Follow the sound of my violin: Granger causality reflects information flow in sound.

Recent research into how musicians coordinate their expressive timing, phrasing, articulation, dynamics, and other stylistic characteristics during performances has highlighted the role of predictive processes, as musicians must anticipate how their partners will play in order to be together. Several studies have used information flow techniques such as Granger causality to show that upcoming movements of a musician can be predicted from immediate past movements of fellow musicians. Although musicians must move to play their instruments, a major goal of music making is to create a joint interpretation through the sounds they produce. Yet, information flow techniques have not been applied previously to examine the role that fellow musicians' sound output plays in these predictive processes and whether this changes as they learn to play together. In the present experiment, we asked professional violinists to play along with recordings of two folk pieces, each eight times in succession, and compared the amplitude envelopes of their performances with those of the recordings using Granger causality to measure information flow and cross-correlation to measure similarity and synchronization. In line with our hypotheses, our measure of information flow was higher from the recordings to the performances than vice versa, and decreased as the violinists became more familiar with the recordings over trials. This decline in information flow is consistent with a gradual shift from relying on auditory cues to predict the recording to relying on an internally-based (learned) model built through repetition. There was also evidence that violinists became more synchronized with the recordings over trials. These results shed light on the planning and learning processes involved in the aligning of expressive intentions in group music performance and lay the groundwork for the application of Granger causality to investigate information flow through sound in more complex musical interactions.

Integrating mental health care into home-based nursing services: A qualitative study utilising normalisation process theory.

AIMS AND OBJECTIVES: To identify barriers and facilitators to implementing community nurses being trained as psychological wellbeing practitioners and integrating this practice into home-based primary care nursing, through key stakeholders' perceptions. BACKGROUND: Current drivers in UK primary care aim to increase access to mental health services and treatment, to achieve parity of esteem between physical and mental health care for patients who are housebound. However, there remains limited evidence on how to successfully implement this. Training community nurses as psychological wellbeing practitioners to offer mental health care alongside their current home-based services is one option. DESIGN: A pluralistic qualitative study. This study followed the COREQ checklist for reporting qualitative research. METHODS: Twenty key stakeholders were purposively recruited and interviewed including twelve health professionals and eight patients. Semi-structured interviews were analysed using a theoretical thematic analysis informed by normalisation process theory concepts of coherence, cognitive participation, collective action and reflexive monitoring, to explore the barriers and facilitators to implementation. RESULTS: Staff and patients reported high coherence and cognitive participation, valuing the integrated roles. Facilitators included the development of clearer referral pathways and increased mental health knowledge in the wider team. However, sustainability and current siloed healthcare systems were identified as barriers to implementation. CONCLUSIONS: A key obstacle to long-term implementation was the practical structures and financial boundaries of siloed healthcare systems, making long-term sustainability unviable. RELEVANCE TO CLINICAL PRACTICE: Community nurses with additional mental health training can integrate these skills in practice and are valued by their team and patients offering holistic care to patients within their home and informal knowledge transfer to the wider team. However, long-term sustainability is required if this is to be adopted routinely. Further evidence is needed to better understand the positive outcomes to patients and potential cost savings.

Meta-analysis of trials in non-alcoholic fatty liver disease with therapeutic interventions for metabolic syndrome.

AIMS: Non-alcoholic fatty liver disease [NAFLD] is associated with metabolic syndrome [MS]. Current guidelines restrict therapy for NAFLD, other than weight loss, in early non-fibrotic disease. It was postulated that intervention with therapies for MS may improve liver fat content. METHODS: A systematic evaluation of Cochrane and PubMed databases was performed for NAFLD or NASH if they were: 1) interventions for metabolic syndrome or diabetes mellitus 2) randomized controlled trials [RCT], with 3) primary outcomes of liver fat content [LFC] (by magnetic resonance spectroscopy [MRS] or liver biopsy (Nonalcoholic Fatty Liver Disease Activity Score [NAS]). RESULTS: There were 30 RCT (in 24 publications) of 2409 subjects. LFC decreased with pioglitazone (MRS, -8.0 ± 1.0 %, p < 0.001), diet and exercise (-7.8 ± 1.7 %, p < 0.001) and omega-3 fatty acids (-6.0 ± 2.5 %, p = 0.02). Decreases in NAS scores were significant for pioglitazone (-1.4 ± 0.4 units, p < 0.001) and D&E (-1.0 ± 0.1 units, p < 0.001). Weight loss correlated with improvement in LFC (p < 0.001) and NAS (p < 0.001). Lowered serum triglycerides correlated with final LFC (p < 0.001) and NAS scores (p < 0.001). CONCLUSIONS: Therapies of MS with weight loss, antiglycemic and triglyceride lowering medicines improved LFC and NAS scores. Further studies are necessary to demonstrate if these therapies would pre-emptively limit progression of disease.

