Stepped Care for Depression: A Systematic Review and Feasibility Study

Doctoral thesis in the field of Health Services Research focussed on the development and evaluation of stepped care treatment for depression. Encompasses two studies (a systematic review and feasibility study) planned and conducted using the Medical Research Council (2008) framework for the development and evaluation of complex interventions. Applies techniques for mixed methods analysis of primary data in highly original ways.Background. Stepped care is widely implemented as a means to organise depression treatment. However, it is unclear how this system and the system it was designed to replace – long-term intensive psychotherapy for all – compare. Aim. To further the development and evaluation of stepped care. Specifically, assess the clinical effectiveness of stepped care and prepare for a fully-powered evaluation of stepped care vs. high-intensity psychotherapy alone for depressed adults. Design. A systematic review and mixed methods feasibility study encompassing a pilot randomised controlled trial and semi-structured interviews. Results of the systematic review. Fourteen randomised controlled trials involving 4580 participants were included. Relative to controls, there was significantly greater improvement in depression for adults treated with stepped care (d=0.34 at six months; 95% CI 0.20 to 0.48). The quality of included studies was good and there was little evidence of publication bias. All comparisons were with usual care. Results of the feasibility study. 66 patients were recruited to the pilot trial. The recruitment rate was 2.9% and follow-up data was obtained from 90.9% of participants. A third of stepped care patients stepped up to high-intensity therapy. Patients improved in both groups: the mean reduction in depressive symptoms was 13.4 in the stepped care group and 13.6 in the high-intensity therapy alone group. Recruitment methods were appropriate to patients and therapists but only somewhat appropriate to IAPT staff. Although the stepped care intervention was broadly acceptable to therapists, patient experience varied and some patients who demonstrated a low level of self-efficacy declined any therapy or dropped out of treatment. Conclusions. The effectiveness of stepped care compared with long-term intensive psychological therapy for all has not yet been established. A fully-powered trial of stepped care vs. high-intensity therapy alone is feasible although pilot trial methods and procedures should be modified to improve recruitment and acceptability.University of Exete

Exploration of the Perceived Success Factors and Barriers for Teen Mothers

In 2015, there were 229,715 babies born to teens between the ages of 15-19 years of age. Over the past few years, teen births have decreased, however the United States still has the highest rate of teen pregnancies. There have been successful teen mothers who have completed high school and have proceeded to attend college and graduate with either a two or four-year degree. It is important to understand this study was not intended to justify research on teen pregnancy or condone teen pregnancy, but there needed to be an awareness made regarding adults who were teen mothers and how they overcame barriers after becoming a teen mother. When a teen gives birth to a child, she is now transitioning into motherhood, and it is important to know what it takes to overcome the stigma that follows teen mothers. Teen mothers are faced with many barriers, and these barriers could be any type of difficulty that prevents teen mothers achieving their own personal success. By collecting data through semi-structured interviews, this study provided awareness of how adult women overcame the stigma of teenage pregnancy. Each participant defined the success they had experienced in different ways. However, the focus was success, and learning how teen mothers have overcome and knocked down barriers in order to be successful is important. The intent of this research was to bring about an awareness that teen parenting programs work, and they are important to have in place for teen mothers. Although the number of teen mothers has continued to decrease, there are still teen mothers, and they should have programs available to help them reach their definition and desired goals of success

Student use of computers in the media center: does it support educational goals?

This study explored the ways students from study halls used computers in a media center at 22 student workstations. A shift toward use of computers and electronic resources for recreation and for research had been observed. A study was initiated to determine what students accomplish during these periods and if their use benefited learning. The first research method employed was a direct observation of 1264 students visiting the media center during 64 different periods over a three-week time period. Students were observed and the kinds of applications used were counted. In a second method, ninety-seven students from across the school\u27s population completed a questionnaire. Questions focused on student choice of computer applications and the satisfaction of their experience. Of the 694 students observed using computers, 67% browsed the web and 10% were using the web for research. Sixty-four percent of the 97 students reported that their computer use satisfied some research need, supported some learning in a subject, enhanced learning in some way, and were interested in learning more using a computer. These numbers are indicative of the lure and appeal computers hold for youth. This study reinforces the need for innovative measures to maximize learning as an educational goal of computer use

