A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service

Objective: To evaluate CBTp delivered by non-expert therapists, using CBT relevant measures. Methods: Participants (N=74) were randomised into immediate therapy or waiting list control groups. The therapy group was offered six months of therapy and followed up three months later. The waiting list group received therapy after waiting nine months (becoming the delayed therapy group). Results: Depression improved in the combined therapy group at both the end of therapy and follow-up. Other significant effects were found in only one of the two therapy groups (positive symptoms; cognitive flexibility; uncontrollability of thoughts) or one of the two timepoints (end of therapy: PANSS general symptoms, anxiety, suicidal ideation, social functioning, resistance to voices; follow-up: power beliefs about voices, negative symptoms). There was no difference in costs between the groups. Conclusions: The only robust improvement was in depression. Nevertheless, there were further encouraging but modest improvements in both emotional and cognitive variables, in addition to psychotic symptoms.

The effects of mass loading the ossicles with a floating mass transducer on middle ear transfer function

Hypothesis: The aim of this study was to measure the mass loading effect of an active middle-ear implant (the Vibrant Soundbridge) in cadaver temporal bones. Background: Implantable middle ear hearing devices such as Vibrant Soundbridge have been used as an alternative to conventional hearing aids for the rehabilitation of sensorineural hearing loss. Other than the obvious disadvantage of requiring implantation middle ear surgery, it also applies a direct weight on the ossicular chain which, in turn, may have an impact on residual hearing. Previous studies have shown that applying a mass directly on the ossicular chain has a damping effect on its response to sound. However, little has been done to investigate the magnitude and the frequency characteristics of the mass loading effect in devices such as the Vibrant Soundbridge. Methods: Five fresh cadaver temporal bones were used. The stapes displacement was measured using laser Doppler vibrometry before and after the placement of a Vibrant Sound-bridge floating mass transducer. The effects of mass and attachment site were compared with the unloaded response. Measurements were obtained at frequencies between 0.1 and 10 kHz and at acoustic input levels of 100 dB sound pressure level. Each temporal bone acted as its own control. Results: Placement of the floating mass transducer caused a reduction of the stapes displacement. There were variations between the bones. The change of the stapes displacement varied from 0 dB to 28 dB. The effect was more prominent at frequencies above 1,000 Hz. Placing the floating mass transducer close to the incudostapedial joint reduced the mass loading effect. Conclusion: The floating mass transducer produces a measurable reduction of the stapes displacement in the temporal bone model. The effect is more prominent at high frequencies.

Scanning LDV for vibration measurement of filiform hairs in crickets in response to induced airflow - art. no. 63450E

Cercal hairs represent in cricket a wind sensitive escape system, able to detect the airflow generated from predating species. These sensors have been studied as a biomimetic concept to allow the development of MEMS for biomedical use. In particular, the behaviour of the hairs, including airflow response, resonant frequency and damping, has been investigated up to a frequency of 20 kHz. The microscopic nature of the hairs, the complex vibrations of excited hairs and the high damping of the system suggested that the use of Laser Doppler vibrometry could possibly improve the test performance. Two types of tests were performed: in the first case the hairs were indirectly excited using the signal obtained from a vibrating aluminium plate, whilst in the second case the hairs were directly excited using a white noise chirp. The results from the first experiment indicated that the hairs move in-phase with the exciting signal up to frequencies in the order of 10 kHz, responding to the vibration modes of the plate with a signal attenuation of 12 to 20 dB. The chirp experiment revealed the presence of rotational resonant modes at 6850 and 11300 Hz. No clear effect of hair length was perceivable on the vibration response of the filiform sensors. The obtained results proved promising to support the mechanical and vibration characterisation of the hairs and suggest that scanning Laser vibrometry can be used extensively on highly dampened biological materials.

