Internet-delivered cognitive behaviour therapy for chronic health conditions: self-guided versus team-guided.

There is growing interest in offering Internet-delivered cognitive behaviour therapy (ICBT) to individuals with chronic health conditions, with this process often being guided by a single clinician. Due to lack of full time personnel, it is sometimes necessary to have multiple clinicians offer guidance or for no guidance to be offered. In this randomized trial, we compared team-guided ICBT (n = 90) to self-guided ICBT (n = 88). Participants completed measures at pre-, post-, and 3-months post-ICBT. Both groups showed similar rates of treatment completion and large improvements on depression and anxiety at post-treatment and follow-up. Unexpectedly, more participants in the self-guided versus team-guided condition showed clinically significant improvement on depression at post-treatment (76.5% vs 49.2%) and follow-up (70% vs 45.6%). Thus, team-guided ICBT may not provide significant benefits compared to self-guided ICBT. However, it may be an alternative approach to consider among a population of high risk individuals that wants or requires closer monitoring of symptoms.Trail registration TRN: NCT03500237; Date: April 18, 2018.

Induction of DNA double-strand breaks by monochlorophenol isomers and ChKM in human gingival fibroblasts.

Phenol has been traditionally used in dental treatment as a sedative for the pulp or as disinfectant for carious cavity and root canal. However, phenol is regarded as a mutagenic and carcinogenic agent and its use in dental practice is now therefore restricted. Monochlorophenols are derivatives of phenol, which are still used clinically as root canal disinfectants, they are even more active antiseptics/disinfectants than phenol, and the so-called Walkhoff (ChKM) solution makes use of monochlorophenol for root canal disinfection. Ingredients in the ChKM solution are the monochlorophenol compound 4-chlorophenol (4-CP), camphor, and menthol. In literature, the use of the ChKM solution is controversial because of a possible DNA toxicity of the ingredient 4-CP. However, it is unknown whether ChKM can really induce DNA damage in human oral cells. In this study, the induction of DNA double-strand breaks (DSBs) by ChKM and monochlorophenol compounds (2-chlorophenol, 2-CP; 3-chlorophenol, 3-CP; and 4-chlorophenol, 4-CP) was tested in human gingival fibroblasts (HGFs). DNA DSBs (foci) induced in HGFs unexposed and exposed to monochlorophenols or ChKM solution were investigated using the γ-H2AX DNA focus assay, which is a direct marker for DSBs. DSBs result in the ATM-dependent phosphorylation of the histone H2AX. When cells were exposed to medium or medium + DMSO (1 %) (negative controls), an average of 3 foci per cell were found. In positive control cells (H2O2 + medium, or H2O2 + medium + DMSO (1 %), an average of 35 foci each were found. About 20 DSB foci per cell were found, when HGFs were exposed to 2-CP (4 mM), 3-CP (2.3 mM), 4-CP (2.1 mM), or ChKM (corresponding to 1.5 mM 4-CP). Our results show increasing DNA toxicities in the order of 2-CP < 3-CP < 4-CP < ChKM solution. An additive DNA toxicity was found for 4-CP in combination with camphor in the ChKM solution, compared to the 4-CP alone. No significant differences regarding multi-foci cells (cells that contain more than 40 foci) were found when HGFs were exposed to the EC50 concentrations (given in parenthesis) of ChKM (1.5 mM), 4-CP (2.1 mM), or 2-CP (4 mM). Significantly fewer multi-foci cells were found when HGFs were exposed to the EC50 concentration (given in parenthesis) of 3-CP (2.3 mM), compared to the EC50 concentrations of ChKM, 4-CP, or 2-CP. Monochlorophenol compounds and/or ChKM solution can induce DSBs in primary human oral (cavity) cells, which underscores their genotoxic capacity.

A randomized factorial trial of internet-delivered cognitive behavioural therapy: An 8-week program with or without extended support and booster lesson.

