Preventing depression: Qualitatively examining the benefits of depression-focused iCBT for participants who do not meet clinical thresholds

•First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds•Successful application of cognitive and behavioural strategies reported•Increased insight/awareness and improved self-efficacy reported•The format of online delivery was reported as helpful.•Findings align with previous face-to-face and iCBT treatments.

Increased speed and sensitivity, and reduced sample size of a micro-radioallergosorbent test (MRAST)

Performance of the radioallergosorbent test (RAST) in small volumes (MRAST) increases the efficiency with which both IgE antibody and 125I-anti-IgE bind. The rate at which antibody binds is increased up to 290-fold so that the assay can be completed in 60 min with comparable sensitivity to RAST. The increased speed of binding is achieved by the use of small incubation volumes which does not affect the rate at which bound antibody is dissociated. The resulting change in the equilibrium in favour of antibody binding yields a 10-fold increase in sensitivity which makes it possible to use as little as 5 microliter of sample compared with 50 microliter which is normal for RAST. MRAST can be used to measure IgE antibody in heel prick blood samples taken from babies, in rat sera and in other situations where the sample is in short supply.

Hypothermia among resort skiers: 19 cases from the Snowy Mountains

Even in relatively temperate environments, accidental hypothermia is a potentially lethal complication of exposure. We have reviewed our experience of accidental hypothermia among recreational alpine skiers at an Australian resort during the 1983 and 1984 seasons. There were 19 cases of accidental hypothermia, which occurred in 10 men and nine women who were aged between six and 47 years (mean age, 15.9 years) and who had rectal temperatures that ranged from less than 35 degrees C to 36 degrees C. The temperature at presentation to the Ski Injury Clinic was less than 35 degrees C in seven cases. One patient presented to the Clinic with a gastrointestinal haemorrhage in addition to hypothermia, and one was initially thought to be suffering from alcohol intoxication. Two patients were lost in the snow overnight. All patients were removed from the snow, changed into warm dry clothes where necessary, and their body temperatures allowed to return to normal spontaneously (17 patients), or were exposed to heat actively by means of inhaled, heated, humidified air (two severely obtunded patients). All patients responded satisfactorily. There were no deaths and no sequelae. We conclude that all skiers should be advised to wear effective thermal insulation, and to ski with a partner to ensure that adequate care is taken to prevent accidental hypothermia. Inhalational "warming" is effective in the treatment of hypothermia in obtunded patients.

Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study

AIMS

Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies.

METHODS AND RESULTS

Two hundred and ten patients underwent CMR (median 4 days [IQR 3-7]) and transthoracic echocardiography (median 4 days [IQR 3-7]) early after STEMI presentation with serial follow-up CMR (median 55 days [IQR 46-64]) and echocardiography studies (median 54 days [IQR 45-64]) performed subsequently. The incidence of LV thrombus was 12.3% (26/210) by CMR and 6.2% (13/210) by two-dimensional echocardiography. Echocardiography had 50% sensitivity and 100% specificity for LV thrombus detection compared to CMR. LV thrombus was found in 23.6% of patients with anterior STEMI (22/93). Ischaemic stroke occurred in 1.4% of patients (3/210). Patients with LV thrombus had lower baseline LV ejection fraction (LVEF) (34.9% vs 47.4%, p < 0.001). Microvascular obstruction was more common in patients with LV thrombus (77% vs 39%, p < 0.001). Patients with LV thrombus had increased LV dimensions with larger LV end-diastolic (19 ml [IQR 9-44] vs 6 ml [IQR -4-18], p < 0.001) and end-systolic volumes (10 ml [IQR 0-22] vs -4 ml [IQR -12-4], p < 0.001).

CONCLUSION

CMR increases the detection of LV thrombi which standard echocardiography may underestimate. Serial studies post-STEMI may improve detection of LV thrombus, which is more prevalent in patients with anterior infarction, moderate LV dysfunction and adverse LV remodelling. This subgroup of patients may represent a high-risk group for targeted serial screening with CMR.

