Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties.

BACKGROUND: The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS: Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION: Clinical trial registration: ISRCTN 11620914.

Incorporating RTLS-Based Spatiotemporal Information in Studying Physical Activities of Clinical Staff.

Clinicians and staff who work in intense hospital settings such as the emergency department (ED) are under an extended amount of mental and physical pressure every day. They may spend hours in active physical pressure to serve patients with severe injuries or stay in front of a computer to review patients' clinical history and update the patients' electronic health records (EHR). Nurses on the other hand may stay for multiple consecutive days of 9-12 working hours. The amount of pressure is so much that they usually end up taking days off to recover the lost energy. Both of these extreme cases of low and high physical activities are shown to affect the physical and mental health of clinicians and may even lead to fatigue and burnout.In this study Real-Time location systems (RTLS) are used for the first time, to study the amount of physical activity exerted by clinicians. RTLS systems have traditionally been used in hospital settings for locating staff and equipment, whereas our proposed method combines both time and location information together to estimate the duration, length, and speed of movements within hospital wards such as the ED. It is also our first step towards utilizing non-wearable devices to measure sedentary behavior inside the ED. This information helps to assess the workload on the care team and identify means to reduce the risk of performance compromise, fatigue, and burnout.We used one year worth of raw RFID data that covers movement records of 38 physicians, 13 residents, 163 nurses, 33 staff in the ED. We defined a walking path as the continuous sequences of movements and stops and identified separate walking paths for each individual on each day. Walking duration, distance, and speed, along with the number of steps and the duration of sedentary behavior, are then estimated for each walking path. We compared our results to the values reported in the literature and showed despite the low spatial resolution of RTLS, our non-invasive estimations are closely comparable to the ones measured by Fitbit or other wearable pedometers.Clinical Relevance- Adequate assessment of workload in a dynamic care delivery space plays an important role in ensuring safe and optimal care delivery [7]. Systems capable of measuring physical activities on a continuous basis during daily work can provide precious information for a variety of purposes including automated assessment of sedentary behaviors and early detection of work pressure. Such systems could help facilitate targeted changes in the number of staff, duration of their working shifts leading to a safer and healthier environment for both clinicians and patients.

Advances in Cardiac Pacing: Arrhythmia Prediction, Prevention and Control Strategies.

Cardiac arrhythmias constitute a tremendous burden on healthcare and are the leading cause of mortality worldwide. An alarming number of people have been reported to manifest sudden cardiac death as the first symptom of cardiac arrhythmias, accounting for about 20% of all deaths annually. Furthermore, patients prone to atrial tachyarrhythmias such as atrial flutter and fibrillation often have associated comorbidities including hypertension, ischemic heart disease, valvular cardiomyopathy and increased risk of stroke. Technological advances in electrical stimulation and sensing modalities have led to the proliferation of medical devices including pacemakers and implantable defibrillators, aiming to restore normal cardiac rhythm. However, given the complex spatiotemporal dynamics and non-linearity of the human heart, predicting the onset of arrhythmias and preventing the transition from steady state to unstable rhythms has been an extremely challenging task. Defibrillatory shocks still remain the primary clinical intervention for lethal ventricular arrhythmias, yet patients with implantable cardioverter defibrillators often suffer from inappropriate shocks due to false positives and reduced quality of life. Here, we aim to present a comprehensive review of the current advances in cardiac arrhythmia prediction, prevention and control strategies. We provide an overview of traditional clinical arrhythmia management methods and describe promising potential pacing techniques for predicting the onset of abnormal rhythms and effectively suppressing cardiac arrhythmias. We also offer a clinical perspective on bridging the gap between basic and clinical science that would aid in the assimilation of promising anti-arrhythmic pacing strategies.