While internet-delivered cognitive behavioural therapy (ICBT) is effective, some patients suggest extended support post-treatment could improve care. In this randomized factorial trial, we examined the benefits of an 8-week therapist-assisted ICBT program offered with or without an optional 4-week extension of support (Factor 1) and with or without an optional booster lesson (Factor 2). Patients screened for ICBT for depression and/or anxiety were randomly assigned to the conditions (N = 434) and we examined the use of the extension and booster, differences between those who did or did not use extension or booster, and the impact of the extension or booster on outcomes, engagement, and satisfaction at 26-weeks post-enrollment. Therapists recorded time and observations with offering support during the extension and booster. In the extension group, 54.4% (n = 56) requested the extension, while in the booster group 50.9% (n = 56) accessed the booster, and in the combined group, 41.6% (n = 47) requested the extension and 51.3% (n = 58) accessed the booster. Those who requested the extension were older, and more likely to report medication and mental health service use and severe mental health-related disability at pre-treatment; they also reported putting less effort into ICBT and finding skills more difficult. The booster was more often used among those with lower symptom severity, and those who put more effort into and had more positive experiences with ICBT. As expected, those assigned to extension sent more messages to their therapist, and those assigned to booster logged in more often. Therapists also took more time to deliver ICBT with an extension (>18 min) or booster (>13 min) compared to the 8-week program, and perceived extension and booster as beneficial for some, but not all patients. Treatment satisfaction was high across conditions, and effect sizes were large from pre-treatment to 26-week follow-up on most measures. No significant group differences were found in this study. Lack of group differences, however, could reflect low use of the extension and booster. Results provide helpful information about the demand for extensions and boosters, and provide directions for future research.

A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support.

With the growing demand for internet-delivered cognitive behavioural therapy (iCBT), this pragmatic factorial (2 × 2 × 2) randomized controlled trial evaluated strategies for facilitating iCBT engagement and outcomes in routine care. Specifically, the benefits to patients and therapists of using homework reflection questionnaires and offering patients twice-weekly therapist support were examined. Patients (n = 632) accepted into iCBT for depression and/or anxiety were randomly assigned to complete homework reflection questionnaires or not (factor 1), receive once- or twice-weekly support (factor 2), and to receive care from therapists employed in one of two settings (iCBT clinic or a community mental health clinic; factor 3). Outcomes were measured at pre-treatment, and 8, 12, and 24-weeks post-enrollment. Therapist time was tracked and a focus group was conducted to examine therapist experiences. No differences in patient outcomes were found between therapists employed in the two settings; as such, these two groups were combined for further analyses. In terms of engagement, homework reflection questionnaires were associated with fewer website log-ins and days accessing iCBT; twice-weekly support was associated with more patient emails sent to therapists. Despite engagement differences, homework reflection questionnaires and twice-weekly support did not significantly impact primary outcomes; all groups showed large improvements in depression and anxiety that were maintained at 24-week follow-up. Therapists perceived a number of benefits and challenges associated with responding to homework reflection questionnaires and offering twice-weekly support; most notably the strategies did not benefit all patients. Twice-weekly support was associated with increased therapist time and organizational challenges. It is concluded that neither completion of homework questionnaires nor offering twice-weekly support significantly improve iCBT in routine care.

Androgen control of territorial marking in the Mongolian gerbil.

Gerbils mark objects with the secretion of a midventral sebaceous gland. Both the behavior and the gland integrity are under androgen control, as indicated by castration and replacement with testosterone propionate. The integrity of the gland seems less important for marking than an influence on the central nervous system, although the gland can be used as an external measure of androgen levels. It is possible that the secretion acts as a pheromone to signal territorial possession.

Identification of a ventral scent marking pheromone in the male Mongolian gerbil (Meriones unguiculatus).

Sebum from the ventral scent marking gland of the male Mongolian gerbil was fractionated and tested for its ability to elicit behavioral response in a conditioning task and in a stimulus preference situation. The active fraction was identified as phenylacetic acid; both it and a synthetic sample elicited the same behavioral response. Phenylacetic acid appears to be a major pheromone of the male Mongolian gerbil.

Haloperidol and clonidine increase, and apomorphine decreases ultrasonic vocalizations by gerbils.

Ten psychotropic drugs that have putative effects on central brain neurotransmitters were assessed for influences on ultrasonic signaling relative to general activity in male Mongolian gerbils. Haloperidol (1 mg/kg IP), a dopamine antagonist, and clonidine (0.1 mg/kg IP), a norepinephrine agonist, increased ultrasonic signaling, and apomorphine (5 mg/kg IP), a dopamine agonist, decreased ultrasonic signaling. Catecholamines may modulate ultrasonic signaling in the gerbil. Body temperature changes were positively with ultrasonic emission in tests after saline, haloperidol, apomorphine, and 5-hydroxytryptophan (30 mg/kg IP).

Body temperature and grooming in the Mongolian gerbil.