You mean I have to teach sustainability too? Initial teacher education students’ perspectives on the sustainability cross-curriculum priority

Abstract: In this paper, we report on an investigation into initial teacher education students (ITES) understandings of sustainability and the Australian National Curriculum Sustainability Cross Curricular Priority (CCP). We also explore their willingness and capacities to embed the CCP into their own teaching practices. The ITESs (N=392) completed a quantitative survey with a series of Likert Scale questions and were asked to list “5 words” when they think of sustainability. Analysis reveals that ITESs have generally limited to moderate understandings of sustainability and education for sustainability, but lesser understandings of the Sustainability CCP and the 9 organising ideas. Understandings of sustainability were dominated by an environmental focus. We conclude this paper with a discussion of the implications of narrow environmental understandings of sustainability. We explore factors that limit and enable teacher educators to embed sustainability education more explicitly. We note the importance role teacher educators play in supporting ITESs to better understand sustainability

Detection and quantification of 14 Campylobacter species in pet dogs reveals an increase in species richness in feces of diarrheic animals

<p>Abstract</p> <p>Background</p> <p>The genus <it>Campylobacter </it>includes many species, some of which are known human and animal pathogens. Even though studies have repeatedly identified domestic dogs as a risk factor for human campylobacteriosis, our understanding of <it>Campylobacter </it>ecology in this reservoir is limited. Work to date has focused primarily on a limited number of species using culture-based methods. To expand our understanding of <it>Campylobacter </it>ecology in dogs, a collection of fecal samples from 70 healthy and 65 diarrheic pet dogs were examined for the presence and levels of 14 <it>Campylobacter </it>species using quantitative PCR.</p> <p>Results</p> <p>It was found that 58% of healthy dogs and 97% of diarrheic dogs shed detectable levels of <it>Campylobacter </it>spp., with <it>C. coli, C. concisus, C. fetus, C. gracilis, C. helveticus, C. jejuni, C. lari, C. mucosalis, C. showae, C. sputorum </it>and <it>C. upsaliensis </it>levels significantly higher in the diarrheic population. Levels of individual <it>Campylobacter </it>species detected ranged from 10³to 10⁸organisms per gram of feces. In addition, many individual samples contained multiple species of <it>Campylobacter</it>, with healthy dogs carrying from 0-7 detectable species while diarrheic dogs carried from 0-12 detectable species.</p> <p>Conclusions</p> <p>These findings represent the largest number of <it>Campylobacter </it>species specifically tested for in animals and is the first report to determine quantifiable levels of <it>Campylobacter </it>being shed from dogs. This study demonstrates that domestic dogs can carry a wide range of <it>Campylobacter </it>species naturally and that there is a notable increase in species richness detectable in the diarrheic population. With several of the detected <it>Campylobacter </it>species known or emerging pathogens, these results are relevant to both ecological and public health discussions.</p

Structure of human saposin A at lysosomal pH.

The saposins are essential cofactors for the normal lysosomal degradation of complex glycosphingolipids by acid hydrolase enzymes; defects in either saposin or hydrolase function lead to severe metabolic diseases. Saposin A (SapA) activates the enzyme β-galactocerebrosidase (GALC), which catalyzes the breakdown of β-D-galactocerebroside, the principal lipid component of myelin. SapA is known to bind lipids and detergents in a pH-dependent manner; this is accompanied by a striking transition from a `closed' to an `open' conformation. However, previous structures were determined at non-lysosomal pH. This work describes a 1.8 Å resolution X-ray crystal structure determined at the physiologically relevant lysosomal pH 4.8. In the absence of lipid or detergent at pH 4.8, SapA is observeed to adopt a conformation closely resembling the previously determined `closed' conformation, showing that pH alone is not sufficient for the transition to the `open' conformation. Structural alignments reveal small conformational changes, highlighting regions of flexibility.CHH is funded by a Wellcome Trust PhD studentship, RJR is supported by a Principal Research Fellowship funded by the Wellcome Trust (Grant No. 082961/Z/07/Z) and JED is supported by a Royal Society University Research Fellowship (UF100371). The Cambridge Institute for Medical Research is supported by a Wellcome Trust Strategic Award (100140).This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1107/S2053230X1500858