Transported to New South Wales: medical convicts 1788-1850

Images

Automated Method of Grading Vitreous Haze in Patients With Uveitis for Clinical Trials

Purpose

Uveitis is associated with accumulation of exudate in the vitreous, which reduces fundus visibility. The condition is assessed in patients by subjectively matching fundus photographs to a six-level (NIH) or nine-level (Miami) haze scale. This study aimed to develop an objective method of assessing vitreous haze.

Methods

An image-processing algorithm was designed that quantifies vitreous haze via high-pass filtering, entropy analysis, and power spectrum integration. The algorithm was refined using nine published photographs that represent incremental levels of fundus blur and applied without further refinement to 120 random fundus photographs from a uveitis image library. Computed scores were compared against the grades of two trained readers of vitreous haze and against acutance, a generic measure of image clarity, using Cohen's κ and Gwet's AC statistics.

Results

Exact agreement between algorithm scores and reader grades was substantial for both NIH and Miami scales (κ = 0.61 and 0.67, AC = 0.82 and 0.92). Within-one (κ = 0.78 and 0.82) and within-two (κ = 0.80 and 0.84) levels of agreement were almost perfect. The correspondence was comparable to that between readers. Whereas, exact (κ = 0.45 and 0.44, AC = 0.73 and 0.75), within-one (κ = 0.69 and 0.68), and within-two (κ = 0.73 and 0.72) levels of agreement for the two scales were moderate to substantial for acutance calculations.

Conclusions

The computer algorithm produces a quantitative measure of vitreous haze that correlates strongly with the perception of expert graders.

Translational Relevance

The work offers a rapid, unbiased, standardized means of assessing vitreous haze for clinical and telemedical monitoring of uveitis patients.

Gliadin IgG subclass antibodies in patients with coeliac disease

We have measured IgG1, 2, 3 and 4 subclass antibodies to gliadin and casein in normal controls, treated and untreated coeliac patients. The amount of antibody in each subclass was determined separately as a titre and as a concentration, by reference to a standard curve. Both methods of quantitation, carried out in separate assays, yielded comparable results (IgG antibody r = 0.86, IgG1 antibody r = 0.89). In all the coeliac patients, the majority of antibody was IgG1, and little IgG2, 3, 4 antibody was detected. Untreated coeliac patients had higher titres of IgG and IgG1 antibodies to gliadin and casein compared with normal controls. In the treated coeliac patients compared with the normal controls, there was no significant difference between the titres of IgG and IgG1 antibodies to gliadin but there were higher titres to casein.

Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes

INTRODUCTION

In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking.

METHODS

This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7).

RESULTS

Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6).

DISCUSSION

The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program.

FUNDING

The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES).

Spontaneous emission in non-local materials

Light-matter interactions can be strongly modified by the surrounding environment. Here, we report on the first experimental observation of molecular spontaneous emission inside a highly non-local metamaterial based on a plasmonic nanorod assembly. We show that the emission process is dominated not only by the topology of its local effective medium dispersion, but also by the non-local response of the composite, so that metamaterials with different geometric parameters but the same local effective medium properties exhibit different Purcell factors. A record-high enhancement of a decay rate is observed, in agreement with the developed quantitative description of the Purcell effect in a non-local medium. An engineered material non-locality introduces an additional degree of freedom into quantum electrodynamics, enabling new applications in quantum information processing, photochemistry, imaging and sensing with macroscopic composites.

Effectiveness of nursing interventions in people with personality disorders

BACKGROUND

Nurses usually provide care for people with personality disorders on a day-to-day basis. Consequently, it is important to establish how effective nursing interventions are for those with personality disorders, both in terms of general management and more specific therapeutic approaches. These are also issues of current political and professional debate. The crucial question, however, for planners, providers and commissioners of services is, What research evidence is there about effectiveness? There is also a need to determine what further research is necessary to evaluate programmes for managing or modifying behaviours.

AIM

The aim of this paper is to report on a systematic review of the literature on the effectiveness of nursing interventions in people with personality disorders, whether delivered by nurses alone or in combination with other health care professionals.

METHOD

The review was conducted according to the United Kingdom National Health Service Centre for Reviews and Dissemination guidelines. Literature was identified from electronic database searching, footnote chasing, hand searching of journals and contact with authors of studies. Narrative synthesis was undertaken in relation to study design, participants, and type of intervention.

