Background/objectives: Individuals with severe mental illness (SMI) have a reduced life expectancy of 15-25 years. This is due to a number of modifiable and non-modifiable risk factors. Levels of overweight and obesity in this group are 1.8 times higher than in the general population and diet quality is poor. Excess weight is linked to a range of serious long-term physical and mental health conditions. This paper presents the findings of a large cross-sectional survey of adults living with SMI. The survey aimed to understand the current weight, weight gain and diet quality of this group and secondly, to explore the association between weight change, diet quality, antipsychotic medication and weight management. Methods: Five hundred and twenty-nine participants (58% male, mean age 49.3) living with SMI completed the survey. Results: Results showed 42% of the sample were living with obesity and almost half reported having gained 6 kg or more at least once in their adult life. Overall, 6% of the sample reported eating no fruit or vegetables and the same proportion had the highest consumption of carbonated drinks. There was no difference by weight category. Those taking antipsychotic medication and currently managing their weight were more likely to experience weight gain or fluctuation. Conclusions: These results suggest that excess weight and poor diet quality are a major problem in adults with SMI and that current weight management provision is ineffective in addressing the specific needs of people living with SMI.

5%–10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP. ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7–16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months. 268 CYPs were randomized to OST ( n  = 134) or CBT ( n  = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n  = 76), 7.4 (PP, n  = 57), OST: 7.4 (ITT, n  = 73), 7.6 (PP, n  = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI −0.449 to 0.202 (ITT), mean difference −0.204, 95% CI −0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT. One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.

This paper systematically reviewed the literature reporting the validity and reliability of hyperpolarised gas MRI as a marker of lung health in cystic fibrosis (CF). MEDLINE, EMBASE and grey literature were searched for studies assessing the measurement properties of hyperpolarised helium-3 or xenon-129 MRI. The COSMIN risk of bias tool was used to critically appraise eligible studies. Findings show hyperpolarised gas MRI was able to detect structural and functional abnormalities in the lungs, detect response to treatments, and is more sensitive than FEV1 in detecting ventilation defects in CF patients. There was moderately robust evidence for construct validity of hyperpolarised gas MRI, although evidence for other types of validity is currently low. Nonetheless, high quality studies concluded that hyperpolarised gas MRI is a reliable tool and test results are reproducible in CF patients. Hyperpolarised gas MRI is a promising tool for detecting early CF pulmonary disease and for longitudinal monitoring of CF.

BACKGROUND:Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES:To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN:Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING:Six paediatric neuromuscular units. PARTICIPANTS:Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS:Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES:Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS:Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS:The focus on delivery in hospitals limits generalisability. CONCLUSIONS:Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION:Current Controlled Trials ISRCTN41002956. FUNDING:This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.

Standard treatment of Duchenne muscular dystrophy (DMD) includes regular physiotherapy. There are no data to show whether adding aquatic therapy (AT) to land-based exercises helps maintain motor function. We assessed the feasibility of recruiting and collecting data from boys with DMD in a parallel-group pilot randomised trial (primary objective), also assessing how intervention and trial procedures work.

Although colour vision defects are quite common in optic neuritis and multiple sclerosis, there is a lack of general agreement as to the nature of the colour vision defect associated with demyelinating diseases. We investigated whether there is selective involvement of particular channels in demyelinating disease by recording visually evoked cortical potentials (VEPs) elicited by grating patterns that selectively stimulate the chromatic pathways. This paper contains preliminary results on a small number of patients who have essentially recovered from or have suffered no spatial vision loss. None of these patients showed S cone pathway deficits; all deficits involved pathways with L or M cone input.

CSF pulsation suggests variation in the size of the cerebral ventricles during the cardiac cycle. The arterial blood flow and venous outflow are two major components that contribute to the variation. High-resolution MR imaging with cardiac gating provides sharp delineation of the cerebral ventricles with clear boundaries. Subtle changes in the size of the ventricles during the cardiac cycle are measurable with high precision and accuracy by using a sophisticated automated edge-detection algorithm. In 12 normal individuals, the cerebral ventricles were examined, and the size of the lateral ventricles showed a 10-20% change during the cardiac cycle. The pattern is complex but similar in appearance to the intracranial pressure pulse waveform. The variation suggests that the choroid plexus may play a greater role as a source of CSF pulsation that currently acknowledged. The ability to measure the variations in ventricular volume has clinical implication as a noninvasive method for the diagnosis of diseases with abnormal brain elasticity.