Introduction: Nanoparticles have been successfully used for cancer drug delivery since 1995. In the design of commercial nanoparticles, size and surface characteristics have been exploited to achieve ...efficacious delivery. However, the design of optimized drug delivery platforms for efficient delivery to disease sites with minimal off-target effects remains a major research goal. One crucial element of nanoparticle design influencing both pharmacokinetics and cell uptake is nanoparticle morphology (both size and shape). In this succinct review, the authors collate the recent literature to assess the current state of understanding of the influence of nanoparticle shape on the effectiveness of drug delivery with a special emphasis on cancer therapy.Areas covered: This review draws on studies that have focused on the role of nonspherical nanoparticles used for cancer drug delivery. In particular, the authors summarize the influence of nanoparticle shape on biocirculation, biodistribution, cellular uptake and overall drug efficacy. By comparing spherical and nonspherical nanoparticles, they establish some general design principles to serve as guidelines for developing the next generation of nanocarriers for drug delivery.Expert opinion: Pioneering studies on nanoparticles show that nonspherical shapes show great promise as cancer drug delivery vectors. Filamentous or worm-like micelles together with other rare morphologies such as needles or disks may become the norm for next-generation drug carriers, though at present, traditional spherical micelles remain the dominant shape of nanocarriers described in the literature due to synthesis and testing difficulties. The few reports that do exist describing nonspherical nanoparticles show a number of favorable properties that should encourage more efforts to develop facile and versatile nanoparticle synthesis methodologies with the flexibility to create different shapes, tunable sizes and adaptable surface chemistries. In addition, the authors note that there is a current lack of understanding into the factors governing (and optimizing) the inter-relationships of size, surface characteristics and shapes of many nanoparticles proposed for use in cancer therapy.
IntroductionNew international clinical practice guidelines exist for identifying infants at high risk of cerebral palsy (CP) earlier: between 12 to 24 weeks corrected age, significantly earlier than ...previous diagnosis windows in Australia at 19 months. The earlier detection of infants at high risk of CP creates an opportunity for earlier intervention. The quality of the parent-infant relationship impacts various child outcomes, and is leveraged in other forms of intervention. This paper presents the protocol of a randomised controlled trial of an online parent support programme, Early Parenting Acceptance and Commitment Therapy (Early PACT) for families of infants identified as at high risk of CP. We predict that participating in the Early PACT programme will be associated with improvements in the parent-infant relationship, in parent mental health and well-being as well as infant behaviour and quality of life.Methods and analysisThis study aims to recruit 60 parents of infants (0 to 2 years old corrected age) diagnosed with CP or identified as at high risk of having CP. Participants will be randomly allocated to one of two groups: Early PACT or waitlist control (1:1). Early PACT is an online parent support programme grounded in Acceptance and Commitment Therapy (ACT). It is delivered as a course on an open source course management system called edX. Early PACT is designed to support parental adjustment and parent-infant relationship around the time of early diagnosis. Assessments will be conducted at baseline, following completion of Early PACT and at 6-month follow-up (retention). The primary outcome will be the quality of parent-child interactions as measured by the Emotional Availability Scale. Standard analysis methods for randomised controlled trial will be used to make comparisons between the two groups (Early PACT and waitlist control). Retention of effects will be examined at 6-month follow-up.Ethics and disseminationThis study is approved through appropriate Australian and New Zealand ethics committees (see in text) with parents providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations.Trial registration detailsThis trial has been prospectively registered on 12 June 2018 to present (ongoing) with the Australian New Zealand Clinical Trials Registry (ACTRN12618000986279); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=3 74 896
A mindfulness yoga program (MiYoga) was developed and trialled with children with cerebral palsy and their parents. This mixed-method study explores the experiences of children and parents who ...participated in MiYoga, to assess its acceptability, feasibility and implementation.
Of the forty-two child-parent dyads who participated in the MiYoga randomised control trial, 19 children and 22 parents were interviewed individually in a semi-structured way about their experiences of MiYoga. Participants rated their mood on a 5-point scale before and after each session and completed short questionnaires at the end of each session.
Children and parents reported improved mood after each MiYoga session. Parents reported being more aware of their thoughts and feelings and possibly became more aware of their day-to-day mindlessness.
MiYoga significantly improved children and parents’ mood. Parents reported gains in awareness as well as challenges of adhering to the home practice.
