The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

BACKGROUND: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. METHODS AND FINDINGS: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n?=?863) at six, and 67% (n?=?810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. CONCLUSIONS: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions

Helical mutations in type I collagen that affect the processing of the amino-propeptide result in an Osteogenesis Imperfecta/Ehlers-Danlos Syndrome overlap syndrome

Background: Whereas mutations affecting the helical domain of type I procollagen classically cause Osteogenesis Imperfecta (OI), helical mutations near the amino (N)-proteinase cleavage site have been suggested to result in a mixed OI/Ehlers-Danlos syndrome (EDS)-phenotype. Methods: We performed biochemical and molecular analysis of type I (pro-) collagen in a cohort of seven patients referred with a clinical diagnosis of EDS and showing only subtle signs of OI. Transmission electron microscopy of the dermis was available for one patient. Results: All of these patients harboured a COL1A1 / COL1A2 mutation residing within the most N-terminal part of the type I collagen helix. These mutations affect the rate of type I collagen N-propeptide cleavage and disturb normal collagen fibrillogenesis. Importantly, patients with this type of mutation do not show a typical OI phenotype but mainly present as EDS patients displaying severe joint hyperlaxity, soft and hyperextensible skin, abnormal wound healing, easy bruising, and sometimes signs of arterial fragility. In addition, they show subtle signs of OI including blue sclerae, relatively short stature and osteopenia or fractures. Conclusion: Recognition of this distinct phenotype is important for accurate genetic counselling, clinical management and surveillance, particularly in relation to the potential risk for vascular rupture associated with these mutations. Because these patients present clinical overlap with other EDS subtypes, biochemical collagen analysis is necessary to establish the correct diagnosis

Congestion and Safety: A Spatial Analysis of London

Spatially disaggregate Enumeration District (ED) level data for London is used in an analysis of various area-wide factors on road casualties. Data on 15335 EDs was input into a geographic information system (GIS) that contained data on road characteristics, public transport accessibility, information of nearest hospital location, car ownership and road casualties. Demographic data for each ED was also included. Various count data models e.g., negative binomial or zero-inflated Poisson and negative binomial models were used to analyze the associations between these factors with traffic fatalities, serious injuries and slight injuries. Different levels of spatial aggregation were also examined to determine if this affected interpretation of the results. Different pedestrian casualties were also examined. Results suggest that dissimilar count models may have to be adopted for modeling different types of accidents based on the dependent variable. Results also suggest that EDs with more roundabouts are safer than EDs with more junctions. More motorways are found to be related to fewer pedestrian casualties but higher traffic casualties. Number of households with no car seems to have more traffic casualties. Distance of the nearest hospital from EDs tends to have no significant effect on casualties. In all cases, it is found that EDs with more employees are associated with fewer casualties.

Bimetallic au/ag metal superstructures from macromolecular metal complexes in solid-state

Indexación: Web of Science; Scielo.Novel bimetallic Au/Ag superstructures have been prepared from solid-state pyrolysis of the macromolecular complexes Chitosan(MLn/M'Ln)n y PSP-4-PVPx( MLn/M'Ln)n with MLn = AuCl3 and M'Ln = Ag(CF3SO3)The characterization was made from XRD (X-ray diffraction of powder), SEM and EDS analysis. Morphologies are influenced by both the nature of the polymer and the metal/polymer, molar ratio of the polymer precursor. EDS analysis suggests a core/shell Au/Ag structure for the materials. A probable mechanism of the formation of these superstructures is discussed. Although separated reports of metallic superstructures of Au or Ag have been recently described, the here reported are the first bimetallic Au/Ag. Key words: Superstructures, Macromolecular complexes, metallic Au and Ag, Pyrolysishttp://ref.scielo.org/y6jcg

Inter-laboratory comparison of a WDS-EDS quantitative X-ray microanalysis of a metallic glass

We conducted an inter-laboratory study of a metallic glass whose main component is nickel. Two determinations of the mass fractions of the different elements present within the sample were asked to the participants: one at an acceleration voltage of 15 or 20 kV and another one at 5 kV. We compare the mass fractions obtained from wavelength dispersive (WDS) and energy dispersive spectrometries (EDS) and also try to find an influence of the kind of EDS detector and its entrance window, the background subtraction method, the use or not of standards as well as the quantification method. Both means of WDS and EDS mass fractions are close to the reference values. The dispersion of the results was larger at 5 kV than at 15-20 kV owing to the use of the L lines rather than K lines and to the lowest collected intensities. There is an exception with the case of boron because at the lowest voltage, the excitation condition is more favourable for the production of the K line. It appears that the dispersion of the results is larger with EDS than with WDS but it was not possible to find a correlation between the large dispersion and one of the considered experimental parameters and quantification factors. Thus, one can think that electron microprobes are inherently better for the determination of mass fractions or that the implementation of quantitative analysis must be optimized for some cases, especially in SEMs.Comment: Members of the GN-MEBA, SEMPA users group and Belgian laboratories coordinated by Universite Catholique de Louvain are thanked for their participation to this inter-laboratory stud

Architecture-Driven Semantic Analysis of Embedded Systems (Eds) Dagstuhl Seminar 12272

Architectural modeling of complex embedded systems is gaining prominence in recent years, both in academia and in industry. An architectural model represents components in a distributed system as boxes with well-defined interfaces, connections between ports on component interfaces, and specifies component properties that can be used in analytical reasoning about the model. Models are hierarchically organized, so that each box can contain another system inside, with its own set of boxes and connections between them. The goal of Dagstuhl Seminar 12272 “Architecture-Driven Semantic Analysis of Embedded Systems” is to bring together researchers who are interested in defining precise semantics of an architecture description language and using it for building tools that generate analytical models from architectural ones, as well as generate code and configuration scripts for the system. This report documents the program and the outcomes of the presentations and working groups held during the seminar

A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments

Counter-Rotation in Disk Galaxies

Counter-rotating galaxies host two components rotating in opposite directions with respect to each other. The kinematic and morphological properties of lenticulars and spirals hosting counter-rotating components are reviewed. Statistics of the counter-rotating galaxies and analysis of their stellar populations provide constraints on the formation scenarios which include both environmental and internal processes.Comment: 10 pages, 2 figures. To appear in ASP Conf. Ser., Multi-Spin Galaxies, E. Iodice and E. M. Corsini (eds.