Young-adult children of alcoholic parents: protective effects of positive family functioning

The occurrence of alcoholism is clustered within families, but the detrimental effect of a positive family history may vary with the degree of family impairment involved. In this study we assessed the effects of family history and family environment on alcohol misuse. From ongoing studies we recruited parents who had a child aged 18–30, 20 with a DSM-III-R alcohol dependence diagnosis, 20 without. The child then completed a multidimensional assessment. The young-adult participants included 20 men and 20 women (mean age=24.8). Differences by family history were restricted to substance abuse behaviors. While a high level of alcohol problems occurred in both groups, those with an alcohol-dependent parent were more likely to be heavy drinkers and showed more symptoms of alcohol dependence. Overall psychological adjustment did not differ between the groups, however. Alcohol misuse measures did correlate moderately with symptoms of poor emotional health. The most important correlates of alcohol misuse measures in this study were exposure to parental alcoholism, abusive punishment, and psychological symptoms, with some separation of effects in the two subgroups. Psychological symptoms had a stronger relationship with misuse in subjects with social-drinking parents, while abuse was more associated in the group with an alcohol-dependent parent. These results confirm the importance of environmental interactions with familial risk. A biological vulnerability from an alcohol-dependent parent was not sufficient or necessary for the participants in this study to develop alcohol dependence as a young adult, although there was an increased risk. There appear to be strong protective effects of positive family relationships on the potential negative effects of a family history of alcoholism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73415/1/j.1360-0443.1992.tb02681.x.pd

Factors Influencing the Pursuit of Careers in Academic Medicine: A Survey of MD-PhD Residents in Dermatology Programs in the United States

A survey of all MD-PhD residents in dermatology in the United States was conducted to evaluate the factors important to them in making career pathway decisions. Twenty-six MD-PhDs responded to the survey representing a 90% response rate. Although essentially all entered dermatology with the intention of pursuing a career in academic medicine, 77% percent thought they would be in academic medicine 5 years post-residency. Factors explored for a negative influence on entrance into academic medicine post-residency were 1) financial concerns, 2) length of training, 3) research hiatus due to clinical training, and 4) eligibility for existing funding mechanisms

Comparison of Convective Overshooting Models and Their Impact on Abundances from Integrated Light Spectroscopy of Young (<< 3 Gyr) Star Clusters

As part of an ongoing program to measure detailed chemical abundances in nearby galaxies, we use a sample of young to intermediate age clusters in the Large Magellanic Cloud with ages of 10 Myr to 2 Gyr to evaluate the effect of isochrone parameters, specifically core convective overshooting, on Fe abundance results from high resolution, integrated light spectroscopy. In this work we also obtain fiducial Fe abundances from high resolution spectroscopy of the cluster individual member stars. We compare the Fe abundance results for the individual stars to the results from isochrones and integrated light spectroscopy to determine whether isochrones with convective overshooting should be used in our integrated light analysis of young to intermediate age (10 Myr -3 Gyr) star clusters. We find that when using the isochrones from the Teramo group, we obtain more accurate results for young and intermediate age clusters over the entire age range when using isochrones without convective overshooting. While convective overshooting is not the only uncertain aspect of stellar evolution, it is one of the most readily parametrized ingredients in stellar evolution models, and thus important to evaluate for the specific models used in our integrated light analysis. This work demonstrates that our method for integrated light spectroscopy of star clusters can provide unique tests for future constraints on stellar evolution models of young and intermediate age clusters.Comment: 16 pages, accepted for publication in Ap