Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials.

BACKGROUND: Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design. METHODS: A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition. RESULTS: Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only. CONCLUSIONS: This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action

Severely Photosensitive Psoriasis: A Phenotypically Defined Patient Subset

A subset of patients with chronic plaque psoriasis exhibits severely photosensitive psoriasis (PP) with a pronounced seasonal pattern, but the pathomechanism is not understood. We performed two related studies; first, a detailed clinical characterization of PP, and second, a controlled investigation exploring the underlying pathomechanisms through the assessment of disease onset after photoprovocation. Patients with PP (n=20) showed striking female predominance (19F:1M), very low mean age of psoriasis onset (11 years, range 2–24), family history of psoriasis (13/20), a strong HLA–Cw*0602 association (16/17), and a rapid abnormal clinical response to broadband UVA, comprising erythema±scaling plaques (17/20). Subsequently, patients with PP (n=10), non-PP (n=9), and healthy volunteers (n=11) were challenged with low-dose broadband UVA on 3 consecutive days, and serial biopsies were taken after 6hours to 7 days and from unchallenged skin. Histological changes consistent with early psoriasis occurred in 4 of 10 PP patients, but in neither of the control groups, with significant dermal infiltration by neutrophils, CD4+, CD8+, and CD45RO+ cells at 24h, accompanied by acanthosis. Thus, a phenotypically distinct subset of psoriasis has been characterized. In contrast with earlier assumptions, UV can provoke psoriasiform features rapidly de novo; a role for memory effector T cells is supported in the early phase

Study protocol for a randomised, controlled platform trial estimating the effect of autobiographical Memory Flexibility training (MemFlex) on relapse of recurrent major depressive disorder.

INTRODUCTION: Major depressive disorder (MDD) is a chronic condition. Although current treatment approaches are effective in reducing acute depressive symptoms, rates of relapse are high. Chronic and inflexible retrieval of autobiographical memories, and in particular a bias towards negative and overgeneral memories, is a reliable predictor of relapse. This randomised controlled single-blind trial will determine whether a therapist-guided self-help intervention to ameliorate autobiographical memory biases using Memory Flexibility training (MemFlex) will increase the experience of depression-free days, relative to a psychoeducation control condition, in the 12 months following intervention. METHODS AND ANALYSIS: Individuals (aged 18 and above) with a diagnosis of recurrent MDD will be recruited when remitted from a major depressive episode. Participants will be randomly allocated to complete 4 weeks of a workbook providing either MemFlex training, or psychoeducation on factors that increase risk of relapse. Assessment of diagnostic status, self-report depressive symptoms, depression-free days and cognitive risk factors for depression will be completed post-intervention, and at 6 and 12 months follow-up. The cognitive target of MemFlex will be change in memory flexibility on the Autobiographical Memory Test- Alternating Instructions. The primary clinical endpoints will be the number of depression-free days in the 12 months following workbook completion, and time to depressive relapse. ETHICS AND DISSEMINATION: Ethics approval has been granted by the NHS National Research Ethics Committee (East of England, 11/H0305/1). Results from this study will provide a point-estimate of the effect of MemFlex on depressive relapse, which will be used to inform a fully powered trial evaluating the potential of MemFlex as an effective, low-cost and low-intensity option for reducing relapse of MDD. TRIAL REGISTRATION NUMBER: NCT02614326.This work is supported by a grant to TD from the UK Medical Research Council, grant number MC_US_A060_0019

