The effectiveness of an online support group for members of the community with depression: a randomised controlled trial

Background: Internet support groups (ISGs) are popular, particularly among people with depression, but there is little high quality evidence concerning their effectiveness. Aim: The study aimed to evaluate the efficacy of an ISG for reducing depressive symptoms among community members when used alone and in combination with an automated Internet-based psychotherapy training program. Method: Volunteers with elevated psychological distress were identified using a community-based screening postal survey. Participants were randomised to one of four 12-week conditions: depression Internet Support Group (ISG), automated depression Internet Training Program (ITP), combination of the two (ITP+ISG), or a control website with delayed access to ecouch at 6 months. Assessments were conducted at baseline, post-intervention, 6 and 12 months. Results: There was no change in depressive symptoms relative to control after 3 months of exposure to the ISG. However, both the ISG alone and the combined ISG+ITP group showed significantly greater reduction in depressive symptoms at 6 and 12 months follow-up than the control group. The ITP program was effective relative to control at post-intervention but not at 6 months. Conclusions: ISGs for depression are promising and warrant further empirical investigation.The trial was funded by a National Health and Medical Research Council Project Grant 471435. KG is supported by NHMRC Fellowship No. 525413 and HC is supported by Fellowship No. 525411. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

EcoCTD for profiling oceanic physical-biological properties from an underway ship

Author Posting. © American Meteorological Society, 2020. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of the Atmospheric and Oceanic Technology 37(5), (2020): 825-840, doi:10.1175/JTECH-D-19-0145.1.The study of ocean dynamics and biophysical variability at submesoscales of O(1) km and O(1) h raises several observational challenges. To address these by underway sampling, we recently developed a towed profiler called the EcoCTD, capable of concurrently measuring both hydrographic and bio-optical properties such as oxygen, chlorophyll fluorescence, and optical backscatter. The EcoCTD presents an attractive alternative to currently used towed platforms due to its light footprint, versatility in the field, and ease of deployment and recovery without cranes or heavy-duty winches. We demonstrate its use for gathering high-quality data at submesoscale spatiotemporal resolution. A dataset of bio-optical and hydrographic properties, collected with the EcoCTD during field trials in 2018, highlights its scientific potential for the study of physical–biological interactions at submesoscales.Authors would like to acknowledge Melissa Omand, Ben Pietro, and Jing He for their valuable input during the design phase of the EcoCTD, as well as for their support for deploying the EcoCTD in the field. We are grateful to Eva Alou, Andrea Carbonero, and John Allen for providing calibrated data from the shipboard CTD. Authors would also like to thank Don Peters along with Dynamics System Analysis Ltd. for facilitating access to ProteusDS and providing support in using the software. We are grateful to the crew of the RV Armstrong and NRV Alliance for their support in the field. Development of the EcoCTD is supported by the Office of Naval Research (ONR) through the CALYPSO Departmental Research Initiative (Grant N000141613130). Advanced field testing was supported by Woods Hole Oceanographic Institution internal funding. MATLAB routines for data processing are publicly available at https://github.com/mfreilich1/ecoctd_processing.2020-11-0

Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients The ROADMAP Study 2-Year Results

OBJECTIVES The authors sought to provide the pre-specified primary endpoint of the ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) trial at 2 years. BACKGROUND The ROADMAP trial was a prospective nonrandomized observational study of 200 patients (97 with a left ventricular assist device [LVAD], 103 on optimal medical management [OMM]) that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients. METHODS The primary composite endpoint was survival on original therapy with improvement in 6-min walk distance \u3e= 75 m. RESULTS Patients receiving LVAD versus OMM had lower baseline health-related quality of life, reduced Seattle Heart Failure Model 1-year survival (78% vs. 84%; p = 0.012), and were predominantly INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 4 (65% vs. 34%; p \u3c 0.001) versus profiles 5 to 7. More LVAD patients met the primary endpoint at 2 years: 30% LVAD versus 12% OMM (odds ratio: 3.2 [95% confidence interval: 1.3 to 7.7]; p = 0.012). Survival as treated on original therapy at 2 years was greater for LVAD versus OMM (70 +/- 5% vs. 41 +/- 5%; p \u3c 0.001), but there was no difference in intent-to-treat survival (70 +/- 5% vs. 63 +/- 5%; p = 0.307). In the OMM arm, 23 of 103 (22%) received delayed LVADs (18 within 12 months; 5 from 12 to 24 months). LVAD adverse events declined after year 1 for bleeding (primarily gastrointestinal) and arrhythmias. CONCLUSIONS Survival on original therapy with improvement in 6-min walk distance was superior with LVAD compared with OMM at 2 years. Reduction in key adverse events beyond 1 year was observed in the LVAD group. The ROADMAP trial provides risk-benefit information to guide patient- and physician-shared decision making for elective LVAD therapy as a treatment for heart failure. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients [ROADMAP]; NCT01452802

Submesoscale processes at shallow salinity fronts in the Bay of Bengal : observations during the winter monsoon