Strategies and biases in location memory in Williams syndrome

Individuals with Williams syndrome (WS) demonstrate impaired visuo-spatial abilities in comparison to their level of verbal ability. In particular, visuo-spatial construction is an area of relative weakness. It has been hypothesised that poor or atypical location coding abilities contribute strongly to the impaired abilities observed on construction and drawing tasks [Farran, E. K., & Jarrold, C. (2005). Evidence for unusual spatial location coding in Williams syndrome: An explanation for the local bias in visuo-spatial construction tasks? Brain and Cognition, 59, 159-172; Hoffman, J. E., Landau, B., & Pagani, B. (2003). Spatial breakdown in spatial construction: Evidence from eye fixations in children with Williams syndrome. Cognitive Psychology, 46, 260-301]. The current experiment investigated location memory in WS. Specifically, the precision of remembered locations was measured as well as the biases and strategies that were involved in remembering those locations. A developmental trajectory approach was employed; WS performance was assessed relative to the performance of typically developing (TD) children ranging from 4- to 8-year-old. Results showed differential strategy use in the WS and TD groups. WS performance was most similar to the level of a TD 4-year-old and was additionally impaired by the addition of physical category boundaries. Despite their low level of ability, the WS group produced a pattern of biases in performance which pointed towards evidence of a subdivision effect, as observed in TD older children and adults. In contrast, the TD children showed a different pattern of biases, which appears to be explained by a normalisation strategy. In summary, individuals with WS do not process locations in a typical manner. This may have a negative impact on their visuo-spatial construction and drawing abilities. (c) 2007 Elsevier Ltd. All rights reserved.

Upper limb tremor suppression in ADL via an orthosis incorporating a controllable double viscous beam actuator

Neuromuscular disorders affect millions of people world-wide. Upper limb tremor is a common symptom, and due to its complex aetiology it is difficult to compensate for except, in particular cases by surgical intervention or drug therapy. Wearable devices that mechanically compensate for limb tremor could benefit a considerable number of patients, but the technology to assist suffers in this way is under-developed. In this paper we propose an innovative orthosis that can dynamically suppress pathological tremor, by applying viscous damping to the affected limb in a controlled manner. The orthosis design utilises a new actuator design based on Magneto-Rheological Fluids that efficiently deliver damping action in response to the instantaneous tremor frequency and amplitude.

Clinical potential and design of programmable mechanical impedances for orthotic applications

A person with a moderate or severe motor disability will often use specialised or adapted tools to assist their interaction with a general environment. Such tools can assist with the movement of a person's arms so as to facilitate manipulation, can provide postural supports, or interface to computers, wheelchairs or similar assistive technologies. Designing such devices with programmable stiffness and damping may offer a better means for the person to have effective control of their surroundings. This paper addresses the possibility of designing some assistive technologies using impedance elements that can adapt to the user and the circumstances. Two impedance elements are proposed. The first, based on magnetic particle brakes, allows control of the damping coefficient in a passive element. The second, based on detuning the P-D controller in a servo-motor mechanism, allows control of both stiffness and damping. Such a mechanical impedance can be modulated to the conditions imposed by the task in hand. The limits of linear theory are explored and possible uses of programmable impedance elements are proposed.

Robots with a gentle touch: advances in assistive robotics and prosthetics

As healthcare costs rise and an aging population makes an increased demand on services, so new techniques must be introduced to promote an individuals independence and provide these services. Robots can now be designed so they can alter their dynamic properties changing from stiff to flaccid, or from giving no resistance to movement, to damping any large and sudden movements. This has some strong implications in health care in particular for rehabilitation where a robot must work in conjunction with an individual, and might guiding or assist a persons arm movements, or might be commanded to perform some set of autonomous actions. This paper presents the state-of-the-art of rehabilitation robots with examples from prosthetics, aids for daily living and physiotherapy. In all these situations there is the potential for the interaction to be non-passive with a resulting potential for the human/machine/environment combination to become unstable. To understand this instability we must develop better models of the human motor system and fit these models with realistic parameters. This paper concludes with a discussion of this problem and overviews some human models that can be used to facilitate the design of the human/machine interfaces.

