Transdiagnostic CBT treatment of co-morbid anxiety and depression in an older adult: Single case experimental design

Background: Despite the prevalence of co-morbid anxiety and depression in older adults, evaluation of suitable clinical models is rare. Aims: This study tested the acceptability and effectiveness of a transdiagnostic approach to treating co-morbid anxiety and depression in an older adults in a routine clinical setting. Method: In an A/B single case experimental design, a patient completed five daily ideographic measures of anxiety and depression across baseline and treatment and the HADS at five time points over time, including 3-month follow-up. The 8-session treatment was transdiagnostic CBT informed by the Unified Protocol. Results: All sessions were attended. Significant baseline-treatment improvements were found for daily structure, mood, confidence and worry, with large associated effect sizes. The HADS showed that the patient met recovery criteria by the end of treatment, with some evidence of anxious relapse at follow-up. Conclusion: Transdiagnostic CBT offers promise as a treatment approach to mixed anxiety and depression in older adults. The model needs to be further tested using more rigorous and suitably powered methodologies

The Nuclear Science References (NSR) Database and Web Retrieval System

The Nuclear Science References (NSR) database together with its associated Web interface, is the world's only comprehensive source of easily accessible low- and intermediate-energy nuclear physics bibliographic information for more than 200,000 articles since the beginning of nuclear science. The weekly-updated NSR database provides essential support for nuclear data evaluation, compilation and research activities. The principles of the database and Web application development and maintenance are described. Examples of nuclear structure, reaction and decay applications are specifically included. The complete NSR database is freely available at the websites of the National Nuclear Data Center http://www.nndc.bnl.gov/nsr and the International Atomic Energy Agency http://www-nds.iaea.org/nsr.Comment: 16 pages, 5 figure

Exploring relapse through a network analysis of residual depression and anxiety symptoms after cognitive behavioural therapy : a proof-of-concept study

Objective: Many patients relapse within one year of completing effective cognitive behavioural therapy (CBT) for depression and anxiety. Residual symptoms at treatment completion have been demonstrated to predict relapse, and so this study used network analyses to improve specificity regarding which residual anxiety and depression symptoms predict relapse. Method: A cohort study identified relapse cases following low- and high-intensity CBT in a stepped care psychological therapy service. The sample included N=867 ‘recovered’ treatment completers that attended a six-month follow-up review. At follow-up, N=93 patients had relapsed and N=774 remained in-remission. Networks of final treatment session depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated for both sub-groups. Results: Qualitatively similar symptom networks were found. Difficulty concentrating was a highly central symptom in the relapse network, whilst of only average centrality in the remission network. In contrast, trouble relaxing was highly central in the remission network, whilst of only average centrality in the relapse network. Discussion: Identification of central residual symptoms holds promise in improving the specificity of prognostic models and the design of evidence-based relapse prevention strategies. The small sample of relapse cases limits this study’s ability to draw firm conclusions

An Intelligent Empowering Agent (IEA) to Provide Easily Understood and Trusted Health Information Appropriate to the User Needs

Most members of the public, including patients, usually obtain health information from Web searches using generic search engines, which is often overwhelming, too generic, and of poor quality. Although patients may be better informed, they are often none the wiser and not empowered to communicate with medical professionals so that their care is compatible with their needs, values, and best interests. Intelligent Empowering Agents (IEA) use AI to filter medical information and assist the user in the understanding of health information about specific complaints or health in general. We have designed and developed a prototype of an IEA that dialogues with the user in simple language, collects health information from the Web, and provides tailored, easily understood, and trusted information. It empowers users to create their own comprehensive and objective opinion on health matters that concern them. This paper describes the IEA main characteristics and presents the results of subjective and objective tests carried out to assess the effectiveness of the IEA

Battlezone: An examination of the physiological responses, movement demands and reproducibility of small-sided cricket games