Introduction
Capturing the patient experience of living with a rare disease such as X-linked hypophosphataemia (XLH) is critical for a holistic understanding of the burden of a disease. The ...complexity of the disease coupled with the limited population makes elicitation of the patient burden methodologically challenging. This study used qualitative information direct from patient and caregiver statements to assess the burden of XLH.
Methods
A thematic analysis was conducted on statements received during a National Institute for Health and Care Excellence (NICE) online public open consultation from 15 June to 6 July 2018. Researchers and clinical experts generated themes and codes based on expected aspects of XLH burden. Statements were independently coded by two reviewers, adding additional codes as required, and analysed by frequency and co-reporting across age groups.
Results
The majority of responses were submitted from UK-based patients with some from the USA and Australia, and the statements related to children, adolescents and adults. The findings suggest that the greatest burden experienced by children is associated with conventional therapy, co-reported with dosing regimen, adherence, distress and pain. During adolescence, the burden becomes increasingly complex and multi-factorial, with an increasing psychological burden. In adults, conventional therapy co-reported with bone deformity and orthopaedic surgery, as well as pain, mobility, fatigue and dental problems, featured highly.
Discussion
Whilst our study was opportunistic in nature, it has highlighted the clear and distinctive evolution of the burden of XLH, transitioning from being therapy-oriented in childhood to multi-factorial in adolescence, and finally to adulthood with its high impact on need for other interventions, function and mobility. This qualitative thematic analysis enhances the understanding of the symptom and treatment burden of XLH.
To test an online course Parenting Acceptance and Commitment Therapy (PACT) in an RCT with families of children with cerebral palsy (CP), predicting improvements in emotional availability and parent ...and child adjustment.
67 families of children (2–10 years) with CP participated. Families were randomly assigned to waitlist control or PACT. Assessments at baseline, post-intervention and at six-month follow up (durability of intervention effects) focussed on emotional availability, adjustment and quality of life. Analysis consisted of repeated measure linear regression models.
At postintervention (T2), an intervention effect was demonstrated for two aspects of observed emotional availability: parental non-intrusiveness MD = 0.68 (−0.56 to 1.92), p = 0.050 and child involvement, MD = 0.91 (−0.36 to 2.18), p = 0.011. An intervention effect was also found for the parent-reported emotional availability in terms of child involvement. Further intervention effects were found in parent-report measures of child quality of life (social wellbeing and acceptance, participation and physical health), parental mindfulness, parental acceptance, support, social connection, and meaning. No effects were found on parent or child adjustment. Analyses focussed on durability of intervention effect, collapsed across groups, indicated that effects persisted at 6 month follow up (T4).
PACT demonstrated an intervention effect for two aspects of emotional availability−parental non-intrusiveness and child involvement−as well as parental mindfulness and child quality of life. Parents reported increased comfort with the CP diagnosis, higher likelihood to seek support, higher likelihood to stay connected to others and greater meaningful living. PACT is an effective online/telehealth parenting support intervention for parents of children with CP.
•First RCT demonstrating an impact of ACTon parent-child emotional availability.•RCT of online/telehealth intervention for families of children with CP.•Improvements in child quality of life and parental mindfulness.
IMPORTANCE: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based ...guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment ...Therapy; PACT).
Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10-24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews.
Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery.
Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care.
IMPLICATIONS FOR REHABILITATION
Parents want clinicians to be honest, supportive and to normalise their grief
Clinicians in rehabilitation would benefit from up-skilling in grief support
Parental support should be built into systems of care for children with cerebral palsy
Aim
To investigate the efficacy of an embodied mindfulness‐based movement programme (MiYoga), targeting attention in children with cerebral palsy (CP).
Method
Total number of participants 42, with 24 ...boys (57.1%) and 18 girls (42.9%); mean age 9y 1mo, SD 3y; Gross Motor Function Classification System levels I=22, II=12, III=8) and their parents were randomized to either MiYoga (n=21) or waitlist comparison (n=21) groups. The primary outcome was attention postintervention measured by the Conners’ Continuous Performance Test, Second Edition (CCPT). Secondary outcomes included parent and child mindfulness, child quality of life, parental well‐being, child executive function, child behaviour, child physical measures, and the parent–child relationship.
