Group membership and staff turnover affect outcomes in group CBT for persistent pain

The effects of two contextual factors, group membership and staff turnover, on the outcome of group cognitive behavioral therapy (CBT) for persistent pain were investigated. The data came from end of treatment and one month follow-up assessments of 3050 individuals who attended an intensive group programme over sixteen years. Intraclass correlations (ICC) showed significant intragroup effects on self-efficacy (ICC = 0.16 at end of treatment; 0.12 at one month), catastrophizing (ICC = 0.06; 0.13) and distance walked (ICC = 0.20; 0.19). This underlines the importance of modelling group membership when analyzing data from group interventions. Linear regression showed that high periods of staff turnover were significantly related to poorer outcomes on self-efficacy and distance walked at end of treatment, with the effect on self-efficacy persisting to one month follow-up. Having demonstrated significant contextual effects in an existing data set, further research is needed to explore the mechanisms by which these effects operate

A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p&gt

Optimisation in behavioural synthesis using hierarchical expansion: module ripping

During behavioural synthesis, an abstract functional description of a system is mapped automatically onto a physical structure. In a competitive setting, this mapping will be highly optimised - the dataflow is re-arranged, units and registers are multiplexed and so on - to deliver a final structure that meets some overall user supplied specification. Ultimately, however, the physical functional units are drawn from some predefined (human designed) library - these may be thought of as the leaf-level modules in the design hierarchy. Design re-use and increasing sophistication of module libraries inevitably leads to leaf modules becoming larger and more complex. As these modules are, by definition, atomic, a synthesis system is unable to capitalise on any internal similarities the leaf modules may possess. This paper describes the design, construction and effects of using a hierarchically defined module library. The set of leaf-level modules made available to the synthesis environment is conventional - add, subtract, multiply and so on - but the optimiser is capable of ?ripping apart? these modules to manipulate their inner structures. Two advantages accrue from this technique: (1) it is possible to optimise behavioural designs far more effectively, with up to a 65% reduction in area, and a 46% reduction in delay reported, and (2) it is possible to build library modules that have tightly controllable internal timing relationships. This is essential when designing systems that communicate externally via low-level protocols, but behavioural synthesis, by its very nature, usually distorts timing information. Using this technique, it is possible to create ?islands of fixed timing? embedded in the synthesised design

Simultaneous Optimisation of Dynamic Power, Area and Delay in Behavioural Synthesis

Concern over power dissipation coupled with the continuing rise in system size and complexity means that there is a growing need for high-level design tools capable of automatically optimising systems to take into account power dissipation, in addition to the more conventional metrics of area, delay and testability. Current methods for reducing power consumption tend to be ad-hoc: for example, slowing down, or turning off idle parts of the system, or a controlled reduction in power supply. The behavioural synthesis system described in this paper features an integrated incremental power estimation capability, which makes use of activity profiles, generated automatically through simulation of a design on any standard VHDL simulator; accurate circuit-level cell models (generated, again automatically, via Spice simulation); and a comprehensive system power model. This data, along with similar estimators for area and delay, guides the optimisation of a design towards independent, user-specified objectives for final area, delay, clock speed, and energy consumption. In addition, a range of power reducing features are included encompassing: supply voltage scaling, clock gating, input latching, input gating, low-power cells, and pipelined and multicycle units. These are automatically exploited during optimisation as part of the area/delay/power dissipation trade-off process. The resulting system is capable of reducing the estimated energy consumption of several benchmark designs by factors of between 3.5 and 7.0 times. Furthermore, the design exploration capability enables a range of alternative structural implementations to be generated from a single behavioural description, with differing area/delay/power trade-offs

Kinesiophobia, self-efficacy and pain-related disability in patients with non-specific low back pain