Author Posting. © American Meteorological Society, 2018. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 48 (2018): 479-509, doi:10.1175/JPO-D-16-0283.1.Lateral submesoscale processes and their influence on vertical stratification at shallow salinity fronts in the central Bay of Bengal during the winter monsoon are explored using high-resolution data from a cruise in November 2013. The observations are from a radiator survey centered at a salinity-controlled density front, embedded in a zone of moderate mesoscale strain (0.15 times the Coriolis parameter) and forced by winds with a downfront orientation. Below a thin mixed layer, often ≤10 m, the analysis shows several dynamical signatures indicative of submesoscale processes: (i) negative Ertel potential vorticity (PV); (ii) low-PV anomalies with O(1–10) km lateral extent, where the vorticity estimated on isopycnals and the isopycnal thickness are tightly coupled, varying in lockstep to yield low PV; (iii) flow conditions susceptible to forced symmetric instability (FSI) or bearing the imprint of earlier FSI events; (iv) negative lateral gradients in the absolute momentum field (inertial instability); and (v) strong contribution from differential sheared advection at O(1) km scales to the growth rate of the depth-averaged stratification. The findings here show one-dimensional vertical processes alone cannot explain the vertical stratification and its lateral variability over O(1–10) km scales at the radiator survey.S. Ramachandran acknowledges support from the National Science Foundation through award OCE 1558849 and the U.S. Office of Naval Research, Grants N00014-13-1-0456 and N00014-17- 1-2355. A. Tandon acknowledges support from the U.S. Office of Naval Research, Grants N00014-13-1-0456 and N00014-17-1-2355. J. T. Farrar and R. A. Weller were supported by the U.S. Office of Naval Research, Grant N00014-13-1-0453, to collect the UCTD data and process theUCTD and shipboard meteorological data. J. Nash, J. Mackinnon, and A. F. Waterhouse acknowledge support from the U. S. Office of Naval Research, Grants N00014-13-1-0503 and N00014-14-1-0455. E. Shroyer acknowledges support from the U. S. Office of Naval Research, Grants N00014-14-10236 and N00014-15- 12634. A. Mahadevan acknowledges support fromthe U. S. Office of Naval Research, Grant N00014-13-10451. A. J. Lucas and R. Pinkel acknowledge support from the U. S. Office of Naval Research, Grant N00014-13-1-0489.2018-08-2

From salty to fresh—salinity processes in the Upper-ocean Regional Study-2 (SPURS-2) : diagnosing the physics of a rainfall-dominated salinity minimum

Author Posting. © The Oceanography Society, 2015. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 28, no. 1 (2015): 150-159, doi:10.5670/oceanog.2015.15.One of the notable features of the global ocean is that the salinity of the North Atlantic is about 1 psu higher than that of the North Pacific. This contrast is thought to be due to one of the large asymmetries in the global water cycle: the transport of water vapor by the trade winds across Central America and the lack of any comparable transport into the Atlantic from the Sahara Desert. Net evaporation serves to maintain high Atlantic salinities, and net precipitation lowers those in the Pacific. Because the effects on upper-ocean physics are markedly different in the evaporating and precipitating regimes, the next phase of research in the Salinity Processes in the Upper-ocean Regional Study (SPURS) must address a high rainfall region. It seemed especially appropriate to focus on the eastern tropical Pacific that is freshened by the water vapor carried from the Atlantic. In a sense, the SPURS-2 Pacific region will be looking at the downstream fate of the freshwater carried out of the SPURS-1 North Atlantic region. Rainfall tends to lower surface density and thus inhibit vertical mixing, leading to quite different physical structure and dynamics in the upper ocean. Here, we discuss the motivations for the location of SPURS-2 and the scientific questions we hope to address

Sea surface temperature signatures of oceanic internal waves in low winds

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 112 (2007): C06014, doi:10.1029/2006JC003947.In aerial surveys conducted during the Tropical Ocean–Global Atmosphere Coupled Ocean-Atmosphere Response Experiment and the low-wind component of the Coupled Boundary Layer Air-Sea Transfer (CBLAST-Low) oceanographic field programs, sea surface temperature (SST) variability at relatively short spatial scales (O(50 m) to O(1 km)) was observed to increase with decreasing wind speed. A unique set of coincident surface and subsurface oceanic temperature measurements from CBLAST-Low is used to investigate the subsurface expression of this spatially organized SST variability, and the SST variability is linked to internal waves. The data are used to test two previously hypothesized mechanisms for SST signatures of oceanic internal waves: a modulation of the cool-skin effect and a modulation of vertical mixing within the diurnal warm layer. Under conditions of weak winds and strong insolation (which favor formation of a diurnal warm layer), the data reveal a link between the spatially periodic SST fluctuations and subsurface temperature and velocity fluctuations associated with oceanic internal waves, suggesting that some mechanism involving the diurnal warm layer is responsible for the observed signal. Internal-wave signals in skin temperature very closely resemble temperature signals measured at a depth of about 20 cm, indicating that the observed internal-wave SST signal is not a result of modulation of the cool-skin effect. Numerical experiments using a one-dimensional upper ocean model support the notion that internal-wave heaving of the warm-layer base can produce alternating bands of relatively warm and cool SST through the combined effects of surface heating and modulation of wind-driven vertical shear.We gratefully acknowledge funding for this research from the Office of Naval Research through the CBLAST Departmental Research Initiative (grants N00014-01-1-0029, N00014-05-10090, N00014-01-1-0081, N00014-04-1-0110, N00014-05-1-0036, N00014-01-1-0080) and the Secretary of the Navy/Chief of Naval Operations Chair (grant N00014-99-1-0090)