Social prescribing for people with complex needs: a realist evaluation.

BACKGROUND: Social Prescribing is increasingly popular, and several evaluations have shown positive results. However, Social Prescribing is an umbrella term that covers many different interventions. We aimed to test, develop and refine a programme theory explaining the underlying mechanisms operating in Social Prescribing to better enhance its effectiveness by allowing it to be targeted to those who will benefit most, when they will benefit most. METHODS: We conducted a realist evaluation of a large Social Prescribing organisation in the North of England. Thirty-five interviews were conducted with stakeholders (clients attending Social Prescribing, Social Prescribing staff and general practice staff). Through an iterative process of analysis, a series of context-mechanism-outcome configurations were developed, refined and retested at a workshop of 15 stakeholders. The initial programme theory was refined, retested and 'applied' to wider theory. RESULTS: Social Prescribing in this organisation was found to be only superficially similar to collaborative care. A complex web of contexts, mechanisms and outcomes for its clients are described. Key elements influencing outcomes described by stakeholders included social isolation and wider determinants of health; poor interagency communication for people with multiple needs. Successful Social Prescribing requires a non-stigmatising environment and person-centred care, and shares many features described by the asset-based theory of Salutogenesis. CONCLUSIONS: The Social Prescribing model studied is holistic and person-centred and as such enables those with a weak sense of coherence to strengthen this, access resistance resources, and move in a health promoting or salutogenic direction.

Identifying the evidence base of interventions supporting mental health nurses to cope with stressful working environments: A scoping review.

AIM: To scope the evidence on interventions used to help mental health nurses cope with stressful working environments. BACKGROUND: Nursing managers may implement interventions to support mental health nurses cope in their role. However, the evidence supporting these interventions has not been recently reviewed. METHODS: A scoping review was conducted which entailed searching and selecting potential studies, undertaking data extraction and synthesis. RESULTS: Eighteen studies published since 2000 were identified. They employed different designs, ten used quasi-experimental methods. Interventions involving active learning appeared beneficial, for example stress reduction courses and mindfulness. However, small sample sizes, short follow-up periods and variation in outcome measures make it difficult to identify the optimum interventions. No studies have considered cost-effectiveness. CONCLUSION: There is some evidence that mental health nurses benefit from interventions to help them cope with stressful working environments. However, higher quality research is needed to establish the effectiveness and cost-effectiveness of different interventions. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should provide opportunities and encourage mental health nurses to engage in active learning interventions, for example mindfulness to help them cope with stressful working environments. Nurses also want managers to address organisational issues; however, no research on these types of interventions was identified.

Sensory over-responsivity is related to GABAergic inhibition in thalamocortical circuits.

Sensory over-responsivity (SOR), extreme sensitivity to or avoidance of sensory stimuli (e.g., scratchy fabrics, loud sounds), is a highly prevalent and impairing feature of neurodevelopmental disorders such as autism spectrum disorders (ASD), anxiety, and ADHD. Previous studies have found overactive brain responses and reduced modulation of thalamocortical connectivity in response to mildly aversive sensory stimulation in ASD. These findings suggest altered thalamic sensory gating which could be associated with an excitatory/inhibitory neurochemical imbalance, but such thalamic neurochemistry has never been examined in relation to SOR. Here we utilized magnetic resonance spectroscopy and resting-state functional magnetic resonance imaging to examine the relationship between thalamic and somatosensory cortex inhibitory (gamma-aminobutyric acid, GABA) and excitatory (glutamate) neurochemicals with the intrinsic functional connectivity of those regions in 35 ASD and 35 typically developing pediatric subjects. Although there were no diagnostic group differences in neurochemical concentrations in either region, within the ASD group, SOR severity correlated negatively with thalamic GABA (r = -0.48, p < 0.05) and positively with somatosensory glutamate (r = 0.68, p < 0.01). Further, in the ASD group, thalamic GABA concentration predicted altered connectivity with regions previously implicated in SOR. These variations in GABA and associated network connectivity in the ASD group highlight the potential role of GABA as a mechanism underlying individual differences in SOR, a major source of phenotypic heterogeneity in ASD. In ASD, abnormalities of the thalamic neurochemical balance could interfere with the thalamic role in integrating, relaying, and inhibiting attention to sensory information. These results have implications for future research and GABA-modulating pharmacologic interventions.