Psychological factors like kinesiophobia and self-efficacy have been shown to be associated with pain and disability perception in patients with non-specific low back pain (NSLBP). The association among extent of kinesiophobia, self efficacy, pain intensity and disability in patients presenting with NSLBP and the predictor of disability among pain intensity, self-efficacy and kinesiophobia in these patients were investigated in this study.The research design was an analytical cross sectional survey involving 275 consecutively selected individuals diagnosed with NSLBP at a tertiary hospital in southwestern Nigeria. The main outcome measures used were: Quadruple Visual Analogue Scale (QVAS), Tampa Scale for Kinesiophobia (TSK), Revised Oswestry Disability Questionnaire (RODQ) and Self-Efficacy in Rehabilitation Scale (SER).The mean age of the participants was 51.62±13.4 years. The extent of kinesiophobia and measure of selfefficacy were high and above average as seen in 71.7% and 94.3% of the participants respectively. The mean scores on TSK, RODQ, SER and pain intensity were 39.45±5.91, 36.98±15.97, 98.68±21.4 and 7.35±1.94 respectively. Participants with high scores on TSK had significantly high scores on RODQ and low scores on SER. There was a significant positive association between extent of kinesiophobia, disability and selfefficacy (p<0.05). Self-efficacy, pain intensity and kinesiophobia significantly predicted extent of disability (p<0.05).Patients with NSLBP exhibited fear of re-injury (kinesiophobia). Patients with high level of kinesiophobia had increased pain intensity and reduced self-efficacy. High levels of kinesiophobia accompanied by increased pain intensity and decreased self-efficacy were significant predictors of pain related disability in patients with NSLBP.Keywords: Non-specific low back pain, self-efficacy, kinesiophobia, perceived disabilit

Seasonal effects to metallothionein responses to metal exposure in a naturalised population of Ruditapes philippinarum in a semi-enclosed estuarine environment

The Manila clam (Ruditapes philippinarum), an invasive species in Northern Europe, can be used as a bioindicator of metal pollution. Seasonal effects on metallothionein (MT) production have not been considered in this species at the northernmost extent of its European distribution. This study assesses the annual seasonal effects on MT and metal concentrations in R. philippinarum from Poole Harbour, UK. R. philippinarum were collected in winter, spring, summer, and autumn throughout 2015, and MT and metal concentrations, as well as biotic and abiotic variables, were quantified. During winter, linear regression analysis showed significant positive relationships between tissue metal and MT concentrations. However, during spring and summer, these relationships were mostly insignificant. MT concentrations during spring had significant positive relationships with tissue and whole weight. Significant positive relationships were also observed between MT and condition index, during summer. During spring and summer, biotic factors seem to override the role of MT as a detoxification mechanism for metal exposure in this species. This is probably due to an increase in MT concentration in spring caused by gametogenesis, associated with increased tissue weight as the gonads expand. A depletion of energy resources, or physical stressors such as heat, may be attributed to the reduced MT production in clams of poor body condition in summer. The evidence from this study suggests that MT may only be a useful biomarker of metal pollution during winter in R. philippinarum in the UK. This verifies the natural variability of MT in this species at high latitudes, and highlights the potential and limits to a widely available bioindicator of metal pollution

A retrospective study on the effects of illness severity and atrial fibrillation on outcomes in the intensive care unit

Introduction: Atrial fibrillation (AF) is common in patients in the intensive care unit (ICU) and has been associated with worse outcomes. However, it is unclear whether AF itself adds to the risk of death or is merely a marker of illness severity. We aimed to record the incidence and outcomes of all patients with different categories of AF and determine whether AF was an independent predictor of death.<p></p> Methods: This retrospective cohort study was undertaken in the ICU of a tertiary-referral university hospital. Category of AF, sex, C-reactive protein (CRP) level, APACHE II score, predicted hospital mortality and survival outcomes were analysed from 1084 records. Percentages, medians and interquartile ranges were used to describe the sample. Chi-square test and the non-parametric Mann–Whitney U test were used, as appropriate, for statistical analysis. Logistic regression analyses were performed to evaluate the association of AF with death in the ICU adjusting for age, sex, CRP level and APACHE II score.<p></p> Results: Overall, 13.6% of patients developed new-onset AF during their critical illness, while 4.3% had a pre-existing history. The hospital mortality rate was higher in those with AF compared with those without (47.9% vs. 30.9%, p<0.001) and higher in those with newly diagnosed AF compared with those with a prior history (53.1% vs. 31.9%, p=0.012). CRP levels were higher in those with AF (p<0.001) compared with those without and higher in those with newly diagnosed AF compared with those with a prior history (p=0.012). On multivariate logistic regression analysis, only the APACHE II score was found to be an independent predictor of death.<p></p> Conclusion: Despite the higher mortality rate in patients with AF, the APACHE II score was the only independent predictor of death within the ICU. Prospective studies are required to explore the apparently reduced risk of dying among those with a prior history of AF.<p></p&gt

