COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder.

BACKGROUND: The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated. AIM: This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year. METHOD: 1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment. RESULTS: During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65-0.68) and depression symptom severity (g = 0.56-0.65), medium to large reductions in psychological distress (g = 0.77-0.83) and small reductions in disability (g = 0.35-.50). CONCLUSION: Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.

A randomized trial assessing the impact of three different glycoprotein IIb/IIIa antagonists on glycoprotein IIb/IIIa platelet receptor inhibition and clinical endpoints in patients with acute coronary syndromes.

AIMS: To compare three glycoprotein IIb/IIIa receptor antagonists (GPIs) in terms of platelet inhibition and major adverse cardiac events (MACEs), and assess the rate of bleeding and MACEs between GPIs and coadministered P2Y12 agents. METHODS: Eighty-three acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with planned GPI use were randomized to receive high-dose bolus tirofiban, double-bolus eptifibatide, or abciximab followed by a 12-hour infusion. Glycoprotein IIb/IIIa platelet receptor inhibition was measured at baseline and at 10 minutes, 1 hour, and 24 hours postbolus dose. Major adverse cardiac events and bleeding complications at 30 days were documented. The incidence of MACEs and bleeding in patients receiving ticagrelor or prasugrel were compared to those given clopidogrel. RESULTS: There were no statistically significant differences in platelet inhibition between GPIs at 10 minutes (P=.085) and 1 hour (P=.337). At 24 hours, abciximab achieved statistically significantly higher median [interquartile range] platelet inhibition (75 [65-88]%) compared to tirofiban (28 [3-56]%; P<.0001) and eptifibatide (44 [31-63]%; P=.007). There were no differences in bleeding or MACEs depending on GPI or P2Y12 inhibitor administered. CONCLUSIONS: Glycoprotein receptor inhibitors achieve similar levels of platelet inhibition at 10 minutes and 1 hour; however, abciximab maintains this benefit 24 hours after bolus dose. We did not witness an increased rate of bleeding in patients given new potent P2Y12 inhibitors and a GPI in the modern era.

Automated and visual measurements of estrous behavior and their sources of variation in Holstein heifers. II: Standing and lying patterns.

Lying (LY) and standing (ST) behavior of Holstein heifers (n = 57) was studied from Day -7 to Day +2 relative to estrus (Day 0) using leg-mounted accelerometers. A total of 269 estrus episodes were studied. The objectives were to quantify the effects of estrus on ST and LY patterns, identify sources of variation, and provide insight into new approaches for the use of sensors in estrus detection. The sensors were used to obtain ST bout frequency (bouts per day), total daily ST time, and mean bout duration and duration of the longest bout for ST and LY on a daily basis. Estrus episodes were identified using walking activity peaks and validated by ovarian ultrasonography. Repeated-measures ANOVA was used to analyze the effects of estrus order (pubertal vs. second and greater), season, time of estrus onset, category of baseline walking activity, and number of heifers simultaneously in estrus on ST and LY variables. Overall, ST bout frequency was lower, whereas mean ST bout duration, duration of the longest ST bout, and total daily ST time were longer on Day 0 (P < 0.05). The longest ST bout increased from 232 ± 5 minutes on Day -7 to 488 ± 16 minutes on Day 0 (P < 0.05), and on Day 0, it started within -2 to 4 hours of time of estrus onset. Measurements of ST bouts varied the most on Day 0 (coefficient of variation = 21.5%-52.8%). The pubertal estrus was characterized by smaller increase in mean ST bout duration, longest ST bout duration, and total daily ST time (P < 0.05) compared to the second and greater episodes. Second and greater episodes had greater longest LY bout on Day +1, but on Day 0 it was not different from other nonestrus days (P < 0.01). The longest ST bout on Day 0 was longer for heifers with high baseline walking activity and for episodes occurring during the cold season (P < 0.05). The effect of estrus on ST variables for morning-onset episodes was observed only on Day 0. Episodes with afternoon and night onset showed the effect of estrus spread over Days -1 and 0, resulting in a smaller change between Day -7 and Day 0. The number of heifers simultaneously in estrus did not affect the studied variables (P > 0.05). Measurements of ST and LY changed during estrus and were correlated to walking activity. The large increase in duration of the longest ST bout and its occurrence in proximity of estrus onset suggest potential for automation. Incorporating measurements of ST and LY corrected for sources of variation could improve estrus detection systems.