The Mongolian gerbil, Meriones unguiculatus, like many other rodents, releases a complex mixture of pigments and lipids from the Harderian gland during a self-groom. The material exits from the external nares of the nose, is mixed with saliva, and spread widely over the pelage. Cold temperatures, especially, are effective in initiating grooming. A self-groom is associated with an increase in body temperature (compensatory thermogenesis in the cold). In addition to acting as a chemosignal, the Harderian material serves two major homeostatic functions: (1) the lipids on the pelage act to insulate the animal against cold and wetness, and (2) the lipids and pigments darken the pelage and increase radiant absorption. Body temperature is thus maintained at a higher level than would otherwise be the case. The amount of Harderian material found on the pelage varies with Harderianectomy, sandbathing, and ambient temperatures. Animals prevented from sandbathing accumulate excess lipids on the pelage, and cold temperatures facilitate the acquisition of lipids on the pelage. Under hot temperatures the grooming of Harderian substances is repressed and the frequency of sandbathing is increased. Thus pelage lipids are reduced in two ways. The amount of Harderian material released during an autogroom is inversely related to the ambient temperature, whereas the amount of saliva used for evaporative cooling is positively related to ambient temperature. The net effect is that pelage lipids are increased and maintained during cold conditions, and are reduced during hot conditions. In hot environments the gerbil switches from the spread of Harderian material for insulation to the spread of saliva for evaporative cooling. The gerbil optimizes its body temperature by varying the frequency of grooming and sandbathing, and by altering the amount of Harderian material and saliva released. Other species living in arid environments may use similar mechanisms to stabilize body temperature. Self-grooming is a critical behavior for meeting thermal needs, and is complexly integrated with related processes.

Computer-controlled cardiopulmonary bypass increases jugular venous oxygen saturation during rewarming.

BACKGROUND: Conventional roller pump apulsatile cardiopulmonary bypass (CPB) was compared with computer-controlled pulsatile bypass, which was designed to recreate biological variability (return of beat-to-beat variability in rate and pressure with superimposed respiratory rhythms). The degree of jugular venous oxygen saturation (SjvO2) less than 50% during rewarming from hypothermic CPB was compared for the two bypass techniques. An SjvO2 less than 50% during rewarming from hypothermic CPB is correlated with cognitive dysfunction in humans. METHODS: Pigs were placed on CPB for 3 hours using a membrane oxygenator with alpha-stat acid-base management and arterial filtration. After baseline measurements and normothermic CPB, the animals were randomized to apulsatile CPB (n = 12) or computer-controlled pulsatile CPB (roller pump speed adjusted by an average of 2.9 voltage output modulations/s; n = 12). The animals were then cooled to a nasopharyngeal temperature of 28 degrees C. During rewarming to stable normothermic temperatures, SjvO2 was measured at 5-minute intervals. The mean and cumulative areas for an SjvO2 less than 50% were determined for all animals. RESULTS: No between-group differences in temperature were noted during hypothermic CPB or during rewarming. The rate of rewarming was not different between groups. Mean arterial pressure, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood also did not differ between groups. The hemoglobin concentration was within 0.4 g/dL between groups at all time periods. Mean pulse pressure was 10.0 +/- 4.8 mm Hg in the apulsatile CPB group and 20.7 +/- 5.2 mm Hg in the pulsatile CPB group (p = 0.0002; unpaired t test). Markedly greater mean and cumulative areas under the curve for SjvO2 less than 50% were seen with apulsatile CPB (164 +/- 209 versus 1.9 +/- 3.6% x min, p = 0.021; and 1,796 +/- 2,263 versus 23 +/- 45% x min, p = 0.020, respectively). CONCLUSIONS: Computer-controlled pulsatile CPB was associated with significantly greater SjvO2 during rewarming from hypothermic CPB. Both the mean and cumulative areas under the curve for SjvO2 less than 50% exceeded a ratio of 75:1 for apulsatile versus computer-controlled pulsatile CPB. These experiments suggest that cerebral oxygenation was better preserved during rewarming from moderate hypothermia with computer-controlled pulsatile CPB, which returned biologic variability to the flow pattern.

Cerebral hypoxia during cardiopulmonary bypass: a magnetic resonance imaging study.