Results
Children in the MiYoga group demonstrated significantly better attention postintervention than the waitlist comparison group, with lower inattention scores on the hit reaction time standard error (F1,33=4.59, p=0.04, partial eta‐squared ηp2=0.13) variable and fewer perseveration errors (F1,33=4.60, p=0.04, ηp2=0.13) on the CCPT. Intention‐to‐treat analysis also revealed that sustained attention in the MiYoga group was significantly better than in the waitlist comparison group postintervention (F1,37=5.97, p=0.02, ηp2=0.14). Parents in the MiYoga group demonstrated significantly decreased mindfulness (Mindfulness Attention Awareness Scale; F1,33=10.130, p=0.003, ηp2=0.246).
Interpretation
MiYoga offers a lifestyle intervention that improves attention in children with CP. MiYoga can be considered as an additional option to standard rehabilitation to enhance attention for children with CP.
What this paper adds
MiYoga, an embodied mindfulness‐based movement programme, can enhance attention (more attentive and consistent performance) in children with cerebral palsy.
MiYoga had no significant effect on physical functioning.
Resumen
Efecto del programa de yoga mindfulness MiYoga sobre la atención, el comportamiento y los resultados físicos en la parálisis cerebral: un ensayo controlado aleatorizado
Objetivo
Investigar la eficacia de un programa de mindfulness incorporado, MiYoga, dirigido a la atención en niños con parálisis cerebral (PC).
Método
Cuarenta y dos niños con PC (57.1% hombres, edad media 9 años 1 mes, SD 3 años 0 mes, Sistema de clasificación de la función motora gruesa niveles I=22, II=12, III=8) y sus padres fueron aleatorizados a MiYoga (n=21) o grupos de comparación en lista de espera (n=21). El resultado primario fue la atención post intervención medida por la prueba de rendimiento continuo de Conners, segunda edición (CCPT). Los resultados secundarios incluyeron mindfulness de los padres e hijos, la calidad de vida del niño, el bienestar de los padres, la función ejecutiva del niño, el comportamiento del niño, las medidas físicas del niño y la relación entre padres e hijos.
Resultados
Los niños del grupo MiYoga demostraron una atención significativamente mejor post intervención que el grupo de comparación de la lista de espera, con puntuaciones de inatención más bajas en el error estándar de tiempo de reacción (F1,33=4.59, p=0.04, eta parcial ηp2 =0.13) variable y menos errores de perseveración (F1, 33=4.60, p=0.04, ηp2=0.13) en el CCPT. El análisis por intención de tratar también reveló que la atención sostenida en el grupo MiYoga fue significativamente mejor que en el grupo de comparación de la lista de espera post intervención (F1,37=5,97, p=0,02, ηp2=0,14). Los padres del grupo MiYoga demostraron una disminución significativa de mindfulness (Mindfulness Attention Awareness Scale, F1,33=10.130, p=0.003, ηp2=0.246).
Interpretación
MiYoga ofrece una intervención en el estilo de vida que mejora la atención en niños con PC. MiYoga puede considerarse como una opción adicional a la rehabilitación estándar para mejorar la atención de los niños con PC.
Resumo
Efeito do programa de yoga e atenção plena MiYoga na atenção, comportamento, e resultados físicos em paralisia cerebral: um ensaio clínico randomizado
Objetivo
Investigar a eficácia de um programa baseado em atenção plena, MiYoga, voltado para a atenção em crianças com paralisia cerebral (PC).
Método
Quarenta e duas crianças com PC (57,1% do sexo masculino; média de idade 9a1m, DP 3a 0m; Níveis do Sistema de classificação da função motora grossa I=22, II=12, III=8) e seus pais foram randomizados para participar do grupo MiYoga (n=21) ou uma lista de espera de comparação (n=21). O desfecho primário foi a atenção pós‐intervenção mensurada pelo Teste de Desempenho Contínuo de Conners, segunda edução (TDCC). Desfechos secundários incluíram a atenção plena dos pais e crianças, qualidade de vida da criança, bem estar dos pais, função executiva da criança, medidas físicas da criança, e relação pai‐filho.
Resultados
Crianças no grupo MiYoga demonstraram atenção significativamente melhor pós‐intervenção do que o grupo comparação da lista de espera, com menores escores de desatenção na variável erro padrão do tempo de reação para apertar (F1,33=4,59, p=0,04, partial eta squared ηp2=0,13) e menores erros de perserveração (F1,33=4,60, p=0,04, ηp2=0,13) no TDCC. A análise de intenção de tratar também revelou que a atenção sustentada no grupo MiYoga foi significantemente melhor do que o grupo de comparalição de lista de esperra após a intervenção (F1,37=5,97, p=0,02, ηp2=0,14). Pais no grupo MiYoga demonstraram significantemente menos atenção plena (Mindfulness Attention Awareness Scale; F1,33=10,130, p=0,003, ηp2=0,246).