As cricket training typically involves separate skill and conditioning sessions, this study reported on the movement demands, physiological responses and reproducibility of the demands of small-sided cricket games. Thirteen amateur, male cricket players (age: 22.8 ± 3.5 years, height: 1.78 ± 0.06 m, body mass: 78.6 ± 7.1 kg) completed two sessions of a generic small-sided cricket game, termed Battlezone; consisting of six repeat 8-over bouts. Heart rate and movement demands were continuously recorded, whilst blood lactate concentration and perceived exertion were recorded after each respective bout. Batsmen covered the greatest distance (1147 ± 175 m) and demonstrated the greatest mean movement speed (63 ± 9 m · min-1) during each bout. The majority of time (65-86%) was spent with a heart rate of between 51-85% HRmax and a blood lactate concentration of 1.1-2.0 mmol · L-1. Rating of perceived exertion ranged between 4.2-6.0. Movement demands and physiological responses did not differ between standardised sessions within respective playing positions (P > 0.05). The reliability for the majority of movement demands and physiological responses were moderate to high (CV: 5-17%; ICC: 0.48-1.00) within all playing positions. These results suggest that the physiological responses and movement characteristics of generic small-sided cricket games were consistent between sessions within respective playing positions. © 2013 Copyright Taylor and Francis Group, LLC

The acceptability, effectiveness, and durability of cognitive analytic therapy : Systematic review and meta‐analysis

Objectives This paper sought to conduct a meta‐analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. Design Systematic review and meta‐analysis. Methods PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre–post/post‐follow‐up effect sizes (ESs) were extracted and synthesized in a random‐effects meta‐analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between‐group ES from trials of CAT. Results Twenty‐five studies providing pre–post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre–post improvements in global functioning (ES = 0.86; 95% CI 0.71–1.01, N = 628), moderate‐to‐large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51–0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80–1.29, N = 586). All these effects were maintained or improved upon at follow‐up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small–moderate, significant post‐treatment benefits compared to comparators in nine clinical trials (ES = 0.36–0.53; N = 352). The average dropout rate for CAT was 16% (range 0–33%). Conclusions Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base

Numerical simulation of unconstrained cyclotron resonant maser emission

When a mainly rectilinear electron beam is subject to significant magnetic compression, conservation of magnetic moment results in the formation of a horseshoe shaped velocity distribution. It has been shown that such a distribution is unstable to cyclotron emission and may be responsible for the generation of Auroral Kilometric Radiation (AKR) an intense rf emission sourced at high altitudes in the terrestrial auroral magnetosphere. PiC code simulations have been undertaken to investigate the dynamics of the cyclotron emission process in the absence of cavity boundaries with particular consideration of the spatial growth rate, spectral output and rf conversion efficiency. Computations reveal that a well-defined cyclotron emission process occurs albeit with a low spatial growth rate compared to waveguide bounded simulations. The rf output is near perpendicular to the electron beam with a slight backward-wave character reflected in the spectral output with a well defined peak at 2.68GHz, just below the relativistic electron cyclotron frequency. The corresponding rf conversion efficiency of 1.1% is comparable to waveguide bounded simulations and consistent with the predictions of kinetic theory that suggest efficient, spectrally well defined radiation emission can be obtained from an electron horseshoe distribution in the absence of radiation boundaries.Publisher PD

Effectiveness of the unified protocol for treating co-morbid health anxiety and depression : an empirical case study

Aims: The unified protocol (UP) is indicated when patients present with co-morbidity, but no studies have previously investigated the effectiveness of the UP with co-morbid health anxiety and depression. Method: An A/B single case design evaluated outcomes for a 27-year-old male presenting with health anxiety and co-morbid depression. Following a 21-day assessment-baseline period containing three sessions, the manualised UP was delivered across a 42-day period containing seven intervention sessions. Four idiographic measures (occurrence and duration of health checking, sleep duration and food intake satisfaction) were collected daily throughout, and two nomothetic measures were collected at four time points. Results: All sessions were attended. Number of health checking episodes reduced from four per day to two per day. A 59 minute per day reduction in time spent health checking occurred, and sleep increased by 100 minutes per night. There was little apparent change in terms of food intake satisfaction. There was a reliable and clinically significant reduction in depression. Discussion: Further testing of the effectiveness of the UP with co-morbid health anxiety and depression in true single case experimental designs is now indicated