Modified brinley plots: advantages and disadvantages

Accepted manuscrip

Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial

BACKGROUND Comorbid anxiety in bipolar disorder (BD) is associated with greater illness severity, reduced treatment response, and greater impairment. Treating anxiety in the context of BD is crucial for improving illness course and outcomes. The current study examined the feasibility, acceptability and preliminary efficacy of the Unified Protocol (UP), a transdiagnostic cognitive behavioral therapy, as an adjunctive treatment to pharmacotherapy for BD and comorbid anxiety disorders. METHODS Twenty-nine patients with BD and at least one comorbid anxiety disorder were randomized to pharmacotherapy treatment-as-usual (TAU) or TAU with 18 sessions of the UP (UP+TAU). All patients completed assessments every four weeks to track symptoms, functioning, emotion regulation and temperament. Linear mixed-model regressions were conducted to track symptom changes over time and to examine the relationship between emotion-related variables and treatment response. RESULTS Satisfaction ratings were equivalent for both treatment groups. Patients in the UP+TAU group evidenced significantly greater reductions over time in anxiety and depression symptoms (Cohen's d's>0.80). Baseline levels of neuroticism, perceived affective control, and emotion regulation ability predicted magnitude of symptom change for the UP+TAU group only. Greater change in perceived control of emotions and emotion regulation skills predicted greater change in anxiety related symptoms. LIMITATIONS This was a pilot feasibility and acceptability trial; results should be interpreted with caution. CONCLUSIONS Treatment with the UP+TAU was rated high in patient satisfaction, and resulted in significantly greater improvement on indices of anxiety and depression relative to TAU. This suggests that the UP may be a feasible treatment approach for BD with comorbid anxiety.This work was supported by a Postdoctoral National Research Service Award from the National Institutes of Health [F32 MH098490] to K. Ellard. (F32 MH098490 - Postdoctoral National Research Service Award from the National Institutes of Health)Accepted manuscrip

Better health through better infrastructure

Welcome to HaCIRIC’s 2009 Progress Report. Better Health through Better Infrastructure offers a chance to reflect on both the achievements of our short history and on the strategy for going forward. The Centre is now in its third year since foundation. In that time, we have taken enormous strides and have begun to fulfill the imagination and foresight of our funders. We are starting to make a real, measurable impact on the health and care sectors and their supply chains. We have also grown to understand much better the main issues facing our stakeholders and to fashion four key areas upon which to focus our future activity. HaCIRIC, as Patricia Leahy of the National Audit Office says, is ‘bringing innovative, rigorous analysis to the field’. She highlights the useful outputs that are now emerging from all the universities involved. Our mission – to improve health outcomes through innovative thinking about infrastructure – is bold and creative. It is helping, as Professor Duane Passman of Brighton and Sussex University Hospitals NHS Trust, suggests, ‘to take us back to being world class researchers in infrastructure and the built environment’. This goal is absolutely right for the times, as governments all over the world struggle to create greater value out of tighter budgets. As is clear from this report, HaCIRIC understands the real needs of the sector. It has created the capacity, the vision and the drive to deliver what is needed

The effect of expectation on satisfaction in total knee replacements : a systematic review

Total knee replacement has reliably been shown to have a beneficial effect in knee osteoarthritis; however, around 17 % of patients are dissatisfied with the result. A commonly proposed mechanism driving the dissatisfaction rate is a discrepancy between expected and actual/perceived outcome. Our aim was to conduct a systematic review examining any association between pre-operative expectations and satisfaction. A comprehensive electronic search strategy was used to identify studies from MEDLINE, EMBASE, and the Cochrane Library from inception until May 2015. Data was extracted according to PRISMA guidelines and an online, published protocol. Four studies are included in this review. One study found an association between expectations and satisfaction. Different measures of expectation and satisfaction were used in all studies. To date, there is no consensus on how expectations or satisfaction should be measured, and a large number of studies that have the available information failed to conduct the relevant sub-group analysis. Further elucidation and consensus of how to measure expectations and satisfaction around joint replacement would aid this area of study greatly. On the basis of the current evidence it appears expectations have a small effect, if any, on satisfaction after knee replacement

Does religion make a difference? : assessing the effects of Christian affiliation and practice on marital solidarity and divorce in Britain, 1985-2005

