Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Examining Cognitive Models of Obsessive Compulsive Disorder in Adolescents

Abstract. Three influential theoretical models of OCD focus upon the cognitive factors of inflated responsibility (Salkovskis, 1985), thought-action fusion (Rachman, 1993) and meta-cognitive beliefs (Wells and Matthews, 1994). Little is known about the relevance of these models in adolescents or about the nature of any direct or mediating relationships between these variables and OCD symptoms. This was a cross-sectional correlational design with 223 non-clinical adolescents aged 13 to 16 years. All participants completed questionnaires measuring inflated responsibility, thought-action fusion, meta-cognitive beliefs and obsessive-compulsive symptoms. Inflated responsibility, thought-action fusion and metacognitive beliefs were significantly associated with higher levels of obsessive-compulsive symptoms. These variables accounted for 35% of the variance in obsessive-compulsive symptoms, with inflated responsibility and meta-cognitive beliefs both emerging as significant independent predictors. Inflated responsibility completely mediated the effect of thoughtaction fusion and partially mediated the effect of meta-cognitive beliefs. Support for the downward extension of cognitive models to understanding OCD in a younger population was shown. Findings suggest that inflated responsibility and meta-cognitive beliefs may be particularly important cognitive concepts in OCD. Methodological limitations must be borne in mind and future research is needed to replicate and extend findings in clinical samples. Keywords: Obsessive compulsive disorder, adolescents, cognitive models.

Photoperiod sensitivity affects flowering duration in wheat

Flowering and successful pollination in wheat are key determinants of both quantity and quality of grain. Bread wheat line ‘Paragon’, introgressed with single or multiple day length insensitivity alleles was used to dissect the effects on the timing and duration of flowering within a hierarchical plant architecture. Flowering of wheat plants was observed in a series of pot-based and field experiments. Ppd-D1a was the most potent known allele affecting the timing of flowering, requiring the least thermal time to flowering across all experiments. The duration of flowering for individual lines was dominated by the shift in the start of flowering in later tillers and the number of tillers per plant, rather than variation in flowering duration of individual spikes. There was a strong relationship between flowering duration and the start of flowering with the earliest lines flowering for the longest. The greatest flowering overlap between tillers was recorded for the Ppd-1b. Across all lines, a warmer environment significantly reduced the duration of flowering and the influence of Ppd-1a alleles on the start of flowering. These findings provide evidence of pleiotropic effects of the Ppd-1a alleles, and have direct implications for breeding for increased stress resilient wheat varieties.

Patterns of hominin occupation and cultural diversity across the Gebel Akhdar of Northern Libya over the last ~200 kyr

Excavations at Haua Fteah cave in Cyrenaica, Libya, have revealed a cultural sequence that may span the last glacial–interglacial-glacial cycle. The TRANS-NAP project has been re-excavating Haua Fteah and conducting geoarchaeological survey of an ecologically diverse landscape that includes the fertile Gebel Akhdar and littoral, pre-desert, and desert biomes. A major aim of this project is to characterize cultural and environmental changes across the region and correlate the surface archaeology with that from Haua Fteah. To date, 181 sites have been recorded, ranging from the Middle Stone Age (MSA) to Late Stone Age (LSA). Their geographic distribution suggests temporal variation in patterns of hominin habitat preference, with significantly more LSA than MSA sites at higher elevations. The surface archaeology also points to substantial spatiotemporal technological variation within the MSA. These patterns may be explained by both paleoenvironmental change and paleodemographic shifts in the region, resulting in a variety of hominin adaptive responses.

Overcoming your child’s fears and worries: guided self-help manual for therapists working with groups

This manual for therapists accompanies ‘Overcoming your child’s fears and worries’ (Creswell & Willetts, 2007), a guide for parents to help their children overcome difficulties with anxiety

Overcoming your child’s fears and worries: guided parent delivered CBT treatment manual for therapists

This manual for therapists accompanies ‘Overcoming your child’s fears and worries’ (Creswell & Willetts, 2007), a guide for parents to help their children overcome difficulties with anxiety

Atmospheric versus vegetation controls of Amazonian tropical rain forest evapotranspiration: Are the wet and seasonally dry rain forests any different?

This study analyzes evapotranspiration data for three wet and two seasonally dry rain forest sites in Amazonia. The main environmental (net radiation, vapor pressure deficit, and aerodynamic conductance) and vegetation (surface conductance) controls of evapotranspiration are also assessed. Our research supports earlier studies that demonstrate that evapotranspiration in the dry season is higher than that in the wet season and that surface net radiation is the main controller of evapotranspiration in wet equatorial sites. However, our analyses also indicate that there are different factors controlling the seasonality of evapotranspiration in wet equatorial rain forest sites and southern seasonally dry rain forests. While the seasonality of evapotranspiration in wet equatorial forests is driven solely by environmental factors, in seasonally dry forests, it is also biotically controlled with the surface conductance varying between seasons by a factor of approximately 2. The identification of these different drivers of evapotranspiration is a major step forward in our understanding of the water dynamics of tropical forests and has significant implications for the future development of vegetation-atmosphere models and land use and conservation planning in the region.