Vocal-motor interference eliminates the memory advantage for vocal melodies.

Spontaneous motor cortical activity during passive perception of action has been interpreted as a sensorimotor simulation of the observed action. There is currently interest in how sensorimotor simulation can support higher-up cognitive functions, such as memory, but this is relatively unexplored in the auditory domain. In the present study, we examined whether the established memory advantage for vocal melodies over non-vocal melodies is attributable to stronger sensorimotor simulation during perception of vocal relative to non-vocal action. Participants listened to 24 unfamiliar folk melodies presented in vocal or piano timbres. These were encoded during three interference conditions: whispering (vocal-motor interference), tapping (non-vocal motor interference), and no-interference. Afterwards, participants heard the original 24 melodies presented among 24 foils and judged whether melodies were old or new. A vocal-memory advantage was found in the no-interference and tapping conditions; however, the advantage was eliminated in the whispering condition. This suggests that sensorimotor simulationduring the perception of vocal melodies is responsible for the observed vocal-memory advantage.

Presleep α-Lactalbumin Consumption Does Not Improve Sleep Quality or Time-Trial Performance in Cyclists.

We tested the hypothesis that presleep consumption of α-lactalbumin (LA), a fraction of whey with a high abundance of tryptophan, would improve indices of sleep quality and time-trial (TT) performance in cyclists relative to an isonitrogenous collagen peptide (CP) supplement lacking tryptophan. Using randomized, double-blind, crossover designs, cyclists consumed either 40 g of LA or CP 2 hr prior to sleep. In Study 1, six elite male endurance track cyclists (age 23 ± 6 years, V˙O2peak 70.2 ± 4.4 ml·kg-1·min-1) consumed a supplement for three consecutive evenings before each 4-km TT on a velodrome track, whereas in Study 2, six well-trained cyclists (one female; age 24 ± 5 years, V˙O2peak 66.9 ± 8.3 ml·kg-1·min-1) consumed a supplement the evening before each 4-km TT on a stationary cycle ergometer. Indices of sleep quality were assessed with wrist-based actigraphy. There were no differences between the CP and LA supplements in terms of total time in bed, total sleep time, or sleep efficiency in Study 1 (LA: 568 ± 71 min, 503 ± 67 min, 88.3% ± 3.4%; CP: 546 ± 30 min, 479 ± 35 min, 87.8% ± 3.1%; p = .41, p = .32, p = .74, respectively) or Study 2 (LA: 519 ± 90 min, 450 ± 78 min, 87.2% ± 7.6%; CP: 536 ± 62 min, 467 ± 57 min, 87.3% ± 6.4%; p = .43, p = .44, p = .97, respectively). Similarly, time to complete the 4-km TT was unaffected by supplementation in Study 1 (LA: 274.9 ± 7.6 s; CP: 275.5 ± 7.2 s; p = .62) and Study 2 (LA: 344.3 ± 22.3 s; CP: 343.3 ± 23.0 s; p = .50). Thus, relative to CP, consuming LA 2 hr prior to sleep over 1-3 days did not improve actigraphy-based indices of sleep quality or 4-km TT performance in cyclists.

Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of psychosis: a systematic review.

Background: Psychosis is a public health concern. There is increasing evidence suggesting trauma can play a pivotal role in the development and maintenance of psychosis. Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for trauma and could be a vital addition to the treatment of psychosis. Objective: To explore the evidence for EMDR as a treatment for psychosis, focussing on the safety, effectiveness and acceptability of this intervention for this population. Methods: Four databases (Cochrane, EMBASE, MEDLINE PsychINFO), and the Francine Shapiro Library were systematically searched, along with grey literature and reference lists of relevant papers. No date limits were applied as this is an area of emerging evidence. Studies were screened for eligibility based on inclusion and exclusion criteria. The included studies were quality assessed and data was extracted from the individual studies, and synthesized using a narrative synthesis approach. Results: Six studies met the inclusion criteria (1 RCT, 2 Pilot studies, 2 Case series and 1 Case report). Across the studies EMDR was associated with reductions in delusional and negative symptoms, mental health service and medication use. Evidence for reductions in auditory hallucinations and paranoid thinking was mixed. No adverse events were reported, although initial increases in psychotic symptoms were observed in two studies. Average dropout rates across the studies were comparable to other trauma-focused treatments for PTSD. The acceptability of EMDR was not adequately measured or reported. Conclusion: EMDR appears a safe and feasible intervention for people with psychosis. The evidence is currently insufficient to determine the effectiveness and acceptability of the intervention for this population. Larger confirmative trials are required to form more robust conclusions.