Calibration of closed loop controllers for setting impedances in force-reflecting systems

This paper discusses a new method of impedance control that has been successfully implemented on the master robot of a teleoperation system. The method involves calibrating the robot to quantify the effect of adjustable controller parameters on the impedances along its different axes. The empirical equations relating end-effector impedance to the controller's feedback gains are obtained by performing system identification tests along individual axes of the robot. With these equations, online control of end-effector stiffness and damping is possible without having to monitor joint torques or solving complex algorithms. Hard contact conditions and compliant interfaces have been effectively demonstrated on a telemanipulation test-bed using appropriate combinations of stiffness and damping settings obtained by this method.

The effects of the RAW filter on the climatology and forecast skill of the SPEEDY model

In a recent study, Williams introduced a simple modification to the widely used Robert–Asselin (RA) filter for numerical integration. The main purpose of the Robert–Asselin–Williams (RAW) filter is to avoid the undesired numerical damping of the RA filter and to increase the accuracy. In the present paper, the effects of the modification are comprehensively evaluated in the Simplified Parameterizations, Primitive Equation Dynamics (SPEEDY) atmospheric general circulation model. First, the authors search for significant changes in the monthly climatology due to the introduction of the new filter. After testing both at the local level and at the field level, no significant changes are found, which is advantageous in the sense that the new scheme does not require a retuning of the parameterized model physics. Second, the authors examine whether the new filter improves the skill of short- and medium-term forecasts. January 1982 data from the NCEP–NCAR reanalysis are used to evaluate the forecast skill. Improvements are found in all the model variables (except the relative humidity, which is hardly changed). The improvements increase with lead time and are especially evident in medium-range forecasts (96–144 h). For example, in tropical surface pressure predictions, 5-day forecasts made using the RAW filter have approximately the same skill as 4-day forecasts made using the RA filter. The results of this work are encouraging for the implementation of the RAW filter in other models currently using the RA filter.

Assimilation impacts on Arctic Ocean circulation, heat and freshwater

We investigate the Arctic basin circulation, freshwater content (FWC) and heat budget by using a high-resolution global coupled ice–ocean model implemented with a state-of-the-art data assimilation scheme. We demonstrate that, despite a very sparse dataset, by assimilating hydrographic data in and near the Arctic basin, the initial warm bias and drift in the control run is successfully corrected, reproducing a much more realistic vertical and horizontal structure to the cyclonic boundary current carrying the Atlantic Water (AW) along the Siberian shelves in the reanalysis run. The Beaufort Gyre structure and FWC and variability are also more accurately reproduced. Small but important changes in the strait exchange flows are found which lead to more balanced budgets in the reanalysis run. Assimilation fluxes dominate the basin budgets over the first 10 years (P1: 1987–1996) of the reanalysis for both heat and FWC, after which the drifting Arctic upper water properties have been restored to realistic values. For the later period (P2: 1997–2004), the Arctic heat budget is almost balanced without assimilation contributions, while the freshwater budget shows reduced assimilation contributions compensating largely for surface salinity damping, which was extremely strong in this run. A downward trend in freshwater export at the Canadian Straits and Fram Strait is found in period P2, associated with Beaufort Gyre recharge. A detailed comparison with observations and previous model studies at the individual Arctic straits is also included.

How well do coupled models replicate ocean energetics relevant to ENSO?

Accurate replication of the processes associated with the energetics of the tropical ocean is necessary if coupled GCMs are to simulate the physics of ENSO correctly, including the transfer of energy from the winds to the ocean thermocline and energy dissipation during the ENSO cycle. Here, we analyze ocean energetics in coupled GCMs in terms of two integral parameters describing net energy loss in the system using the approach recently proposed by Brown and Fedorov (J Clim 23:1563–1580, 2010a) and Fedorov (J Clim 20:1108–1117, 2007). These parameters are (1) the efficiency c of the conversion of wind power into the buoyancy power that controls the rate of change of the available potential energy (APE) in the ocean and (2) the e-folding rate a that characterizes the damping of APE by turbulent diffusion and other processes. Estimating these two parameters for coupled models reveals potential deficiencies (and large differences) in how state-of-the-art coupled GCMs reproduce the ocean energetics as compared to ocean-only models and data assimilating models. The majority of the coupled models we analyzed show a lower efficiency (values of c in the range of 10–50% versus 50–60% for ocean-only simulations or reanalysis) and a relatively strong energy damping (values of a-1 in the range 0.4–1 years versus 0.9–1.2 years). These differences in the model energetics appear to reflect differences in the simulated thermal structure of the tropical ocean, the structure of ocean equatorial currents, and deficiencies in the way coupled models simulate ENSO.