BACKGROUND: Neurocognitive deficits after open heart operations have been correlated to jugular venous oxygen desaturation on rewarming from hypothermic cardiopulmonary bypass (CPB). Using a porcine model, we looked for evidence of cerebral hypoxia by magnetic resonance imaging during CPB. Brain oxygenation was assessed by T2*-weighted imaging, based on the blood oxygenation level-dependent effect (decreased T2*-weighted signal intensity with increased tissue concentrations of deoxyhemoglobin). METHODS: Pigs were placed on normothermic CPB, then cooled to 28 degrees C for 2 hours of hypothermic CPB, then rewarmed to baseline temperature. T2*-weighted, imaging was undertaken before CPB, during normothermic CPB, at 30-minute intervals during hypothermic CPB, after rewarming, and then 15 minutes after death. Imaging was with a Bruker 7.0 Tesla, 40-cm bore magnetic resonance scanner with actively shielded gradient coils. Regions of interest from the magnetic resonance images were analyzed to identify parenchymal hypoxia and correlated with jugular venous oxygen saturation. Post-hoc fuzzy clustering analysis was used to examine spatially distributed regions of interest whose pixels followed similar time courses. Attention was paid to pixels showing decreased T2* signal intensity over time. RESULTS: T2* signal intensity decreased with rewarming and in five of seven experiments correlated with the decrease in jugular venous oxygen saturation. T2* imaging with fuzzy clustering analysis revealed two diffusely distributed pixel groups during CPB. One large group of pixels (50% +/- 13% of total pixel count) showed increased T2* signal intensity (well-oxygenated tissue) during hypothermia, with decreased intensity on rewarming. Changes in a second group of pixels (34% +/- 8% of total pixel count) showed a progressive decrease in T2* signal intensity, independent of temperature, suggestive of increased brain hypoxia during CPB. CONCLUSIONS: Decreased T2* signal intensity in a diffuse spatial distribution indicates that a large proportion of cerebral parenchyma is hypoxic (evidenced by an increased proportion of tissue deoxyhemoglobin) during CPB in this porcine model. Neuronal damage secondary to parenchymal hypoxia may explain the postoperative neuropsychological dysfunction after cardiac operations.

Vitamin E and sex behavior in mice.

C57BL/6J male mice responded to dietary deficiency of vitamin E with reduction in spermatogenesis. Sex behavior and seminal vesicle weight were unaffected. Supplements of alphabeta-tocopherol (vitamin E) at 0.33 or 72 IU per day maintained spermatogenesis but did not affect seminal vesicles or sex behavior.

The effects of odors from stressed mice on conspecific behavior.

Four experiments correlate conspecific reactions to odors from stressed (foot shocked) BALB/cJ mice with the frequency of specific motor activities and taste avoidance. Where behavior was restricted to forward and backward movement in a tube, animals tended to avoid the side where the odors from stressed animals entered. In a more socially complex home cage (3 recipients) a wide variety of behaviors were affected by odors from stressed conspecifics. Animals were alerted by the odor, searched out the source of the odor and showed increases in general activity, rearing, and air sampling. Many of these behaviors habituated with continuous exposure. The major response to odors from stressed animals was to increase "vigilance." A restriction of behavioral opportunities will lead to odor avoidance; however, when the environment permits, the behavioral reaction to odors becomes more complex. These odors failed to produce conditioned taste aversion, suggesting a sensory specificity in the use of these odors.

Lipopolysaccharide increases ambient temperature preference in C57BL/6J adult mice.

The hypothesis was tested that animals exposed to a potentially dangerous endotoxin would attempt to behaviorally elevate their body temperature, perhaps in an effort to engage those immunological mechanisms which would counter the adverse effects of the endotoxin. Lipopolysaccharide (LPS) from Escherichia coli injected subcutaneously (100 micrograms) in adult C57BL/6J mice increased gradient temperature preference by 2.4 degrees C over saline controls. The increase in body temperature of 1.1 degrees C after LPS injection was due to the preference for higher ambient temperatures and was not the result of a systemic reaction to LPS (animals not exposed to the gradient did not differ in body temperature). In summary, our data indicate that adult mice self-induce a febrile response, perhaps as an attempt to compensate for the physiological impact of the endotoxin.

Removal of Harderian exudates by sandbathing contributes to osmotic balance in Mongolian gerbils.

Whittow [18] has inquired whether any animal can limit insensible perspiration through the integument. Sandbathing by the Mongolian gerbil may be a behavioral mechanism to such effect. Ordinarily, Harderian exudates from the external nares of the nose are spread over the pelage by autogrooming and are removed by sandbathing. Several experiments were designed to explore the hypothesis that removal of Harderian materials from the pelage by sandbathing aids osmoregulation through lowering rate of insensible perspiration. An initial experiment showed body weight losses during water deprivation were greater in intact than in Harderianectomized (Hx) gerbils when neither group could sandbathe, but were equivalent when sandbathing was allowed. Subsequent work indicated that variation in relative humidity was associated with magnitude of the difference in weight loss during water deprivation between intact and Hx gerbils, while change in the ambient temperature was not. Checks on these findings showed (1) that nonthirsty intact and Hx gerbils do not differ in amount of internal water and (2) that grooming water losses probably are equivalent in intact and Hx gerbils.