FINDINGS

Eighteen separate studies were included in the review: four randomized controlled trials, four non-randomized controlled trials, seven before-and-after studies and three case studies.

CONCLUSIONS

There is a weak evidence-base for what constitutes effective nursing intervention with people with personality disorders. There is stronger evidence from mixed disciplines intervention studies than from nursing only intervention studies. Studies of interventions based on psychological approaches show greater improvements in outcomes than nursing management studies.

Target Mediated Drug Disposition Model of CPHPC in Patients with Systemic Amyloidosis

The amyloid deposits that cause disease in systemic amyloidosis always contain the normal plasma protein, serum amyloid P (SAP) component. SAP is the target of a novel immunotherapy approach now being developed to eliminate amyloid deposits. The treatment is enabled by, and critically depends on, the use of the drug (R)-1-[6-[(R)-2-carboxy-pyrrolidin-1-yl]-6-oxo-hexanoyl]pyrrolidine-2-carboxylic acid (CPHPC, GSK2315698, Ro 63-8695), which depletes circulating SAP almost completely but leaves some SAP in amyloid deposits for specific recognition by subsequently administered therapeutic anti-SAP antibodies. Herein, we report a mechanistic model that predicts, with clinically acceptable precision, the exposure-response relationship for CPHPC, both in healthy individuals and in patients with systemic amyloidosis. The model covariates are gender, renal function, total amyloid load, and presence of hepatic amyloid, all of which are known at baseline. The model is being used to predict individualized dosing regimens in an ongoing, first-in-human study with anti-SAP antibodies.

Key components in models of community-based interventions coordinating care in dementia: a mixed studies systematic review protocol

BACKGROUND

Current health and social care systems are providing suboptimal and fragmented care to the growing dementia population. Interventions aiming to coordinate care services for individuals with dementia and their families are already widely used; however, the structure and implementation of these interventions vary. This mixed studies review aims to investigate the key components of effective community-based interventions that focus on coordinating care in dementia.

METHODS

We will search MEDLINE, Cochrane Library, Embase and PsycINFO databases for studies of any design that look at community-based interventions that aim to coordinate dementia care through the allocation of a specified professional responsible for provision of care. Health Management Information Consortium (HMIC), Social Policy and Practice (SPP), ProQuest and International Clinical Trials Registry Platform (ICTRP) databases will be searched for grey literature. Outcomes of interest are health outcome measures that relate to the individual with dementia and/or informal caregiver, measures of resource use or process measures. Two independent reviewers will screen identified papers and extract data from eligible studies. Evidence synthesis will take place in three stages, and methods will be largely dependent on the data available. A sequential review design will be used where the qualitative evidence will be synthesised first, focusing on stakeholder's subjective views of key components. This will drive forward the quantitative stage which will identify key components of effective interventions. The final stage of the review will merge the two strands of evidence through a narrative synthesis.

DISCUSSION

The results from this review will be used to develop a model for a community-based intervention coordinating care in dementia. Furthermore, the findings will help guide future work on intervention development of health and social care services for dementia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015024618.

Cardiac magnetic resonance derived left atrial strain after ST-elevation myocardial infarction: an independent prognostic indicator

Background

The prognostic value of cardiac magnetic resonance (CMR) derived left atrial (LA) strain, ejection fraction (LAEF) and indexed volumes (LAVI_max and LAVI_min) after ST-elevation myocardial infarction (STEMI) remains controversial. The aim of this study was to assess the relationship between LA function and major adverse cardiovascular events (MACE) after STEMI.

Methods

A total of 202 prospectively recruited patients who underwent CMR at median day 4 after STEMI had complete CMR data for feature tracking assessment. LA reservoir and booster strain were quantified based on the average of three independently repeated measurements.