Antecedentes: La psicosis es un problema de salud pública. Cada vez hay más evidencia sugiriendo que el trauma puede desempeñar un papel fundamental en el desarrollo y mantenimiento de la psicosis. La desensibilización y reprocesamiento por movimiento ocular (EMDR en su sigla en inglés) es un tratamiento efectivo para el trauma y podría ser una adición vital al tratamiento de la psicosis.Objetivo: explorar el evidencia de EMDR como tratamiento para la psicosis, enfocándose en la seguridad, efectividad y aceptabilidad de esta intervención para esta población.Métodos: Se realizaron búsquedas sistemáticas en cuatro bases de datos (Cochrane, EMBASE, MEDLINE PsychINFO) y la Biblioteca Francine Shapiro, junto con literatura gris y listas de referencias de artículos relevantes. No se aplicaron límites de fecha ya que esta es un área con evidencia emergente. Los estudios se seleccionaron determinando su elegibilidad según los criterios de inclusión y exclusión. Los estudios incluidos fueron evaluados de acuerdo a su calidad y los datos se extrajeron de los estudios individuales y se sintetizaron utilizando un enfoque de síntesis narrativa.Resultados: Seis estudios cumplieron los criterios de inclusión (1 ensayo controlado aleatorio, 2 estudios piloto, 2 series de casos y 1 informe de caso). En todos los estudios, EMDR se asoció con reducciones en los síntomas delirantes y negativos, el servicio de salud mental y el uso de medicamentos. La evidencia de reducciones en las alucinaciones auditivas y el pensamiento paranoico fue mixta. No se informaron eventos adversos, aunque se observaron aumentos iniciales en los síntomas psicóticos en dos estudios. Las tasas promedio de abandono en los estudios fueron comparables a otros tratamientos centrados en el trauma para el TEPT. La aceptabilidad de EMDR no se midió ni informó adecuadamente.Conclusión: EMDR parece una intervención segura y factible para personas con psicosis. La evidencia es actualmente insuficiente para determinar la efectividad y la aceptabilidad de la intervención para esta población. Se requieren ensayos confirmatorios más grandes para formar conclusiones más sólidas.

EMDR as a treatment for long-term depression: A feasibility study.

OBJECTIVE: Current treatments for long-term depression - medication and psychotherapy - are effective for some but not all clients. New approaches need to be developed to complement the ones already available. This study was designed to test the feasibility of using an effective post-traumatic stress disorder treatment for people with long-term depression. DESIGN: A single-case experimental design with replications was undertaken as a feasibility study of eye movement desensitization and reprocessing (EMDR) in treating long-term depression. METHODS: Thirteen people with recurrent and/or long-term depression were recruited from primary care mental health services and given standard protocol EMDR for a maximum of 20 sessions. Levels of depression were measured before and after treatment and at follow-up, clients also rated their mood each day. RESULTS: Eight people engaged with the treatment; seven of these had clinically significant and statistically reliable improvement on the Hamilton Rating Scale for Depression. Daily mood ratings were highly variable both during baseline and intervention. CONCLUSIONS: EMDR is a feasible treatment for recurrent and/or long-term depression. Research on treatment efficacy and effectiveness is now required. PRACTITIONER POINTS: EMDR may be an effective treatment for depression. EMDR could be considered if first-line approaches (CBT and counselling) have been tried and failed. EMDR may be particularly helpful for service users with a history of trauma.

The feasibility of brief dog-assisted therapy on university students stress levels: the PAwS study.

BACKGROUND: Pet therapy is becoming increasingly popular and is used in a variety of ways from encouraging communication in older adults to improving wellbeing in those with serious mental illness. Increasingly Universities have been offering pet therapy to students in an effort to reduce stress. However, little evidence currently exists to support the effectiveness of reducing measurable stress levels after a standalone drop-in unstructured session. The University of Sheffield's Counselling Service works in partnership with Guide Dogs for the Blind to give students access to calm, well-trained animals for informal group stress relief. AIMS: To assess the feasibility of implementing and evaluating unstructured group interventions with a Guide Dog in training within the university student population. METHODS: One hundred and thirty-one students who attended pet therapy at the University Counselling Service were recruited on a voluntary basis to take part in the research. Stress, measured on the state trait anxiety inventory, and blood pressure were taken before and after a 15-min intervention. RESULTS: All measures showed a statistically significant reduction immediately after the intervention. CONCLUSION: Short interactions with a Guide Dog in training appear to reduce stress in University students. A controlled study is required to investigate further.