Interpretação
O MiYoga oferece uma intervenção de estilo de vida que melhora a atenção em crianças com PC. O MiYoga pode ser considerado como uma opção adicionar para a reabilitação convencional para melhorar a atenção de crianças com PC.
What this paper adds
MiYoga, an embodied mindfulness‐based movement programme, can enhance attention (more attentive and consistent performance) in children with cerebral palsy.
MiYoga had no significant effect on physical functioning.
This article is commented on by Rinehart, Jeste, and Wilson on pages 856–857 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
Video Podcast: https://www.youtube.com/watch?v=i7SBc-DE4tA&feature=youtu.be
A randomised controlled trial (RCT) of a mindfulness-based yoga program, MiYoga, for cerebral palsy (CP) demonstrated improved attention in children and decreased mindfulness in parents ...post-intervention. This paper evaluates the retention of treatment effects at 6-months follow-up.
42 children with CP and their parents participated in a RCT with two groups MiYoga (n = 21) and Waitlist control group (n = 21). Waitlist control participants were offered MiYoga following the post-intervention assessment. 23 out of 42 child-parent dyads from both groups completed follow-up assessment 6-months after completing MiYoga. This paper evaluates and reports data from both groups collapsed (n = 23; MiYoga n = 11; and waitlist control n = 12; 47.8% male; mean age = 9:10 ± 2.4 years) to assess retention from post-MiYoga to follow-up and pre-MiYoga to follow-up. The primary outcome was attention, measured by Conner's Continuous Performance Test II (CCPT). Secondary outcomes included child executive function, physical function, behaviour, quality of life, child and parent mindfulness, personal wellbeing, psychological wellbeing and parent-child relationship.
Paired t-tests showed no significant changes between post-MiYoga to follow-up and pre-MiYoga to follow-up for variables that showed an intervention effect immediately after MiYoga, namely, children's attention variables and parent's mindfulness. Paired t-tests showed that children's executive function and physical function and parent's wellbeing improved significantly from pre-MiYoga to 6-months follow-up which may potentially reflect sleeper or delayed effects of MiYoga.
This study identified possible delayed or sleeper effects in children's executive function and physical function and parent's well-being.
Implications for rehabilitation
6-month follow-up evidence for retention of effects of MiYoga on children's attention was inconsistent; therefore, booster sessions or continued practice of MiYoga as a lifestyle option are needed to maintain an effect on attention.
Because MiYoga can be practised during daily activities, it may provide additional support for children with CP, complementing standard rehabilitation options.
By embedding mindfulness in children and parents' daily activities, MiYoga, could provide families with accessible and time-efficient means of learning and practicing mindfulness.
The purpose of this study was to evaluate the efficacy of mindfulness-based interventions including mindful movements such as yoga on attention and executive function in children and adolescents. ...Systematic searches were conducted on five databases (PubMed, PsycINFO, CINAHL, Web of Science, and Scopus). Included studies consisting of randomized or quasi-randomized controlled trials with a mindfulness-based intervention were assessed for quality, and relevant data was extracted and collated. Thirteen randomized control trials were identified as meeting inclusion criteria, including mindfulness-based psychological interventions (
n
= 7), yoga (
n
= 3), and traditional meditation techniques (
n
= 2). Studies recruited adolescents or children that were typically developing, diagnosed with attention-deficit hyperactivity disorder, orphans, or had reading difficulties, or in correctional schools/institutions. The quality of the 13 studies ranged from low to high based on the PEDro (Physiotherapy Evidence Database) scale with the average score of 6.62 out of the highest possible score of 11 (the higher the score, the higher the quality). Five of the 13 studies found a statistically significant intervention effect for at least one outcome measure of attention or executive function with medium to large effect sizes (0.3–32.03). Mindfulness-based interventions are a promising approach to targeting attention and executive function in children and adolescence, especially with the use of computerized measures as outcome measures. All identified studies included interventions with multiple treatment components, so the effects attributable to mindfulness-based training still remain undetermined. Further quality trials are needed to assess the effectiveness of mindfulness-based interventions in enhancing attention and executive function in children and adolescents.
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