Continuous Flow Left Ventricular Assist Device Improves Functional Capacity and Quality of Life of Advanced Heart Failure Patients

ObjectivesThis study sought to assess the impact of continuous flow left ventricular assist devices (LVADs) on functional capacity and heart failure-related quality of life.BackgroundNewer continuous-flow LVAD are smaller and quieter than pulsatile-flow LVADs.MethodsData from advanced heart failure patients enrolled in the HeartMate II LVAD (Thoratec Corporation, Pleasanton, California) bridge to transplantation (BTT) (n = 281) and destination therapy (DT) (n = 374) trials were analyzed. Functional status (New York Heart Association [NYHA] functional class, 6-min walk distance, patient activity scores), and quality of life (Minnesota Living With Heart Failure [MLWHF] and Kansas City Cardiomyopathy Questionnaires [KCCQ]) were collected before and after LVAD implantation.ResultsCompared with baseline, LVAD patients demonstrated early and sustained improvements in functional status and quality of life. Most patients had NYHA functional class IV symptoms at baseline. Following implant, 82% (BTT) and 80% (DT) of patients at 6 months and 79% (DT) at 24 months improved to NYHA functional class I or II. Mean 6-min walk distance in DT patients was 204 m in patients able to ambulate at baseline, which improved to 350 and 360 m at 6 and 24 months. There were also significant and sustained improvements from baseline in both BTT and DT patients in median MLWHF scores (by 40 and 42 U in DT patients, or 52% and 55%, at 6 and 24 months, respectively), and KCCQ overall summary scores (by 39 and 41 U, or 170% and 178%).ConclusionsUse of a continuous flow LVAD in advanced heart failure patients results in clinically relevant improvements in functional capacity and heart failure-related quality of life

Shigella sonnei genome sequencing and phylogenetic analysis indicate recent global dissemination from Europe

Shigella are human-adapted Escherichia coli that have gained the ability to invade the human gut mucosa and cause dysentery1,2, spreading efficiently via low-dose fecal-oral transmission3,4. Historically, S. sonnei has been predominantly responsible for dysentery in developed countries, but is now emerging as a problem in the developing world, apparently replacing the more diverse S. flexneri in areas undergoing economic development and improvements in water quality4-6. Classical approaches have shown S. sonnei is genetically conserved and clonal7. We report here whole-genome sequencing of 132 globally-distributed isolates. Our phylogenetic analysis shows that the current S. sonnei population descends from a common ancestor that existed less than 500 years ago and has diversified into several distinct lineages with unique characteristics. Our analysis suggests the majority of this diversification occurred in Europe, followed by more recent establishment of local pathogen populations in other continents predominantly due to the pandemic spread of a single, rapidly-evolving, multidrug resistant lineage

Managing cow's milk protein allergy during the 2022 formula shortage: decision-making among pediatric healthcare providers

IntroductionCow's milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices.MethodsThis study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages.Results104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness.DiscussionFindings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care

Intravenous immunoglobulin in the treatment of primary trigeminal neuralgia refractory to carbamazepine: a study protocol[ISRCTN33042138]

BACKGROUND: We have recently reported successful treatment of patients with chronic pain syndromes using human pooled intravenous immunoglobulin (IVIG) in a prospective, open-label cohort study. A randomised, placebo controlled, double blinded study is needed to confirm these results. We chose to study patients with carbamazepine resistant primary Trigeminal Neuralgia (rpTN), as these had responded particularly well to IVIG. A protocol involving the use of IVIG in rpTN is complex for three reasons: 1. The effect of IVIG does not follow simple dose-response rules; 2. The response pattern of patients to IVIG was variable and ranged between no effect at all and pain free remission between two weeks and >1 year; 3. TN is characterized by extremely severe pain, for which operative intervention is (if temporarily) helpful in most patients. DESIGN: A placebo controlled, parallel, add-on model was developed and the primary outcome variable defined as the length of time during which patients remain in the study. Study groups are compared using Kaplan-Maier survival analysis. Patients record their response to treatment ("severe, moderate, slight, no pain"). The study coordinator monitors pain diaries. Severe or moderate pain of three days duration will result in termination of the study for that patient. CONCLUSIONS: This study design utilizes a method of survival analysis and is novel in chronic pain research. It allows for both early departure from the study and voluntary crossover upon non-response. It may be applicable to the analysis of IVIG efficacy in other chronic pain syndromes