Marital breakdown rates were examined among 15,714 adults from the British Social Attitudes dataset for 1985-2005. Separation and divorce peaked at around 50 years of age, and increased significantly over the period of study. Ratios of separation or divorce were compared between respondents who had no religious affiliation and (a) Christian affiliates who attended church at least once a month, (b) Christian affiliates who attended church, but less than once a month, and (c) Christian affiliates who never attended church. The results showed that active Christians were 1.5 times less likely to suffer marital breakdown than non-affiliates, but there was no difference between affiliates who never attended church and those of no religion. Christians who attended infrequently were 1.3 times less likely to suffer marital breakdown compared to non-affiliates, suggesting that even infrequent attendance at church may have some significance for predicting the persistence of martial solidarity

Decreasing the number of arthroscopies in knee osteoarthritis – a service evaluation of a de-implementation strategy

Background: The Personalised Knee Improvement Programme (P-KIP) was developed based on previously published work, with the hypothesis that surgeons would refer patients to a well-structured conservative management intervention instead of for arthroscopy (de-implementation of arthroscopy by substitution with P-KIP). This meets NICE guidelines and international recommendations but such programmes are not widely used in the UK. Our aim was to determine whether P-KIP would reduce the number of arthroscopies performed for knee osteoarthritis. Methods: P-KIP is a conservative care pathway including a group education session followed by individually tailored one-to-one dietician and physiotherapy sessions. Virtual clinic follow-up is conducted three to 6 months after completion of the programme. The service began in July 2015. The number of arthroscopies saved, measured from hospital level coding data, is the primary outcome measure. Interrupted time series analysis of coding data was conducted. As a quality assurance process, patient reported outcome measures (Oxford Knee Score; Euroqol 5D) were collected at baseline and at follow up. Results: Time series analysis demonstrates that the programme saved 15.4 arthroscopies a month (95% confidence interval 9–21; p < 0.001), equating to 184 arthroscopies a year in a single hospital. The PROMs data demonstrated improvements in patient reported outcome scores consistent with previous published reports of conservative interventions in similar patient populations. Conclusions: Results suggest that P-KIP reduces the number of arthroscopies performed, and patients who took part in P-KIP had an improvement in their knee and general health outcomes. P-KIP has the potential to deliver efficiency savings and relive pressure on operative lists, however replication in other sites is required

A Pilot Survey for the H2_2O Southern Galactic Plane Survey (HOPS)

We describe observations with the Mopra radiotelescope designed to assess the feasibility of the H$_2$O maser southern Galactic plane survey (HOPS). We mapped two one-square-degree regions along the Galactic plane using the new 12 mm receiver and the UNSW Mopra spectrometer (MOPS). We covered the entire spectrum between 19.5 and 27.5 GHz using this setup with the main aims of finding out which spectral lines can be detected with a quick mapping survey. We report on detected emission from H$_2$O masers, NH$_3$ inversion transitions (1,1), (2,2) and (3,3), HC$_3$N (3-2), as well as several radio recombination lines.Comment: accepted by PAS

Methane from UV-irradiated carbonaceous chondrites under simulated Martian conditions

A UV photolytic process was studied for the production of methane from carbonaceous chondrites under simulated Martian conditions. Methane evolution rates from carbonaceous chondrites were found to be positively correlated to temperature (−80 to 20°C) and the concentration of carbon in the chondrites (0.2 to 1.69 wt%); and decreased over time with Murchison samples exposed to Martian conditions. The amount of evolved methane (EM) per unit of UV energy was 7.9 × 10−13 mol J−1 for UV irradiation of Murchison (1.69 wt%) samples tested under Martian conditions (6.9 mbar and 20°C). Using a previously described Mars UV model (Moores et al., 2007), and the EM given above, an annual interplanetary dust particle (IDP) accreted mass of 2.4 × 105 kg carbon per year yields methane abundances between 2.2 to 11 ppbv for model scenarios in which 20 to 100% of the accreted carbon is converted to methane, respectively. The UV/CH4 model for accreted IDPs can explain a portion of the globally averaged methane abundance on Mars, but cannot easily explain seasonal, temporal, diurnal, or plume fluctuations of methane. Several impact processes were modeled to determine if periodic emplacement of organics from carbonaceous bolides could be invoked to explain the occurrence of methane plumes produced by the UV/CH4process. Modeling of surface impacts of high-density bolides, single airbursts of low-density bolides, and multiple airbursts of a cascading breakup of a low-density rubble-pile comet were all unable to reproduce a methane plume of 45 ppbv, as reported by Mumma et al