Future Experiences: Sustainable Development and the Global South

The Innovation School at The Glasgow School of Art teaches design as a human-centred practice that can be applied universally to local or global issues, and so acknowledges the stakeholders, systemic elements or actants that lie beyond the human. This Future Experiences project asked the Innovation School’s graduating B.Des Product Design students to address one of the greatest challenges facing humanity today, Sustainable Development, which is defined by the United Nations as: ‘development that meets the needs of the present without compromising the ability of future generations to meet their own needs.’ Now, more than ever, there is a need for greater cooperation at a global level between governments, civil society, the private sector and other stakeholders to ensure that those with the least still have an opportunity to prosper. Sustainable Development recognises that, despite more people around the world living better lives compared with a decade ago, inequalities and climate change threaten to undo the progress made in fields such as healthcare, employment and education. It helps economies to grow through the use of innovative technologies that can unleash opportunities for shared prosperity. It aims to ensure everyone has access to nutritious food, quality education and freedom of speech. And it attempts to do all of this without harming the environment, while seeking to respect local culture, traditions and values. A global action plan initiated by the UN in 2015 sets out 17 Sustainable Development Goals that must be achieved in the next decade as part of the 2030 Agenda for Sustainable Development if we are to end poverty, protect the planet and improve the lives and prospects of everyone, everywhere. These goals now inform ongoing Sustainable Development work all over the world, and also helped guide this Future Experiences project. The project was completed in January 2020, as the deadly and disastrous Covid-19 pandemic was just beginning its spread around the world. This unprecedented catastrophe reinforced the importance of supporting those most in need – the citizens of developing regions in the so-called ‘Global South’. In April 2020, the heads of all the UN’s major agencies issued an open letter warning of the risks the virus posed to the world’s most vulnerable countries. It called on wealthier nations to increase funding and help to tackle issues such as the cessation of aid as a result of cancelled flights and disrupted supply routes. These and many other concerns highlighted during the crisis are among the topics explored in this project, which feels even more relevant and urgent than when it was initiated in the summer of 2019. The project’s main focus was on how design can support development work in the Global South by helping providers move beyond legacy approaches and explore new practices, projects and directions of research. The students stepped outside of their comfort zones and engaged with people living and working in developing nations in order to identify how design innovation might best be used in the context of Sustainable Development. Their speculative visions offered an alternative to existing development frameworks, prompting providers of development to reconsider their modes of operation or how they engage with users. In particular, the students focused on empowering communities by proposing new products, services or interactions, as well as alternative forms of civic organisation or behaviours, that could help these communities to enhance their own sustainable futures. Research and practice within the field of Sustainable Development is currently undergoing a significant shift away from a colonial model that saw international aid being administered by the richest members of the global capitalist North to resolve perceived problems in the poorer South. The students were asked to imagine a global landscape ten years from now in which citizens living and working in developing countries across the Global South are in control of their own development agenda, which in a globalised world, is always also in relation to the North.Based on this more participatory context, the Innovation School’s human-centred, research-driven approach was used to explore new ways of initiating, funding and sustaining projects aimed at providing lasting benefits for specific communities. The outcomes ranged from a new healthcare system that blends traditional and modern medicines, to a technologically advanced refuge for women moving to cities for work, and a service that promotes the use of cleaner energy within homes in rural Africa. For this year’s project, The Innovation School partnered with the University of Glasgow and the Sustainable Futures in Africa Network to provide the students with direct access to academics and development professionals working within the field of Sustainable Development in the Global South. The insights the experts provided about everyday life in nations such as Malawi, Uganda, Botswana and Nigeria helped to inform solutions that address real-world problems. The ambitious collaboration allowed both the Innovation School and its project partners to examine new ways of integrating design and innovation practices into the planning of future Sustainable Development projects

Building social capital through breastfeeding peer support: Insights from an evaluation of a voluntary breastfeeding peer support service in North-West England

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with ’bonding’, ‘bridging’ and ‘linking’ forms of social capital. These insights illuminate how the peer support service facilitates ‘bonds’ with its members, and within and between women who access the service; how the service ‘bridges’ with individuals from different interests and backgrounds, and how ‘links’ were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted

Middle and Late Pleistocene environmental history of the Marsworth area, south-central England