Forest landscape restoration in the drylands of Latin America

Forest Landscape Restoration (FLR) involves the ecological restoration of degraded forest landscapes, with the aim of benefiting both biodiversity and human well-being. We first identify four fundamental principles of FLR, based on previous definitions. We then critically evaluate the application of these principles in practice, based on the experience gained during an international, collaborative research project conducted in six dry forest landscapes of Latin America. Research highlighted the potential for FLR; tree species of high socioeconomic value were identified in all study areas, and strong dependence of local communities on forest resources was widely encountered, particularly for fuelwood. We demonstrated that FLR can be achieved through both passive and active restoration approaches, and can be cost-effective if the increased provision of ecosystem services is taken into account. These results therefore highlight the potential for FLR, and the positive contribution that it could make to sustainable development. However, we also encountered a number of challenges to FLR implementation, including the difficulty of achieving strong engagement in FLR activities among local stakeholders, lack of capacity for community-led initiatives, and the lack of an appropriate institutional and regulatory environment to support restoration activities. Successful implementation of FLR will require new collaborative alliances among stakeholders, empowerment and capacity building of local communities to enable them to fully engage with restoration activities, and an enabling public policy context to enable local people to be active participants in the decision making process. © 2012 by the author(s). Published here under license by the Resilience Alliance

Mid-Miocene cooling and the extinction of tundra in continental Antarctica

A major obstacle in understanding the evolution of Cenozoic climate has been the lack of well dated terrestrial evidence from high-latitude, glaciated regions. Here, we report the discovery of exceptionally well preserved fossils of lacustrine and terrestrial organisms from the McMurdo Dry Valleys sector of the Transantarctic Mountains for which we have established a precise radiometric chronology. The fossils, which include diatoms, palynomorphs, mosses, ostracodes, and insects, represent the last vestige of a tundra community that inhabited the mountains before stepped cooling that first brought a full polar climate to Antarctica. Paleoecological analyses, 40Ar/39Ar analyses of associated ash fall, and climate inferences from glaciological modeling together suggest that mean summer temperatures in the region cooled by at least 8°C between 14.07 ± 0.05 Ma and 13.85 ± 0.03 Ma. These results provide novel constraints for the timing and amplitude of middle-Miocene cooling in Antarctica and reveal the ecological legacy of this global climate transition

Generation of internal waves by eddies impinging on the western boundary of the North Atlantic

Despite the major role played by mesoscale eddies in redistributing the energy of the large-scale circulation, our understanding of their dissipation is still incomplete. This study investigates the generation of internal waves by decaying eddies in the North Atlantic western boundary. The eddy presence and decay are measured from the altimetric surface relative vorticity associated with an array of full-depth current meters extending ~100 km offshore at 26.5°N. In addition, internal waves are analysed over a topographic rise from 2-year high-frequency measurements of an Acoustic Doppler Current Profiler (ADCP), which is located 13 km offshore in 600 m deep water. Despite an apparent polarity independence of the eddy decay observed from altimetric data, the flow in the deepest 100 m is enhanced for anticyclones (25.2 cm s−1) compared with cyclones (-4.7 cm s−1). Accordingly, the internal wave field is sensitive to this polarity-dependent deep velocity. This is apparent from the eddy-modulated enhanced dissipation rate, which is obtained from a finescale parameterization and exceeds 10−9 W kg−1 for near-bottom flows greater than 8 cm s−1. The present study underlines the importance of oceanic western boundaries for removing the energy of low-mode westward-propagating eddies to higher-mode internal waves