Results

MACE occurred in 35 patients during a median follow up of 607 days. Patients with MACE had lower median LA reservoir strain (18.9% vs. 29.4%, P<0.001), LA booster strain (9.4% vs. 13.0%, P=0.002) and LAEF (41.5% vs. 49.2%, P<0.001) than patients without MACE. Kaplan-Meier analyses demonstrated a difference in MACE between high- and low-risk groups for LA reservoir strain (cutoff 19.2%, P<0.001), LA booster strain (cutoff 9.7%, P<0.001) and LAEF (cutoff 38.5%, P<0.001). The AUC increased from 0.713 (95% CI: 0.608-0.818) for LVEF to 0.775 (95% CI: 0.680-0.870) when LA reservoir strain was added to LVEF (P=0.047). Univariate Cox regression analysis showed that all LA parameters had a significant effect on MACE, while multivariate analysis found LA reservoir strain was an independent predictor of MACE (HR 0.905; 95% CI: 0.843-0.972, P=0.006).

Conclusions

CMR derived LA reservoir strain independently predicted MACE after STEMI when adjusted for standard risk measures.

Assessment of the passivation capabilities of two different covalent chemical modifications on GaP(100)

Gallium phosphide is a semiconductor material that can be used for the fabrication of optoelectronic devices. The report compares the ability of two similar organic molecules to form covalent bonds with the GaP(100) surface. Undecenoic acid (UDA) is a terminal alkene that can potentially form Ga-C bonds, and mercaptoundecanoic acid (MUA) is a thiol that can be used to generate Ga-S bonds. The chemical passivation capabilities of the functionalized surfaces exposed to different media were investigated by contact angle measurements, atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS). Toxicity levels, which are important for sensing applications, were evaluated by inductively coupled plasma mass spectrometry (ICP-MS) on the media in which surfaces were stored in order to identify any gallium leaching from the substrates. Both molecules formed fairly disordered monolayers demonstrated by comparable oxide thicknesses. The UDA molecules demonstrated better stability compared to MUA molecules based on contact angle measurements and tilt angle data extracted from XPS results. According to the XPS data, the UDA molecules formed a more dense adlayer compared to MUA molecules. With respect to toxicity, the UDA-functionalized GaP provided better passivation which was confirmed by less gallium leaching into water and saline solutions. Overall, the superior passivation provided by UDA demonstrates that alkene grafting has better potential for modifying GaP based devices such as implantable sensors.

Phase II study of single agent perifosine in patients with hepatocellular carcinoma (HCC)

e15505

Background: Perifosine (Peri) is a novel oral alkylphospholipid with effects on multiple signal transduction pathways including Akt, MAPK and JNK. Unresectable HCC continues to have dismal prognosis. In a phase III randomized study, sorafenib demonstrated a 2% partial response (PR) rate with a median time to symptomatic progression of 4.1 months (mos) and radiologic progression of 5.5 mos, however patients (pts) had not received prior systemic treatment. Hence, additional therapies are needed. Peri was evaluated in a phase II multi-disease trial where 558 pts were randomized to daily vs. weekly schedules of Peri (50/100 mg daily or 900/1,200 mg weekly) with 42 of the pts having HCC. The following are the efficacy and safety results of this sub-group. Methods: Pts with advanced measurable HCC, up to 3 prior systemic treatments allowed. Normal organ / marrow function required. Primary outcome analyses included median time to progression (TTP) and disease control rate (DCR; CR+PR+SD > 12 weeks). Results: Of the 42 HCC pts treated, the median age was 71 (range 26–83), 22 were male and 48% had received > 1 prior systemic therapy. Child-Pugh status not available. As of 12/08, 32/42 pts were evaluable for efficacy (5 withdrew consent < 30 days, 4 toxicity < 30 days, 1 lost to follow up). One patient achieved a PR (3%) and 15 (47%) had stable disease > 12 weeks; overall DCR of 50%. Median TTP was 14 wks (range 2–86). As of 12/08, one patient remains active at 12 mos. The daily dose was well tolerated. The weekly dose was significantly more toxic (3 of the 4 who came off treatment < 30 days due to toxicity were on weekly). Most common grade 1/2 toxicities were GI related and fatigue. Grade 3/4 drug-related toxicities > 10% included: abdominal pain (12%), elevated liver enzymes (10%) and fatigue (10%). Conclusions: Perifosine was well tolerated at the daily dose and overall demonstrates clinical benefit in patients with advanced HCC as reflected by an encouraging TTP. A combination study with sorafenib is ongoing and future randomized studies are under consideration.

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