Managing plasma P concentrations in beef heifers with a slow release vitamin D supplementation

Context In extensive northern grazing systems, supplementation of P is recommended to maximise cattle growth rates and reproduction. Improving the absorption of P for the animal by influencing metabolic pathways has the potential to improve both the productivity and profitability of extensive livestock enterprises. Aims This study evaluated the efficacy of rumen bolus containing 25-hydroxyvitamin D (25OHD), commercially available as Hy-D®, and/or monensin on blood P and Ca concentrations in young cattle. Methods A total of 84 heifers, initial liveweight (mean ± s.e.m.) 184 ± 2.0 kg, were allocated to four groups, dosed with one of four slow release bolus: (1) placebo (control), (2) monensin (120 mg/day), (3) Hy-D® (6 mg/day), or (4) monensin with Hy-D®, and managed on a common unimproved native pasture from August 2012 to February 2013. On four occasions postdosing, liveweight, hip height and body condition scores were recorded, and individual faecal and jugular blood samples were collected. Key results Supplementation with monensin had a significant effect (P < 0.05) on average daily gains for the first 25 days. Interactions between 25OHD and monensin and time × monensin were also significant (P < 0.05). After 188 days, heifers receiving monensin or 25OHD + monensin were 5 and 10 kg heavier respectively, compared with their counterparts in the control and 25OHD groups. Plasma P concentrations at 25 days were 6.6 mg/dL, then increased to between 8.5 and 9.0 mg/dL and maintained this level for up to 109 days with a bolus releasing 6.0 mg/day 25OHD. Conclusions The study demonstrated that sustained and elevated plasma concentrations of both 25OHD and P, compared with control animals, can be achieved. The slow release rumen bolus maintained an elevated plasma concentration of 25OHD, and indicated that a target plasma concentration for 25OHD for increasing P absorption in beef cattle is between 200 and 300 ng/mL. Implications Supplementation of a metabolite of vitamin D influences P metabolism in Brahman heifers under grazing conditions. Integration with standard supplementation practices would optimise growth rates and reproductive performance.

Feasibility of an Intervention to Support Hearing and Vision in Dementia: The SENSE-Cog Field Trial

OBJECTIVES

People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD.

DESIGN

An international single-arm open-label feasibility, acceptability, and tolerability study.

SETTING

Home-based setting in the United Kingdom, France, and Cyprus.

PARTICIPANTS

Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads).

INTERVENTION

A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion.

MEASUREMENTS

Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews.

RESULTS

We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified.

CONCLUSION

This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable.

Better Health Durham: Community Engagement in a Cluster RCT of a Prevention Practitioner Intervention in Low-Income Neighbourhoods

Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening (BETTER) intervention has improved uptake of chronic disease prevention and screening activities in primary care. The BETTER intervention consists of 1:1 visits between prevention practitioners (PPs) and patients (40-65 years). It is unknown if an adapted BETTER could be effective in the community with public health nurses as PPs. Aim: The presentation objective is to describe community engagement strategies in a cluster RCT in low income neighborhoods with low cancer screening rates and low uptake of primary care. Methods: Principles of community-based participatory research were used to design the community engagement strategy in Durham region, Ontario. Key elements included close collaboration with public health partners to identify stakeholders and creating a community advisory committee (CAC) and a primary care engagement group to provide advice. Results: We identified 15 community stakeholder groups (∼47 subgroups) including service organizations, faith groups, and charitable organizations representing diverse constituents. Community outreach activities included in-person meetings and information displays at local events. The CAC is comprised of members of the public and representatives from primary care, social services, and community organizations. The CAC and primary care engagement groups have provided advice on trial recruitment strategies and on the design of the PP visit. Conclusion: The partnership between public health, primary care, and the study team has been crucial to connect with community stakeholders. Community engagement is essential in raising awareness about the study and will contribute to successful recruitment. Trial Registration: NCT03052959

The HARMONIC trial: study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds-a modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults

INTRODUCTION

Anxiety, mood and trauma-related disorders are common, affecting up to 20% of adults. Many of these individuals will experience symptoms of more than one disorder as diagnostically defined. However, most psychological treatments focus on individual disorders and are less effective for those who experience comorbid disorders. The Healthy and Resilient Mind Programme: Building Blocks for Mental Wellbeing (HARMONIC) trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds (SHM)), which synthesises several evidence-based treatment techniques to address the gap in effective interventions for people with complex and comorbid difficulties. This early phase trial aims to estimate the efficacy and feasibility of the transdiagnostic intervention in preparation for a later-phase randomised controlled trial, and to explore mechanisms of change.

