Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial

Background Up to 70% of adolescents with moderate to severe unipolar major depression respond to psychological treatment plus Fluoxetine (20-50 mg) with symptom reduction and improved social function reported by 24 weeks after beginning treatment. Around 20% of non responders appear treatment resistant and 30% of responders relapse within 2 years. The specific efficacy of different psychological therapies and the moderators and mediators that influence risk for relapse are unclear. The cost-effectiveness and safety of psychological treatments remain poorly evaluated. Methods/Design Improving Mood with Psychoanalytic and Cognitive Therapies, the IMPACT Study, will determine whether Cognitive Behavioural Therapy or Short Term Psychoanalytic Therapy is superior in reducing relapse compared with Specialist Clinical Care. The study is a multicentre pragmatic effectiveness superiority randomised clinical trial: Cognitive Behavioural Therapy consists of 20 sessions over 30 weeks, Short Term Psychoanalytic Psychotherapy 30 sessions over 30 weeks and Specialist Clinical Care 12 sessions over 20 weeks. We will recruit 540 patients with 180 randomised to each arm. Patients will be reassessed at 6, 12, 36, 52 and 86 weeks. Methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, research assessors independent of treatment team and blind to randomization, analysis by intention to treat, data management using remote data entry, measures of quality assurance, advanced statistical analysis, manualised treatment protocols, checks of adherence and competence of therapists and assessment of cost-effectiveness. We will also determine whether time to recovery and/or relapse are moderated by variations in brain structure and function and selected genetic and hormone biomarkers taken at entry. Discussion The objective of this clinical trial is to determine whether there are specific effects of specialist psychotherapy that reduce relapse in unipolar major depression in adolescents and thereby costs of treatment to society. We also anticipate being able to utilise psychotherapy experience, neuroimaging, genetic and hormone measures to reveal what techniques and their protocols may work best for which patients.

COCO-2: a model to assess the economic impact of an accident

COCO-2 is a model for assessing the potential economic costs likely to arise off-site following an accident at a nuclear reactor. COCO-2 builds on work presented in the model COCO-1 developed in 1991 by considering economic effects in more detail, and by including more sources of loss. Of particular note are: the consideration of the directly affected local economy, indirect losses that stem from the directly affected businesses, losses due to changes in tourism consumption, integration with the large body of work on recovery after an accident and a more systematic approach to health costs. The work, where possible, is based on official data sources for reasons of traceability, maintenance and ease of future development. This report describes the methodology and discusses the results of an example calculation. Guidance on how the base economic data can be updated in the future is also provided.

Tales of the unexpected: research discoveries that occurred by accident

Data from four experimental research projects are presented which have in common that unexpected results caused a change in direction of the research. A plant growth accelerator caused the appearance of white black bean aphids, a synthetic pyrethroid suspected of enhancing aphid reproduction proved to enhance plant growth, a chance conversation with a colleague initiated a search for fungal DNA in aphids, and the accidental invasion of aphid cultures by a parasitoid reversed the aphid population ranking of two Brussels sprout cultivars. This last result led to a whole series of studies on the plant odour preferences of emerging parasitoids which in turn revealed the unexpected phenomenon that chemical cues to the maternal host plant are left with the eggs at oviposition. It is pointed out that, too often, researchers fail to follow up unexpected results because they resist accepting flaws in their hypotheses; also that current application criteria for research funding make it hard to accommodate unexpected findings.

Big data: a normal accident waiting to happen?

Widespread commercial use of the internet has significantly increased the volume and scope of data being collected by organisations. ‘Big data’ has emerged as a term to encapsulate both the technical and commercial aspects of this growing data collection activity. To date, much of the discussion of big data has centred upon its transformational potential for innovation and efficiency, yet there has been less reflection on its wider implications beyond commercial value creation. This paper builds upon normal accident theory (NAT) to analyse the broader ethical implications of big data. It argues that the strategies behind big data require organisational systems that leave them vulnerable to normal accidents, that is to say some form of accident or disaster that is both unanticipated and inevitable. Whilst NAT has previously focused on the consequences of physical accidents, this paper suggests a new form of system accident that we label data accidents. These have distinct, less tangible and more complex characteristics and raise significant questions over the role of individual privacy in a ‘data society’. The paper concludes by considering the ways in which the risks of such data accidents might be managed or mitigated.

Awareness of number in children with severe and profound learning difficulties: three exploratory case studies

This paper reports on exploratory work investigating how children with severe and profound learning difficulties register an awareness of small quantities and how they might use this information to inform their understanding. It draws on studies of typically developing children and investigates their application to pupils whose response to conventional mathematical tasks are often limited because they lack relevance and interest. The responses of the three pupils to individualized learning contexts mirror the progression suggested in the literature, namely from awareness of number to simple actions using number cues to problem-solving behaviour

Interpreting communication of people with profound and severe learning difficulties

The present paper highlights some of the issues involved in interpreting the communication behaviours of people with profound and multiple learning difficulties (PMLDs). Both inference and intention can play an important role in the communication process, and this raises a number of difficulties and dangers where one of the communication partners is not in a position to correct misunderstandings. The present authors discuss the importance of validating communication and pose a number of key questions to ask those who are most significant in the life of a person with PMLDs. A case study is provided that illustrates a number of these issues.