length. The data provide genetic and molecular insight into how STRUBBELIG regulates intercellular communication in tissue morphogenesis