Scent of gerbil cuisine.

Preweanling and postweaning offspring of gerbil parents fed Purina Laboratory Chow or Pooch dog food show selective preference for odors coming from other animals of these same diets. Odors with differential quality include whole animal, cage material and ventral scent gland sebum. Apparently diet alters chemosignals, even those from a specialized scent gland. Species-specific pheromones may be dependent on ingested foodstuffs or other ecological chemicals.

Washing, drying, and anointing in adult humans (Homo sapiens): commonalities with grooming sequences in rodents.

Very few behavioral patterns generalize across human and nonhuman species. We describe washing, drying, and anointing sequences in humans (Homo sapiens) that may have analogies with other species. The rank ordering of washing, drying, and anointing body parts was obtained over 3 successive days for 37 men and 60 women. Variation in rank ordering of body parts was nonrandom, and a cephalocaudal progression was evident for each behavior. Reliability of the behaviors as well as the correlations across rankings were highly significant, which indicates a generalized cephalocaudal progression for all 3 behaviors. Women's anointing was most variable, which suggests a more specific function. The cephalocaudal action pattern described for humans is similar to that for Mongolian gerbils and laboratory rats. Cross-species functions, such as these, may add to our understanding of common developmental and learning processes.

Harderian gland exudates in the male Meriones unguiculatus regulate female proceptive behavior, aggression, and investigation.

Harderian gland secretions exit from the nose of Meriones unguiculatus during an autogroom (Thiessen, 1977). The exudates act as an attractant pheromone and as a thermoregulatory barrier when spread throughout the pelage. A recent study demonstrated that Harderian exudates in the male guide proceptive behavior in the female (Harriman & Thiessen, 1985). The present study replicated this finding by showing that estrous females direct fewer proceptive acts toward males lacking Harderian glands. In addition, it was found that females are more defensively aggressive toward Harderianectomized males and prefer to spend more time in the vicinity of intact males. It is speculated that Harderian spread allows the female to assess the reproductive competence of the male.

Ventral scent marking in Meriones unguiculatus may contribute to thermoregulation.

Three experiments were conducted with adult male Meriones unguiculatus in an attempt to demonstrate that ventral scent marking can act to transfer body heat to the object marked. Experiment 1 showed that surgical removal of the ventral gland pad reduced the amount of heat transferred by 50%, even though intact and glandless animals did not differ in the average frequency of scent marking. Experiment 2 demonstrated that the difference in heat transfer due to the presence or absence of the scent pad was not due to differential pressure applied to the substrate during marking. Experiment 3 showed that the pattern of ventral hair spread that occurs as an animal moves over an object is different between intact and glandless animals but that this difference does not account for the difference in heat transfer. It is suggested that heat transfer to the environment with ventral scent marking may increase thermoregulatory competence and also may function to volatilize sebum used in chemocommunication.

Development and expression of autogrooming in the Mongolian gerbil, Meriones unguiculatus.

Adult gerbils, Meriones unguiculatus, autogroom their body parts in the order: mouth--nose, face, ears, flank, ventrum, and tail. This is the identical order in which the autogroom matures during the first 33 days of life. The parallel sequencing increases our understanding of neurophysiological processes underlying movement patterns and also indicates how movement patterns evolve.

Environmental tracking by females : Sexual lability.

Human females are generally reserved in their sexuality, in keeping with their heavy investment in reproduction. Males tend to be less reserved. Relative to males, however, females demonstrate more variability in sexuality and are more likely to inhibit or express high levels of sexuality. The heightened variability may in part originate with genetic mechanisms that predispose females toward greater variability (the Lyon hypothesis). Menarche, menstrual cycles, menopause, food reactions, responses to living conditions, reactions to cultural factors, and responses to sexual stimuli and potential mates are unique to or are more variable among females than males. There is a correlation between the variation expressed and female reproductive potential-females tend to shift dramatically from sexual inhibition to sexual expression. Females apparently track the quality of the environment and link their sexuality to reproductive opportunities. Successful male reproduction depends less on quality environments and more on the availability of females. In short, females track the environment; males track the females.