Is there a doctor on the farm? : managing agroecosystems for better human health

Meeting: CGIAR International Centers Week, 23-27 Oct. 2000, Washington, DC, U

Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548]

BACKGROUND: Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and practice in several management techniques, including relaxation, physical exercise, modification of negative thoughts, and goal setting. Few studies have examined the effectiveness of this therapy in older adult samples. METHODS/DESIGN: This is a randomized, controlled trial to assess the effectiveness of a pain self-management training group intervention, as compared with an education-only control condition. Participants are recruited from retirement communities in the Pacific Northwest of the United States and must be 65 years or older and experience persistent, noncancer pain that limits their activities. The primary outcome is physical disability, as measured by the Roland-Morris Disability Questionnaire. Secondary outcomes are depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain-related interference with activities (Brief Pain Inventory). Randomization occurs by facility to minimize cross-contamination between groups. The target sample size is 273 enrolled, which assuming a 20% attrition rate at 12 months, will provide us with 84% power to detect a moderate effect size of .50 for the primary outcome. DISCUSSION: Few studies have investigated the effects of multimodal pain self-management training among older adults. This randomized controlled trial is designed to assess the efficacy of a pain self-management program that incorporates physical and psychosocial pain coping skills among adults in the mid-old to old-old range

Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial

BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of ≤ 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP

Symposium no. 41 Paper no. 1965 Presentation: oral 1965-1

The USEPA SW-846 series of methods, and variations (validated) thereof, for the analysis of TPH contamination in soil have been used to test the dependence of measured TPH levels on method variation in a series of carefully controlled and statistically rigorous experiments. For example, the importance of using a common method, that minimizes evaporative loss, for the simultaneous determination of volatile TPH (C 6 -C 9 ) and BTEX by either gas chromatography flame ionisation detection (GCFID) or by gas chromatography mass selective detection (GCMSD), has been demonstrated. For general TPH analysis, the importance of using baseline-to-baseline rather than peak-to-peak integration is emphasized. Choice of an appropriate calibration standard for volatile TPH has been discussed, and experimental evidence is provided to support the use of n-octane (n-C 8 ) over BTEX or a BTEX/n-C 8 mixture , for both P&amp;T/GCFID and for P&amp;T/GCMSD. For the determination of semi-volatile TPH (C 10 - C 36 ) by a given method, varying the extractant solvent (neat dichloromethane (DCM), 1:1 v/v DCM/acetone or isopropanol), the extraction method (sonication versus soxhlet) and detector type (GCFID versus GCMSD), shows that statistically significant variations in TPH measurements can arise with each type of variation. Therefore, it is concluded that for typical soil samples, standardisation (and optimisation) of method, is an important ongoing issue in efforts to provide a more scientific basis for the measurement of TPH contamination in soil

Symposium no. 41 Paper no. 1965 Presentation: oral 1965-1

The USEPA SW-846 series of methods, and variations (validated) thereof, for the analysis of TPH contamination in soil have been used to test the dependence of measured TPH levels on method variation in a series of carefully controlled and statistically rigorous experiments. For example, the importance of using a common method, that minimizes evaporative loss, for the simultaneous determination of volatile TPH (C 6 -C 9 ) and BTEX by either gas chromatography flame ionisation detection (GCFID) or by gas chromatography mass selective detection (GCMSD), has been demonstrated. For general TPH analysis, the importance of using baseline-to-baseline rather than peak-to-peak integration is emphasized. Choice of an appropriate calibration standard for volatile TPH has been discussed, and experimental evidence is provided to support the use of n-octane (n-C 8 ) over BTEX or a BTEX/n-C 8 mixture , for both P&amp;T/GCFID and for P&amp;T/GCMSD. For the determination of semi-volatile TPH (C 10 - C 36 ) by a given method, varying the extractant solvent (neat dichloromethane (DCM), 1:1 v/v DCM/acetone or isopropanol), the extraction method (sonication versus soxhlet) and detector type (GCFID versus GCMSD), shows that statistically significant variations in TPH measurements can arise with each type of variation. Therefore, it is concluded that for typical soil samples, standardisation (and optimisation) of method, is an important ongoing issue in efforts to provide a more scientific basis for the measurement of TPH contamination in soil

Scientific and Technological Information Services in Australia. II Discipline Formation in Information Management

This second part of an analysis of scientific and technical information services (STI) in Australia considers their development in the context of discipline formation in information management. The case studies used are the STI services from Part I. A case study protocol is used to consider the extent to which the development of the services may be described in terms of information management domains. Specific reference is made to Australian Agriculture and Natural Resources Online (AANRO), the Australian Medical Index (AMI), Australian Nuclear Science &amp; Technology Information (ANSTI), Australian Transport Index (ATRI), AusGeoref and its forerunner AESIS, and the Australian engineering database (ENGINE

Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial

Background: There is a large clinical need for improved treatments for patients with persecutory delusions. We aimed to test whether a new theoretically driven cognitive therapy (the Feeling Safe Programme) would lead to large reductions in persecutory delusions, above non-specific effects of therapy. We also aimed to test treatment effect mechanisms. Methods: We did a parallel, single-blind, randomised controlled trial to test the Feeling Safe Programme against befriending with the same therapists for patients with persistent persecutory delusions in the context of non-affective psychosis diagnoses. Usual care continued throughout the duration of the trial. The trial took place in community mental health services in three UK National Health Service trusts. Participants were included if they were 16 years or older, had persecutory delusions (as defined by Freeman and Garety) for at least 3 months and held with at least 60% conviction, and had a primary diagnosis of non-affective psychosis from the referring clinical team. Patients were randomly assigned to either the Feeling Safe Programme or the befriending programme, using a permuted blocks algorithm with randomly varying block size, stratified by therapist. Trial assessors were masked to group allocation. If an allocation was unmasked then the unmasked assessor was replaced with a new masked assessor. Outcomes were assessed at 0 months, 6 months (primary endpoint), and 12 months. The primary outcome was persecutory delusion conviction, assessed within the Psychotic Symptoms Rating Scale (PSYRATS; rated 0–100%). Outcome analyses were done in the intention-to-treat population. Each intervention was provided individually over 6 months. This trial is registered with the ISRCTN registry, ISRCTN18705064. Findings: From Feb 8, 2016, to July 26, 2019, 130 patients with persecutory delusions (78 [60%] men; 52 [40%] women, mean age 42 years [SD 12·1, range 17–71]; 86% White, 9% Black, 2% Indian; 2·3% Pakistani; 2% other) were recruited. 64 patients were randomly allocated to the Feeling Safe Programme and 66 patients to befriending. Compared with befriending, the Feeling Safe Programme led to significant end of treatment reductions in delusional conviction (−10·69 [95% CI −19·75 to −1·63], p=0·021, Cohen's d=–0·86) and delusion severity (PSYRATS, −2·94 [–4·58 to −1·31], p Interpretation: The Feeling Safe Programme led to a significant reduction in persistent persecutory delusions compared with befriending. To our knowledge, these are the largest treatment effects seen for patients with persistent delusions. The principal limitation of our trial was the relatively small sample size when comparing two active treatments, meaning less precision in effect size estimates and lower power to detect moderate treatment differences in secondary outcomes. Further research could be done to determine whether greater effects could be possible by reducing the hypothesised delusion maintenance mechanisms further. The Feeling Safe Programme could become the recommended psychological treatment in clinical services for persecutory delusions.</p