Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

Aim: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors – the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. Background: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. Methods: The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. Findings: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients

Evaluation of four subcritical response methods for on-line prediction flutter onset in wind-tunnel tests

The methods were evaluated for use in tests where the flutter model is excited solely by airstream turbulence. The methods were: randomdec, power-spectral-density, peak-hold, and cross-spectrum. The test procedure was to maintain a constant Mach number (M) and increase the dynamic pressure (g) in incremental steps. The test Mach numbers were 0.65, 0.75, 0.82, 0.90, and 1.15. The four methods provided damping trends by which the flutter mode could be tracked and extrapolated to a flutter-onset q. A hard flutter point was obtained at M = 0.82. The peak-hold and cross-spectrum methods gave reliable results and could be most readily used for on-line testing. At M = 0.82, a p-k analysis predicted the same flutter mode as the experiment but a 6-percent lower flutter q. At the subcritical dynamic pressures, calculated damping values were appreciably lower than measured data

Near-infrared synchrotron emission from the compact jet of GX339-4

We have compiled contemporaneous broadband observations of the black hole candidate X-ray binary GX 339-4 when in the low/hard X-ray state in 1981 and 1997. The data clearly reveal the presence of two spectral components, with thermal and non-thermal spectra, overlapping in the optical -- near-infrared bands. The non-thermal component lies on an extrapolation of the radio spectrum of the source, and we interpret it as optically thin synchrotron emission from the powerful, compact jet in the system. Detection of this break from self-absorbed to optically thin synchrotron emission from the jet allows us to place a firm lower limit on the ratio of jet (synchrotron) to X-ray luminosities of $\geq 5$%. We further note that extrapolation of the optically thin synchrotron component from the near-infrared to higher frequencies coincides with the observed X-ray spectrum, supporting models in which the X-rays could originate via optically thin synchrotron emission from the jet (possibly instead of Comptonisation).Comment: Accepted for publication in ApJ Lette

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for children with chronic tic disorders (CTDs). Nevertheless, many families of children with CTDs are unable to access CBIT due to a lack of adequately trained treatment providers, time commitment, and travel distance. This study established the interrater reliability between in-person and Voice over Internet Protocol (VoIP) administrations of the Yale Global Tic Severity Scale (YGTSS), and examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT for reducing tics in children with CTDs in an open case series. Across in-person and VoIP administrations of the YGTSS, results showed mean agreement of 91%, 96%, and 95% for motor, phonic, and total tic severity subscales. In the pilot feasibility study, 4 children received 8 weekly sessions of CBIT via VoIP and were assessed at pre- and posttreatment by an independent evaluator. Results showed a 29.44% decrease in clinician-rated tic severity from pre- to posttreatment on the YGTSS. Two of the 4 patients were considered treatment responders at posttreatment, using Clinical Global Impressions–Improvement ratings. Therapeutic alliance, parent and child treatment satisfaction, and videoconferencing satisfaction ratings were high. CBIT was considered feasible to implement via VoIP, although further testing is recommended

An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/ discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin's concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (A(z)). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. A(z) at the D3-4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics. Copyright (C) 2006 S. Karger AG, Basel

Transonic unsteady airloads on an energy efficient transport wing with oscillating control surfaces

An aspect ratio 10.8 supercritical wing with oscillating control surfaces is described. The wing is instrumental with 252 static orifices and 164 in situ dynamic pressure transducers for studying the effects of control surface deflection on steady and unsteady pressures at transonic speeds. Results from initial wind tunnel tests conducted in the Langley Transonic Dynamics Tunnel are discussed. Unsteady pressure results are presented for two trailing edge control surfaces oscillating separately at the design Mach number of 0.78. Some experimental results are compared with analytical results obtained by using linear lifting surface theory

Subsonic and transonic pressure measurements on a high-aspect-ratio supercritical-wing model with oscillating control surfaces

A high aspect ratio supercritical wing with oscillating control surfaces is described. The semispan wing model was instrumented with 252 static orifices and 164 in situ dynamic pressure gases for studying the effects of control surface position and sinusoidal motion on steady and unsteady pressures. Data from the present test (this is the second in a series of tests on this model) were obtained in the Langley Transonic Dynamics Tunnel at Mach numbers of 0.60 and 0.78 and are presented in tabular form

Boldness traits, not dominance, predict exploratory flight range and homing behaviour in homing pigeons

This study investigated whether consistent individual differences in behaviour (particularly exploratory tendency and object neophilia) were associated with the tendency to explore in free-ranging scenarios. This was tested in homing pigeons. The results showed that birds that were more likely to explore in the loft were also more likely to explore the local area during self-driven flights. When birds were released from a fixed release points, those which had explored less took more tortuous and longer routes back to the loft. This demonstrates the cost associated with lack of exploratory behaviour, and also links traits measured in laboratory scenarios to behaviour in free-ranging animals

Geometric and structural properties of a rectangular supercritical wing oscillated in pitch for measurement of unsteady transonic pressure distributions

Wind-tunnel tests to measure unsteady aerodynamic data in the transonic region have been completed on an aspect ratio 2.0 rectangular wing with a supercritical airfoil. The geometric and structural properties of the wing are presented. (Other references contain the measured aerodynamic data.) Both measured and design airfoil coordinates are presented and compared. In addition, measured wing bending and torsional stiffness distributions and some trailing-edge flexibility influence coefficients are presented

Mutation analysis of HIF prolyl hydroxylases (PHD/EGLN) in individuals with features of phaeochromocytoma and renal cell carcinoma susceptibility

Germline mutations in the von Hippel–Lindau disease (VHL) and succinate dehydrogenase subunit B (SDHB) genes can cause inherited phaeochromocytoma and/or renal cell carcinoma(RCC). Dysregulation of the hypoxia-inducible factor (HIF) transcription factors has been linked to VHL and SDHB-related RCC; both HIF dysregulation and disordered function of a prolyl hydroxylase domain isoform 3 (PHD3/EGLN3)-related pathway of neuronal apoptosis have been linked to the development of phaeochromocytoma. The 2-oxoglutarate-dependent prolyl hydroxylase enzymes PHD1 (EGLN2), PHD2 (EGLN1) and PHD3 (EGLN3) have a key role in regulating the stability of HIF-a subunits (and hence expression of the HIF-a transcription factors). A germline PHD2 mutation has been reported in association with congenital erythrocytosis and recurrent extra-adrenal phaeochromocytoma. We undertook mutation analysis of PHD1, PHD2 and PHD3 in two cohorts of patients with features of inherited phaeochromocytoma (nZ82) and inherited RCC (nZ64) and no evidence of germline mutations in known susceptibility genes. No confirmed pathogenic mutations were detected suggesting that mutations in these genes are not a frequent cause of inherited phaeochromocytoma or RCC