Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis.

Obsessive-compulsive disorder (OCD) is a common psychiatric condition that results in significant distress and impairment, and high societal costs. OCD is widely considered to be a chronic condition, however, our understanding of the chronicity of the disorder, and the incidence of spontaneous remission, has largely relied on longitudinal studies of individuals who have received treatment. The aim of the current study is to examine symptom improvement and rate of spontaneous remission in individuals with OCD who were assigned to a no-treatment control group within a randomized controlled trial using a meta-analytic approach. Twelve studies (n = 282; mean age = 35.52; 60.03 % female) were included in the meta-analysis. The pooled within-group effect size was negligible (g = -0.14; 95 % CI [-0.25, -0.04]) and only 4 % of participants demonstrated spontaneous remission across an average of 10.92 weeks (event rate = 0.04; [95 % CI: 0.01, 0.11]). Sample size and duration of OCD symptoms significantly moderated the effect size for symptom change. No moderators were found for symptom remission. The findings add to the small body of literature demonstrating that OCD has a chronic and unremitting course without treatment

Probation staff experiences of managing suicidal and self-harming service users

The current study sought to explore the impact of suicidal behaviours on probation staff, in relation to their experiences of working with Probation service users who have carried out suicide, attempted suicide or self-harm. Thirteen in-depth interviews were carried out with probation staff who had direct contact with Probation service users in one Probation area, and had varying degrees of experience of managing suicidal or self-injurious service users. These were analysed using Thematic Analysis and five themes were identified. Findings indicate that staff felt that suicide and self-harm by service users are serious issues which need to be recognised and dealt with in an effective yet compassionate manner. However not attending the Suicide Prevention Training or lack of experience was perceived as restricting their ability to know how to deal with these individuals, and offer support. Furthermore, staff were emotionally affected by these incidents and it is recommend that they should continue to be provided with access to appropriate support services after an incident

Choroidal and retinal thinning in chronic kidney disease independently associate with eGFR decline and are modifiable with treatment

In patients with chronic kidney disease (CKD), there is an unmet need for novel biomarkers that reliably track kidney injury, demonstrate treatment-response, and predict outcomes. Here, we investigated the potential of retinal optical coherence tomography (OCT) to achieve these ends in a series of prospective studies of patients with pre-dialysis CKD (including those with a kidney transplant), patients with kidney failure undergoing kidney transplantation, living kidney donors, and healthy volunteers. Compared to health, we observed similar retinal thinning and reduced macular volume in patients with CKD and a kidney transplant. However, choroidal thinning in CKD was not seen in patients with a kidney transplant whose choroids resembled those of healthy volunteers. In CKD, the degree of choroidal thinning related to falling eGFR and extent of kidney scarring. Following kidney transplantation, choroidal thickness increased rapidly (~10%) and was maintained over 1-year, whereas gradual choroidal thinning was observed during the 12 months following kidney donation. In patients with CKD, retinal and choroidal thickness independently associated with eGFR decline over 2 years. These observations highlight the potential for retinal OCT to act as a non-invasive monitoring and prognostic biomarker of kidney injury

Evaluation of the Workplace Environment in the UK, and the Impact on Users’ Levels of Stimulation

The purpose of this study is to evaluate a number of recently completed workplaces in the UK. The first aim is to assess the impact of various aspects of the workplace environment on users’ levels of stimulation. The body of previous research undertaken into the workplace environment, identified the aspects to be investigated. Samples of employees from the sixteen businesses were surveyed to determine their perceptions of the workplaces. The results were entered into a regression analysis, and the most significant predictors of perceived stimulation identified. The data also revealed a dramatic reduction in staff arousal levels from mornings to afternoons. Thus, there is a second aim to determine whether changes to significant aspects of the workplace environment during the day can counteract the reduction in users’ stimulation. Two further workplaces were studied to enable changes to be made over a 12-week period. A sample of employees completed questionnaires, and semi-structured interviews revealed the reasons behind the results. It was found that provision of artwork, personal control of temperature and ventilation and regular breaks were the most significant contributions to increasing stimulation after lunch; while user choice of layout, and design and décor of workspaces and break areas, were the most significant aspects at design stage