The Aqua-Planet Experiment (APE): CONTROL SST Simulation

Climate simulations by 16 atmospheric general circulation models (AGCMs) are compared on an aqua-planet, a water-covered Earth with prescribed sea surface temperature varying only in latitude. The idealised configuration is designed to expose differences in the circulation simulated by different models. Basic features of the aqua-planet climate are characterised by comparison with Earth. The models display a wide range of behaviour. The balanced component of the tropospheric mean flow, and mid-latitude eddy covariances subject to budget constraints, vary relatively little among the models. In contrast, differences in damping in the dynamical core strongly influence transient eddy amplitudes. Historical uncertainty in modelled lower stratospheric temperatures persists in APE. Aspects of the circulation generated more directly by interactions between the resolved fluid dynamics and parameterized moist processes vary greatly. The tropical Hadley circulation forms either a single or double inter-tropical convergence zone (ITCZ) at the equator, with large variations in mean precipitation. The equatorial wave spectrum shows a wide range of precipitation intensity and propagation characteristics. Kelvin mode-like eastward propagation with remarkably constant phase speed dominates in most models. Westward propagation, less dispersive than the equatorial Rossby modes, dominates in a few models or occurs within an eastward propagating envelope in others. The mean structure of the ITCZ is related to precipitation variability, consistent with previous studies. The aqua-planet global energy balance is unknown but the models produce a surprisingly large range of top of atmosphere global net flux, dominated by differences in shortwave reflection by clouds. A number of newly developed models, not optimised for Earth climate, contribute to this. Possible reasons for differences in the optimised models are discussed. The aqua-planet configuration is intended as one component of an experimental hierarchy used to evaluate AGCMs. This comparison does suggest that the range of model behaviour could be better understood and reduced in conjunction with Earth climate simulations. Controlled experimentation is required to explore individual model behaviour and investigate convergence of the aqua-planet climate with increasing resolution.

The role of atmosphere feedbacks during ENSO in the CMIP3 models. Part III: the shortwave flux feedback

Previous studies using coupled general circulation models (GCMs) suggest that the atmosphere model plays a dominant role in the modeled El Nin ̃ o–Southern Oscillation (ENSO), and that intermodel differences in the thermodynamical damping of sea surface temperatures (SSTs) are a dominant contributor to the ENSO amplitude diversity. This study presents a detailed analysis of the shortwave flux feedback (aSW) in 12 Coupled Model Intercomparison Project phase 3 (CMIP3) simulations, motivated by findings that aSW is the primary contributor to model thermodynamical damping errors. A ‘‘feedback decomposition method,’’ developed to elucidate the aSW biases, shows that all models un- derestimate the dynamical atmospheric response to SSTs in the eastern equatorial Pacific, leading to un- derestimated aSW values. Biases in the cloud response to dynamics and the shortwave interception by clouds also contribute to errors in aSW. Changes in the aSW feedback between the coupled and corresponding atmosphere-only simulations are related to changes in the mean dynamics. A large nonlinearity is found in the observed and modeled SW flux feedback, hidden when linearly cal- culating aSW. In the observations, two physical mechanisms are proposed to explain this nonlinearity: 1) a weaker subsidence response to cold SST anomalies than the ascent response to warm SST anomalies and 2) a nonlinear high-level cloud cover response to SST. The shortwave flux feedback nonlinearity tends to be underestimated by the models, linked to an underestimated nonlinearity in the dynamical response to SST. The process-based methodology presented in this study may help to correct model ENSO atmospheric biases, ultimately leading to an improved simulation of ENSO in GCMs.