CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial

Background: Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design: CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion: Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. Trial registration: ISRCTN45842879 (24 July 2012)

Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey

Contains fulltext : 238060.pdf (Publisher’s version ) (Open Access)BACKGROUND: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. METHOD: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes. RESULTS: During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations. CONCLUSIONS: The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS

Cost-effective off-grid automatic precipitation samplers for pollutant and biogeochemical atmospheric deposition

An important transport process for particles and gases from the atmosphere to aquatic and terrestrial environments is through dry and wet deposition. An open-source, modular, off-grid, and affordable instrument that can automatically collect wet-deposition samples allows for more extensive deployment of deposition samplers in fieldwork and would enable more comprehensive monitoring of remote locations. Precipitation events selectively sampled using a conductivity sensor powered by a battery-based supply are central to off-grid capabilities. The prevalence of conductive precipitation – that which initially contains high solute levels and progresses through trace-level concentrations to ultrapure water in full atmospheric washout – depends on the sampling location but is ubiquitous. This property is exploited here to trigger an electric motor (via limit switches) to open and close a lid resting over a funnel opening. The motors are operated via a custom-built and modular digital logic control board, which has a low energy demand. All components, their design and rationale, and their assembly are provided for community use. The modularity of the control board allows the operation of up to six independent wet-deposition units, such that replicate measurements (e.g., canopy throughfall) or different collection materials for various targeted pollutants can be implemented as necessary. We demonstrate that these platforms are capable of continuous operation off-grid for integrated monthly and bimonthly collections performed across the Newfoundland and Labrador Boreal Ecosystem Latitudinal Transect (47 to 53° N) during the growing seasons of 2015 and 2016. System performance was assessed through the measured power consumption from 115 V of alternating current (VAC; grid power) or 12 V of direct current from battery supplies during operation under both standby (40 or 230 mA, respectively) and in-use (78 or 300 mA, respectively) conditions. In the field, one set of triplicate samplers was deployed in the open to collect incident precipitation (open fall), while another set was deployed under the experimental forest canopy (throughfall). The proof-of-concept systems were validated with basic measurements of rainwater chemistry, which found (i) pH values ranging from 4.14 to 5.71 in incident open fall rainwater, (ii) conductivities ranging from 21 to 166 µS cm−1, and (iii) dissolved organic carbon concentrations in open fall and canopy throughfall of 16±10 and 22±12 mg L−1, respectively, with incident fluxes spanning 600 to 4200 mg C m−2 a−1 across the transect. Ultimately, this demonstrates that the customized precipitation sampling design of this new platform enables more universal accessibility of deposition samples for the atmospheric observation community – for example, those who have made community calls for targeting biogeochemical budgets and/or contaminants of emerging concern in sensitive and remote regions.</p

Assessing the toxicity and mitigating the impact of harmful Prymnesium blooms in eutrophic waters of the Norfolk Broads

Prymnesium parvum is a toxin-producing microalga, which causes harmful algal blooms globally, frequently leading to massive fish kills that have adverse ecological and economic implications for natural waterways and aquaculture alike. The dramatic effects observed on fish are thought to be due to algal polyether toxins, known as the prymnesins, but their lack of environmental detection has resulted in an uncertainty about the true ichthyotoxic agents. Using qPCR, we found elevated levels of P. parvum and its lytic virus, PpDNAV-BW1, in a fish-killing bloom on the Norfolk Broads, United Kingdom, in March 2015. We also detected, for the first time, the B-type prymnesin toxins in Broads waterway samples and gill tissue isolated from a dead fish taken from the study site. Furthermore, Norfolk Broads P. parvum isolates unambiguously produced B-type toxins in laboratory-grown cultures. A 2 year longitudinal study of the Broads study site showed P. parvum blooms to be correlated with increased temperature and that PpDNAV plays a significant role in P. parvum bloom demise. Finally, we used a field trial to show that treatment with low doses of hydrogen peroxide represents an effective strategy to mitigate blooms of P. parvum in enclosed water bodies