Group cognitive and behavioral treatment for compulsive hoarding: a preliminary trial

Background: Time‐limited group cognitive behavioral treatments (GCBT) for obsessive–compulsive disorder have demonstrated improvement in target symptoms. One small sample study of GCBT specifically for hoarding problems also showed benefit. This study examines the efficacy of a specialized GCBT for compulsive hoarding on a larger sample. Methods: Thirty‐two clients diagnosed with hoarding participated in five groups. Four groups met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5). All participants had two individual 90‐min home sessions. Self‐report assessments were completed at baseline, mid‐treatment, and post‐treatment about hoarding behavior and related symptoms (e.g., depression). The sample was predominantly female, White, highly educated, unemployed, and not partnered/married; mean age was 53. A majority was diagnosed with major depressive disorder and obsessive–compulsive personality disorder. Results: Participants showed significant improvement from pre‐ to post‐treatment on the Saving Inventory Revised, Saving Cognitions Inventory, Clutter Image Rating, and Clinical Global Severity. The most recent group (n=8) that used a more formalized treatment and research protocol improved significantly more than did earlier members. Conclusion: This study demonstrates the feasibility and modest success of GCBT methods in improving hoarding symptoms. Group treatment may be especially valuable because of its cost‐effectiveness, greater client access to trained clinicians, and reduction in social isolation and stigma linked to this problem. Further research is needed to improve the efficacy of GCBT methods for hoarding and to examine durability of change, predictors of outcomes, and processes that influence change. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Enhancing DNA vaccination by sequential injection of lymph nodes with plasmid vectors and peptides

DNA vaccines or peptides are capable of inducing specific immunity; however, their translation to the clinic has generally been problematic, primarily due to the reduced magnitude of immune response and poor pharmacokinetics. Herein, we demonstrate that a novel immunization strategy, encompassing sequential exposure of the lymph node milieu to plasmid and peptide in a heterologous prime-boost fashion, results in considerable MHC class I-restricted immunity in mice. Plasmid-primed antigen expression was essential for the generation of a population of central memory T cells, expressing CD62L and low in PD-1, with substantial capability to expand and differentiate to peripheral memory and effector cells, following subsequent exposure to peptide. These vaccine-induced T cells dominated the T cell repertoire, were able to produce large amounts of chemokines and pro-inflammatory cytokines, and recognized tumor cells effectively. In addition to outlining a feasible and effective method to transform plasmid DNA vaccination into a potentially viable immunotherapeutic approach for cancer, this study sheds light on the mechanism of heterologous prime-boost and the considerable heterogeneity of MHC class I-restricted T cell responses.     

Socially assistive robots in health and social care: Acceptance and cultural factors. Results from an exploratory international online survey

Aim

This study explored the views of an international sample of registered nurses and midwives working in health and social care concerning socially assistive robots (SARs), and the relationship between dimensions of culture and rejection of the idea that SARs had benefits in these settings.

Methods

An online survey was used to obtain rankings of (among other topics) the extent to which SARs have benefits for health and social care. It also asked for free text responses regarding any concerns about SARs.

Results

Most respondents were overwhelmingly positive about SARs' benefits. A small minority strongly rejected this idea, and qualitative analysis of the objections raised by them revealed three major themes: things might go wrong, depersonalization, and patient-related concerns. However, many participants who were highly accepting of the benefits of SARs expressed similar objections. Cultural dimensions of long-term orientation and uncertainty avoidance feature prominently in technology acceptance research. Therefore, the relationship between the proportion of respondents from each country who felt that SARs had no benefits and each country's ratings on long-term orientation and uncertainty avoidance were also examined. A significant positive correlation was found for long-term orientation, but not for uncertainty avoidance.

Conclusion

Most respondents were positive about the benefits of SARs, and similar concerns about their use were expressed both by those who strongly accepted the idea that they had benefits and those who did not. Some evidence was found to suggest that cultural factors were related to rejecting the idea that SARs had benefits.     

Non-invasive assessment of graft patency using transcutaneous Doppler echocardiography for the validation of functional improvement after PTCA of the LAD via internal thoracic artery graft

Percutaneous transluminal coronary angioplasty (PTCA) of a native coronary artery via internal thoracic artery (ITA) graft after bypass surgery is a relatively rare procedure. Our current study evaluates the flow velocity patterns of the graft before and after PTCA. After intervention the mean diastolic flow velocity increased under rest and stress conditions. In addition, the graft patency was proved not before control angiography after 6 months. It could be verified that the measurement of flow velocity patterns under rest and stress conditions is a useful non-invasive procedure for monitoring long-term patency and PTCA-results of this vessel.     

Pelage insulation, litter size, and ambient temperature impact maternal energy intake and offspring development during lactation

Energy balance during lactation critically influences survival and growth of a mother's offspring, and hence, her reproductive success. Most experiments have investigated the influence of a single factor (e.g., ambient temperature [T_a] or litter size) on the energetics of lactation. Here, we determined the impact of multiple interventions, including increased conductive heat loss consequent to dorsal fur removal, cold exposure (T_a of 5 °C versus 23 °C), and differential lactational load from litters of different sizes (2 or 4 pups), on maternal energy balance and offspring development of Siberian hamsters (Phodopus sungorus). Lower T_a, fur removal, and larger litters were associated with increased maternal food consumption. Females exposed to multiple challenges (e.g., both fur loss and lower T_a) ate substantially more food than those exposed to a single challenge, with no apparent ceiling to elevated food intake (increases up to 538%). Thus, energy intake of dams under these conditions does not appear to be limited by feeding behavior or the size of the digestive tract. Housing at 5 °C attenuated pup weight gain and increased pup mortality to more than 5 times that of litters housed at 23 °C. Increases in the dam's conductive heat loss induced by fur removal did not affect pup weight gain or survival, suggesting that effects of low T_a on pup weight gain and survival reflect limitations in the pups’ ability to ingest or incorporate energy.     

Anterior temporobasal sulcal morphology: development of a reliable rating protocol and normative data

The three anterior temporobasal (aTB) sulci, which are the collateral, rhinal, and occipitotemporal sulci, contribute to the morphology of memory-related structures and are important landmarks for neuroimaging. Prevalence of inter-connections among these sulci may distinguish healthy adults and individuals with memory-related disorders (Kim et al. Neurology 70:2159–2165, 2008; Zhan et al. Hum Brain Mapp 30:874–882, 2009). However, methods for quantifying the existence and nature of such connections are vague and varied, and normative frequencies are inconsistent across studies. Therefore, the goals of the current study are twofold: (1) to develop a reliable method of identifying aTB sulci and their interconnections based on surface renderings generated from serial magnetic resonance images (MRIs). This protocol includes training materials and a rating log (see supplementary materials) that can be disseminated and applied by other researchers. (2) To determine the prevalence of interconnections among the three aTB sulci in a large sample of healthy adults (200 undergraduate students), which can be used as normative data for future comparison with clinical samples. Notably, the resulting protocol, called the Sulcal Classification Rating Protocol for anterior Temporobasal sulci, distinguishes “clear” from “ambiguous” connections. When only clear connections are included, our prevalence rates are consistent with post-mortem findings of Ono et al. (Atlas of the Cerebral Sulci. Thieme Medical Publishers, Inc., New York, 1990); when both clear and ambiguous connections are counted as a connection, our results largely replicate MRI-based findings (e.g., Kim et al. Neurology 70:2159–2165, 2008). We propose that systematic variations in rater classification of ambiguous connections could explain discrepancies in the literature.