Recurrent Deletion of ZNF630 at Xp11.23 Is Not Associated With Mental Retardation

ZNF630 is a member of the primate-specific Xp11 zinc finger gene cluster that consists of six closely related genes, of which ZNF41, ZNF81, and ZNF674 have been shown to be involved in mental retardation. This suggests that mutations of ZNF630 might influence cognitive function. Here, we detected 12 ZNF630 deletions in a total of 1,562 male patients with mental retardation from Brazil, USA, Australia, and Europe. The breakpoints were analyzed in 10 families, and in all cases they were located within two segmental duplications that share more than 99% sequence identity, indicating that the deletions resulted from non-allelic homologous recombination. In 2,121 healthy male controls, 10 ZNF630 deletions were identified. In total, there was a 1.6-fold higher frequency of this deletion in males with mental retardation as compared to controls, but this increase was not statistically significant (P-value = 0.174). Conversely, a 1.9-fold lower frequency of ZNF630 duplications was observed in patients, which was not significant either (P-value = 0.163). These data do not show that ZNF630 deletions or duplications are associated with mental retardation. (C) 2010 Wiley-Liss, Inc.

Transition metal atoms encapsulated in adamantane molecules

We performed a first principles total energy investigation on the structural, electronic, and magnetic properties of 3d-transition metal-encapsulated adamantane molecules (TM@C(10)H(16). with TM = Cr, Mn, Fe, Co, and Ni). We find that the C-C interactions are strong enough to maintain the molecular rigidity upon TM incorporation, although outward relaxations and formation energies are large. We built a microscopic model that explains the electronic structure of those molecules. (C) 2011 Elsevier B.V. All rights reserved.

Structural, Electronic, and Vibrational Properties of Amino-adamantane and Rimantadine Isomers

We performed a first principles total energy investigation on the structural, electronic, and vibrational propel ties of adamantane molecules, functionalized with amine and ethanamine groups. We computed the vibrational signatures of amantadine and rimanadine isomers with the functional groups bonded to clinic:ill carbon sites By comparing Out results with recent infrared and Raman spectroscopic data, we discuss the possible presence of different isomers in experimental samples.

Group IV Graphene- and Graphane-Like Nanosheets

We performed a first-principles investigation on the structural and electronic properties of group IV (C, SiC, Si, Ge, and Sn) graphene-like sheets in flat and buckled configurations and the respective hydrogenated or fluorinated graphane-like ones. The analysis on the energetics, associated with the formation of those structures, showed that fluorinated graphane-like sheets are very stable and should be easily synthesized in the laboratory. We also studied the changes of the properties of the graphene-like sheets as a result of hydrogenation or fluorination. The interatomic distances in those graphane-like sheets are consistent with the respective crystalline ones, a property that may facilitate integration of those sheets within three-dimensional nanodevices.

Crystal engineering using functionalized adamantane

We performed a first-principles investigation on the structural, electronic and optical properties of crystals made of chemically functionalized adamantane molecules. Several molecular building blocks, formed by boron and nitrogen substitutional functionalizations, were considered to build zinc blende and wurtzite crystals, and the resulting structures presented large bulk moduli and cohesive energies, wide and direct bandgaps, and low dielectric constants (low-kappa materials). Those properties provide stability for such structures up to room temperature, superior to those of typical molecular crystals. This indicates a possible road map for crystal engineering using functionalized diamondoids, with potential applications ranging from space filling between conducting wires in nanodevices to nano-electromechanical systems.

Boron and nitrogen functionalized diamondoids: A first principles investigation

Chemically functionalized adamantane molecules have been investigated by first principles total energy calculations. Boron and nitrogen functionalized molecules were found to be very stable, consistent with available experimental data. Two hypothetical molecular crystals, involving functionalized adamantane, were investigated. These molecular crystals presented direct electronic bandgaps and large bulk moduli, which suggested a possible road for molecular self-assembly using functionalized diamondoids. (C) 2010 Elsevier B.V. All rights reserved.

Trends on 3d transition metal impurities in diamond

We carried out a first principles investigation on the electronic properties and chemical trends of 3d transition metal related impurities in diamond. In terms of formation energy, the interstitial site is considerably more unfavorable than the substitutional or divacancy ones. Going from Ti to Ni, the 3d-related energy levels in the gap become deeper toward the valence band in all three sites. However, in the divacancy one, those levels cross with the divacancy-related ones, such that the electronic property of the center depends on the character of the highest occupied level. (C) 2009 Elsevier B.A. All rights reserved.