METHODS/ANALYSIS

We outline a patient-level two-arm randomised controlled trial (HARMONIC) that compares SHM to treatment-as-usual for individuals aged >18 years (n=50) with comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorders diagnoses, recruited from outpatient psychological services within the UK National Health Service (NHS). The co-primary outcomes will be 3-month follow-up scores on self-report measures of depressive symptoms, anxiety symptoms, and disability and functional impairment. Secondary outcomes include changes in symptoms linked to individual disorders. We will assess the feasibility and acceptability of SHM, the utility of proposed outcome measures, and refine the treatment manuals in preparation for a later-phase trial.

ETHICS AND DISSEMINATION

This trial protocol has been approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). We anticipate that trial findings will inform future revisions of clinical guidelines for numerous forms of mood, anxiety and stressor-related disorders. Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations, clinical workshops and a trial website.

TRIAL REGISTRATION

NCT03143634; Pre-results.

Differences in neural and cognitive response to emotional faces in middle-aged dizygotic twins at familial risk of depression

BACKGROUND

Negative bias and aberrant neural processing of emotional faces are trait-marks of depression but findings in healthy high-risk groups are conflicting.

METHODS

Healthy middle-aged dizygotic twins (N = 42) underwent functional magnetic resonance imaging (fMRI): 22 twins had a co-twin history of depression (high-risk) and 20 were without co-twin history of depression (low-risk). During fMRI, participants viewed fearful and happy faces while performing a gender discrimination task. After the scan, they were given a faces dot-probe task, a facial expression recognition task and questionnaires assessing mood, personality traits and coping.

RESULTS

Unexpectedly, high-risk twins showed reduced fear vigilance and lower recognition of fear and happiness relative to low-risk twins. During face processing in the scanner, high-risk twins displayed distinct negative functional coupling between the amygdala and ventral prefrontal cortex and pregenual anterior cingulate. This was accompanied by greater fear-specific fronto-temporal response and reduced fronto-occipital response to all emotional faces relative to baseline. The risk groups showed no differences in mood, subjective state or coping.

CONCLUSIONS

Less susceptibility to fearful faces and negative cortico-limbic coupling during emotional face processing may reflect neurocognitive compensatory mechanisms in middle-aged dizygotic twins who remain healthy despite their familial risk of depression.

A novel resting-state functional magnetic resonance imaging signature of resilience to recurrent depression

BACKGROUND

A high proportion of patients with remitted major depressive disorder (MDD) will experience recurring episodes, whilst some develop resilience and remain in recovery. The neural basis of resilience to recurrence is elusive. Abnormal resting-state connectivity of the subgenual cingulate cortex (sgACC) was previously found in cross-sectional studies of MDD, suggesting its potential pathophysiological importance. The current study aimed to investigate whether resting-state connectivity to a left sgACC seed region distinguishes resilient patients from those developing recurring episodes.

METHOD

A total of 47 medication-free remitted MDD patients and 38 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. Over 14 months, 30 patients remained resilient whilst 17 experienced a recurring episode.

RESULTS

Attenuated interhemispheric left-to-right sgACC connectivity distinguished the resilient from the recurring-episode and control groups and was not correlated with residual depressive symptoms.

CONCLUSIONS

The current study revealed a neural signature of resilience to recurrence in MDD and thereby elucidates the role of compensatory adaptation in sgACC networks.

Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery

Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.

An analysis of drug costs for the management of chemotherapy-related side effects in advanced colorectal cancer

Purpose. To assess whether there is a difference in associated drug costs for the management of chemo therapy-related side effects for patients with advanced colorectal cancer treated with raltitrexed (Tomudex, Zeneca Limited) or 5-FU plus folinic acid (Mayo regimen).

Data Sources. The drugs used for the manage ment of side effects were determined using a UK cohort (n = 62) taken from a large phase III ralti trexed clinical study. This study compared the toler ability and efficacy of raltitrexed vs 5-FU plus low- dose folinic acid and reported a significantly lower incidence of WHO grade 3/4 mucositis and leucope nia with raltitrexed. Drug costs were sourced using the British National Formulary, the Monthly Index of Medical Specialities and the Chemist and Druggist. Drug costs for the management of individual chemo therapy-related side-effects were calculated for both treatment groups and the total mean cost was com pared using the Student t test. Costs associated with the use of drugs for the management of clinically similar side effects, for example, nausea and vomiting were also investigated.

Results. There was a significant reduction in the mean total drug cost per patient for the management of chemotherapy-related side effects in the raltitrexed group compared to the 5-FU/folinic acid treatment group (£,64.27 vs £139.14; P = .0016). Infection was the most costly individual side effect for both treat ment groups but was lower in the raltitrexed cohort (£25.46 vs £59.93). Drug costs for the management of nausea and vomiting, pain and abdominal pain, and mucositis side effects were also considerably lower in the raltitrexed cohort.

Conclusion. The significantly lower drug cost for the management of chemotherapy-related side effects for the raltitrexed patients in the UK cohort suggests that the lower WHO grade 3/4 toxicity observed with raltitrexed in the phase III study would also be associated with a reduction in drug costs for the management of chemotherapy-related side ef fects.