To elucidate the Middle and Late Pleistocene environmental history of south-central England, we report the stratigraphy, sedimentology, palaeoecology and geochronology of some deposits near the foot of the Chiltern Hills scarp at Marsworth, Buckinghamshire. The Marsworth site is important because its sedimentary sequences contain a rich record of warm stages and cold stages, and it lies close to the Anglian glacial limit. Critical to its history are the origin and age of a brown pebbly silty clay (diamicton) previously interpreted as weathered till. The deposits described infill a river channel incised into chalk bedrock. They comprise clayey, silty and gravelly sediments, many containing locally derived chalk and some with molluscan, ostracod and vertebrate remains. Most of the deposits are readily attributed to periglacial and fluvial processes, and some are dated by optically stimulated luminescence to Marine Isotope Stage (MIS) 6. Although our sedimentological data do not discriminate between a glacial or periglacial interpretation of the diamicton, amino-acid dating of three molluscan taxa from beneath it indicates that it is younger than MIS 9 and older than MIS 5e. This makes a glacial interpretation unlikely, and we interpret the diamicton as a periglacial slope deposit. The Pleistocene history reconstructed for Marsworth identifies four key elements: (1) Anglian glaciation during MIS 12 closely approached Marsworth, introducing far-travelled pebbles such as Rhaxella chert and possibly some fine sand minerals into the area. (2) Interglacial environments inferred from fluvial sediments during MIS 7 varied from fully interglacial conditions during sub-stages 7e and 7c, cool temperate conditions during sub-stage 7b or 7a, temperate conditions similar to those today in central England towards the end of the interglacial, and cool temperate conditions during sub-stage 7a. (3) Periglacial activity during MIS 6 involved thermal contraction cracking, permafrost development, fracturing of chalk bedrock, fluvial activity, slopewash, mass movement and deposition of loess and coversand. (4) Fully interglacial conditions during sub-stage 5e led to renewed fluvial activity, soil formation and acidic weathering

ELCID: early lung cancer identification and diagnosis - an embedded interview study to explore patient participation and recruitment

Background The ELCID Trial is a feasibility randomised controlled trial examining the effect on lung cancer diagnosis of giving an urgent chest x-ray to smokers, and recent exsmokers, aged over 60 with new chest symptoms. Aims The qualitative component explores the feasibility of individually randomising patients to an urgent CXR or not and investigates any barriers to patient participation. Methods To date we have conducted semi-structured interviews with six primary care staff (practice managers, research nurses), ten patients randomised to ‘extra-NICE’ guidelines for referral for urgent chest x-ray, and six patients randomised to ‘usual care’ (NICE guidelines)). We hope to also interview patients who decline randomisation. Interviews were analysed using a Framework approach. Results Initial analysis indicated that practices have struggled to recruit patients, partly due to the eligibility criteria that requires ex-smokers to have stopped smoking within the last five years. Practices with a research nurse have recruited the most patients. Patients indicated that they are happy to take part in the trial and their anxiety levels were not raised. Most patients hoped to be randomised to urgent chest x-ray, although those who were not did not go back to their GP to request one. Conclusions Eligibility criteria needed revision to include ex-smokers of any duration. These preliminary findings suggest that the trial appears to be feasible and patients are happy to accept randomisation. The findings will inform the design of the main trial in the future

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds.

BACKGROUND: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. METHOD: Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. RESULTS: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. CONCLUSIONS: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital‐attending children and a randomized controlled proof‐of‐concept trial of trauma‐focused cognitive therapy, for 3‐ to 8‐year‐olds

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6‐year‐old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD‐YC), including the adult‐led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive‐focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD‐YC. Method: Study 1 (N = 105) assessed ASD and PTSD‐YC diagnosis in 3‐ to 8‐year‐old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early‐phase trial comparing CBT‐3M, a cognitive‐focused intervention, to treatment‐as‐usual (TAU) delivered within the UK NHS to 3‐ to 8‐year‐olds diagnosed with PTSD‐YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD‐YC (minus the duration requirement) was 8.6% in the first month post‐trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma‐related characteristics, predicted development of later PTSD‐YC. Early (within one month) diagnosis of acute PTSD‐YC had a positive predictive value of 50% for later PTSD‐YC. In Study 2, most children lost their PTSD‐YC diagnosis following completion of CBT‐3M (84.6%) relative to TAU (6.7%) and CBT‐3M was acceptable to recipient families. Effect sizes were also in favor of CBT‐3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age‐group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive‐focused treatment for PTSD, and a larger trial of CBT‐3M is now warranted

Co-producing across organizational boundaries: promoting asylum seeker integration in Scotland

This paper questions whether asylum seeker integration is promoted through inter-organisational relationships between non-profit and voluntary organisations (NPVOs) and government agencies. It focuses particularly on the role of NPVOs in service delivery (co-management) and in the delivery and planning of public services (co-governance). It presents a research study on the public services provided to asylum seekers in Glasgow and asks the following questions: What role do NPVOs play in the planning and delivery of public services? When planning and delivering public services, to what extent do NPVOs work across organisational boundaries and what kind of relationships exist? And in practice, what makes inter-organisational relationships work? This paper offers new empirical evidence and also contributes to the theoretical debate around the integration of asylum seekers