Selecting Grassland Species for Saline Environments

In Australia, around 5.7 million hectares of agricultural land are currently affected by dryland salinity or at risk from shallow water tables and this figure is expected to increase over the next 50 years (LWRA, 2001). Most improved grassland species cannot tolerate the combined effects of salt and waterlogging and, therefore, the productivity of sown grasslands in salt-affected areas is low. However, there is potential to overcome the lack of suitably adapted fodder species by introducing new, salt and waterlogging-tolerant species and by diversifying the gene pool of proven species. Potential species include exotic, naturalised and native Australian grass, legumes, herb and shrub species that are halophytes and non-halophytes. A collaborative national project in southern Australia commenced in 2004 with the objective of evaluating a range of forage species for saline environments

Sandwich Panel Cores for Blast Applications: Materials and Graded Density

Sandwich composites are of interest in marine applications due to their high strength-to-weight ratio and tailorable mechanical properties, but their resistance to air blast loading is not well understood. Full-scale 100 kg TNT equivalent air blast testing at a 15 m stand-off distance was performed on glass-fibre reinforced polymer (GFRP) sandwich panels with polyvinyl chloride (PVC); polymethacrylimid (PMI); and styrene acrylonitrile (SAN) foam cores, all possessing the same thickness and density. Further testing was performed to assess the blast resistance of a sandwich panel containing a stepwise graded density SAN foam core, increasing in density away from the blast facing side. Finally a sandwich panel containing compliant polypropylene (PP) fibres within the GFRP front face-sheet, was subjected to blast loading with the intention of preventing front face-sheet cracking during blast. Measurements of the sandwich panel responses were made using high-speed digital image correlation (DIC), and post-blast damage was assessed by sectioning the sandwich panels and mapping the damage observed. It was concluded that all cores are effective in improving blast tolerance and that the SAN core was the most blast tolerant out of the three foam polymer types, with the DIC results showing a lower deflection measured during blast, and post-blast visual inspections showing less damage suffered. By grading the density of the core it was found that through thickness crack propagation was mitigated, as well as damage in the higher density foam layers, thus resulting in a smoother back face-sheet deflection profile. By incorporating compliant PP fibres into the front face-sheet, cracking was prevented in the GFRP, despite damage being present in the core and the interfaces between the core and face-sheets

TElmisartan in the management of abDominal aortic aneurYsm (TEDY): The study protocol for a randomized controlled trial

Background: Experimental studies suggest that angiotensin II plays a central role in the pathogenesis of abdominal aortic aneurysm. This trial aims to evaluate the efficacy of the angiotensin receptor blocker telmisartan in limiting the progression of abdominal aortic aneurysm. Methods/Design: Telmisartan in the management of abdominal aortic aneurysm (TEDY) is a multicentre, parallel-design, randomised, double-blind, placebo-controlled trial with an intention-to-treat analysis. We aim to randomly assign 300 participants with small abdominal aortic aneurysm to either 40 mg of telmisartan or identical placebo and follow patients over 2 years. The primary endpoint will be abdominal aortic aneurysm growth as measured by 1) maximum infra-renal aortic volume on computed tomographic angiography, 2) maximum orthogonal diameter on computed tomographic angiography, and 3) maximum diameter on ultrasound. Secondary endpoints include change in resting brachial blood pressure, abdominal aortic aneurysm biomarker profile and health-related quality of life. TEDY is an international collaboration conducted from major vascular centres in Australia, the United States and the Netherlands. Discussion: Currently, no medication has been convincingly demonstrated to limit abdominal aortic aneurysm progression. TEDY will examine the potential of a promising treatment strategy for patients with small abdominal aortic aneurysms. Trial registration: Australian and Leiden study centres: Australian New Zealand Clinical Trials Registry ACTRN12611000931976, registered on 30 August 2011; Stanford study centre: clinicaltrials.gov NCT01683084, registered on 5 September 2012