Validating Nonlinear Registration to Improve Subtraction Images for Lesion Detection and Quantification in Multiple Sclerosis.

BACKGROUND AND PURPOSE: To propose and validate nonlinear registration techniques for generating subtraction images because of their ability to reduce artifacts and improve lesion detection and lesion volume quantification. METHODS: Postcontrast T1 -weighted spin echo and T2 -weighted dual echo images were acquired for 20 patients with relapsing-remitting multiple sclerosis (RRMS) on a monthly basis for a year (14 women, average age 33.6 ± 6.9). The T2 -weighted images from the first scan were used as a baseline for each patient. The images from the last scan were registered to the baseline image. Four different registration algorithms used for evaluation included; linear, halfway linear, nonlinear, and nonlinear halfway. Subtraction images were generated after brain extraction, intensity normalization, and Gaussian blurring. Lesion activity changes along with identified artifacts were scored on all four techniques by two independent observers. Additionally, quantitative analysis of the algorithms was performed by estimating the volume changes of simulated lesions and real lesions. For real lesion volume change analysis, five subjects were selected randomly. Subtraction images were generated between all the 11 time points and the baseline image using linear and nonlinear registration for the five subjects. RESULTS: Lesion activity detection resulted in similar performance among the four registration techniques. Lesion volume measurements on subtraction images using nonlinear registration were closer to lesion volume on T2 -weighted images. A statistically significant difference was observed among the four registration techniques while evaluating yin-yang artifacts. Pairwise comparisons showed that nonlinear registration results in the least amount of yin-yang artifacts, which are significantly different. CONCLUSIONS: Nonlinear registration for generation of subtraction images has been demonstrated to be a promising new technique as it shows improvement in lesion activity change detection. This approach decreases the number of artifacts in subtraction images. With improved lesion volume estimates and reduced artifacts, nonlinear registration may lead to discarding less subject data and an improvement in the statistical power of subtraction imaging studies.

Service user views of spiritual and pastoral care (chaplaincy) in NHS mental health services: a co-produced constructivist grounded theory investigation.

BACKGROUND: Within the UK National Health Service (NHS), Spiritual and Pastoral Care (SPC) Services (chaplaincies) have not traditionally embraced research due to the intangible nature of their work. However, small teams like SPC can lead the way towards services across the NHS becoming patient- centred and patient-led. Using co-production principles within research can ensure it, and the resulting services, are truly patient-led. METHODS: A series of interviews were conducted with service users across directorates of a large NHS mental health Trust. Their views on the quality of SPC services and desired changes were elicited. Grounded theory was used with a constant comparative approach to the interviews and analysis. RESULTS: Initial analysis explored views on spirituality and religion in health. Participants' concerns included what chaplains should do, who they should see, and how soon after admission. Theoretical analysis suggested incorporating an overarching spiritual element into the bio-psycho-social model of mental healthcare. CONCLUSIONS: Service users' spirituality should not be sidelined. To service users with strong spiritual beliefs, supporting their spiritual resilience is central to their care and well-being. Failure will lead to non-holistic care unlikely to engage or motivate.

Thalamic lesions in multiple sclerosis by 7T MRI: Clinical implications and relationship to cortical pathology.

OBJECTIVE: Pathology in both cortex and deep gray matter contribute to disability in multiple sclerosis (MS). We used the increased signal-to-noise ratio of 7-tesla (7T) MRI to visualize small lesions within the thalamus and to relate this to clinical information and cortical lesions. METHODS: We obtained 7T MRI scans on 34 MS cases and 15 healthy volunteers. Thalamic lesion number and volume were related to demographic data, clinical disability measures, and lesions in cortical gray matter. RESULTS: Thalamic lesions were found in 24/34 of MS cases. Two lesion subtypes were noted: discrete, ovoid lesions, and more diffuse lesional areas lining the periventricular surface. The number of thalamic lesions was greater in progressive MS compared to relapsing-remitting (mean ±SD, 10.7 ±0.7 vs. 3.0 ±0.7, respectively, p < 0.001). Thalamic lesion burden (count and volume) correlated with EDSS score and measures of cortical lesion burden, but not with white matter lesion burden or white matter volume. CONCLUSIONS: Using 7T MRI allows identification of thalamic lesions in MS, which are associated with disability, progressive disease, and cortical lesions. Thalamic lesion analysis may be a simpler, more rapid estimate of overall gray matter lesion burden in MS.