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Registered at Clinicaltrials.gov (NCT03900559) on April 9, 2019. Retrospectively registered. Background: More research is needed in the field of Internet-delivered Cognitive Behavioral Treatments (ICBTs) for specific phobia in order to understand which characteristics are important in online exposure scenarios. The aim of the present work was to conduct a feasibility pilot study to explore participants' opinions, preferences, and acceptability ratings of two types of images (still images vs 360◦ navigable images) in an ICBT for Flying Phobia (FP). A secondary aim was to test the potential effectiveness of the two active treatment arms compared to a waiting list control group. An exploratory aim was to compare the role of navigable images vs. still images in the level of sense of presence and reality judgment and explore their possible mediation in treatment effectiveness. Methods: Participants were randomly allocated to three conditions: NO-FEAR Airlines with still images (n = 26), NO-FEAR Airlines with still and navigable images (n = 26), and a waiting list group (n = 26). Primary outcome measures were participants' opinions, preferences, satisfaction, and acceptance regarding the images used in the exposure scenarios. Secondary outcome measures included FP symptomatology outcomes and measures of sense of presence and reality judgment. Results: Participants in the study preferred navigable images over still images before and after treatment (over 84%), and they considered them more effective and logical for the treatment of their problem. However, adherence in the experimental conditions was low (42.3% dropout rate), and more participants withdrew from the group that included navigable images compared to the group that only included still images (14 vs. 8), with no statistical differences in attrition between the two conditions. NO-FEAR Airlines proved to be effective in reducing FP symptomatology compared to the control group, with large between-group effect sizes on all FP measures (ranging from 0.76 to 2.79). No significant mediation effect was found for sense of presence or reality judgment in treatment effectiveness. Discussion: The results of the current study suggest that participants prefer more immersive images in exposure scenarios, providing data that can help to design useful exposure scenarios to treat specific phobias in the future. They also provide evidence supporting the effectiveness of an ICBT for FP.

Legionnaires’ disease (LD) is an atypical pneumonia caused by the inhalation of Legionella. The methods used for the diagnosis of LD are direct culture of respiratory samples and urinary antigen detection. However, the sensitivity of culture is low, and the urinary antigen test is specific only for L. pneumophila sg1. Moreover, as no isolates are obtained, epidemiological studies cannot be performed. The implementation of Nested-sequence-based typing (Nested-SBT) makes it possible to carry out epidemiological studies while also confirming LD, especially in cases caused by non-sg 1. Sixty-two respiratory samples from patients with Legionella clinically confirmed by positive urinary antigen tests were cultured and tested by Nested-SBT, following the European Study Group for Legionella Infections (ESGLI) protocol. Only 2/62 (3.2%) respiratory samples were culture-positive. Amplification and sequencing of Nested-SBT genes were successfully performed in 57/62 samples (91.9%). The seven target genes were characterised in 39/57 (68.4%) respiratory samples, and the complete sequence type (ST) was obtained. The mip gene was the most frequently amplified and sequenced. Nested-SBT is a useful method for epidemiological studies in culture-negative samples, achieving a 28.7-fold improvement over the results of culture studies and reducing the time needed to obtain molecular epidemiological results.

Cristina Botella,1,2 Adriana Mira,1 Inés Moragrega,2,3 Azucena García-Palacios,1,2 Juana Bretón-López,1,2 Diana Castilla,1,2 Antonio Riera López del Amo,1 Carla Soler,1 Guadalupe Molinari,1 Soledad Quero,1,2 Verónica Guillén-Botella,2,3 Ignacio Miralles,1,2 Sara Nebot,1 Berenice Serrano,1,2 Dennis Majoe,4 Mariano Alcañiz,2,5 Rosa María Baños2,31Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain; 2CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain; 3Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain; 4Native Systems Institute, ETH Zurich, Zurich, Switzerland; 5Human-Centered Technology Institute, Universidad Politécnica de Valencia, Valencia, Spain Purpose: Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men).Patients and methods: Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program.Results: Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables.Conclusion: This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to use. Keywords: depression, ease of use, efficacy, Internet, sensors, satisfaction

Legionella is the causative agent of Legionnaires' disease (LD). In Spain, Catalonia is the region with the highest incidence of LD cases. The characterisation of clinical and environmental isolates using molecular epidemiology techniques provides epidemiological data for a specific geographic region and makes it possible to carry out phylogenetic and population-based analyses. The aim of this study was to describe and compare environmental and clinical isolates of Legionella pneumophila in Catalonia using sequence-based typing and monoclonal antibody subgrouping. A total of 528 isolates were characterised. For data analysis, the isolates were filtered to reduce redundancies, and 266 isolates (109 clinical and 157 environmental) were finally included. Thirty-two per cent of the clinical isolates were ST23, ST37 and ST1 while 40% of the environmental isolates were ST284 and ST1. Although the index of diversity was higher in clinical than in environmental ST isolates, we observed that clinical STs were similar to those recorded in other regions but that environmental STs were more confined to particular study areas. This observation supports the idea that only certain STs trigger cases or outbreaks in humans. Therefore, comparison of the genomes of clinical and environmental isolates could provide important information about the traits that favour infection or environmental persistence.

Acceptability (i.e. patients' expectation and satisfaction with the treatment) is claimed as an important and additional criterion besides efficacy. Nevertheless, the literature addressing this issue in the field of Interet-based treatments for specific phobias is scarce, and no studies for Flying Phobia (FP) are available. This study aims to explore the relationship between expectations and satisfaction with treatment and clinical variables in patients who have received an Intemet-based treatment for FP (NO-FEAR Airlines). The sample included 46 participants from a randomized controlled trial. Clinical measures were: Fear of Flying Questionnaire-II, Fear of Flying scale, Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement Scale. Results showed significant correlations between expectations, satisfaction and the change on different clinical variables. Patients' expectations significantly correlated and predicted satisfaction with the treatment. Results also revealed that satisfaction with the treatment remained as a significant predictor of the change on all clinical variables. In sum, this study offers data on the relationship between acceptability measurements and clinical variables in patients receiving an Internet-based treatment for FP.

The present study is aimed to analyze acceptability ratings of positive technologies reported by patients with eating disorders. 54 patients were enrolled in a randomized control trial with two experimental conditions. In the intervention group (n=29), participants performed the best possible self exercise, through positive technologies, for one month. Likewise, participants in the control group (n=25) had to write about their daily activities also through technology. Acceptability levels were rated at the end of the one-month training. Results showed that participants of both conditions reported appropriate levels of satisfaction with the exercises and the technologies and they also perceived the exercises as useful. These results suggest that positive technologies can serve as a supporting tool delivering interventions aimed to improve positive emotions and well-being in clinical samples.

Many medical procedures produce acute pain that in most cases is quite disturbing for the individual. Medication is the treatment of choice for acute pain. However, given the involvement of psychological aspects in the experience of pain, psychological techniques are being used as an effective adjunct to alleviate pain related to medical procedures. In the last years a new technology is demonstrating an enormous potential in this field: Virtual Reality (VR) distraction. In this article we review studies that explore the efficacy of immersive VR distraction in reducing pain related to different medical procedures. We include clinical studies and analogue studies with healthy participants. We discuss the results achieved by these studies and recommend future directions of VR pain control research.