Clinical effectiveness of a pain psychology service within an outpatient secondary care setting

Purpose Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. This paper presents individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy (ACT). Design/methodology/approach Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-14. Outcomes were compared to 2012-13. A patient satisfaction questionnaire was administered and functional outcomes were collated. Findings Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliably improvement increased from 2012-13; 81% reliably improved, 44% made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care. Research limitations/implications Clinically effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs. Practical implications A number of recommendations concerning data collection and future service evaluations are made. Originality/value This paper contributes towards the evidence-base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e., practice-based evidence)

April 30, 1927

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

Validating the Developmental, Diagnostic and Dimensional Interview - Short Form Adult Version (3Di-sva): a diagnostic interview for autism spectrum disorders in adults

Department of Health (2010) guidelines highlight the importance of diagnosis for adults with autism spectrum disorders (ASD) who have not previously had their condition recognised. Reliable, valid and user-friendly diagnostic tools must therefore be available. Part 1: This section critically appraises and systematically reviews 12 studies examining the NICE (2012) recommended adult ASD diagnostic tools. It concludes that there is good evidence to support the use of the Ritvo Asperger Diagnostic Scale-Revised(RAADS-R) and Autism Diagnostic Observation Schedule (ADOS), with some support for the use of the Autism Diagnostic Interview-Revised (ADI-R). However the Adult Asperger Assessment (AAA), Asperger Syndrome Diagnostic Interview (ASDI) and Diagnostic Interview for Social and Communication Disorders (DISCO) appear to have insufficient evidence at present. Further research is indicated for all the instruments. Part 2: This section presents a study of a new informant report diagnostic tool, the Developmental, Diagnostic and Dimensional Interview - Short Form Adult Version (3Di-sva). The 3Di-sva interview was completed with an informant for 27 ASD and 27 non-clinical comparison participants. It demonstrated good psychometric properties, including good internal consistency and inter-rater reliability, and strong sensitivity and specificity. The 3Di-sva is a time and cost-efficient tool, which could be suitable for use as part of a multi-dimensional adult ASD assessment. The study was completed as part of a joint project with McKenner (2015), who examined the 3Di-sva when used in a clinical comparison population. Part 3: This section is a critical appraisal which reflects upon areas relevant to both the literature review and empirical paper. The main focus of the discussion is upon on the idea of ideal versus achievable research and upon my learning process about research within NHS settings

Geography of Diet in the UK Women’s Cohort Study: A Cross-Sectional Analysis

Diet can influence health outcomes and chronic disease risk, therefore a better understanding of factors influencing diet is important in promotion of healthier dietary choices. Many factors influence food choice, including the environment in which we live. This study aims to explore differences in dietary pattern consumption by two spatial measures: Government Office Region (a large regional unit of geography) and Output Area Classification (a small area geography combined with demographic characteristics). A cross-sectional analysis using data from the UK Women’s Cohort Study was carried out. This cohort included ~35000 middle aged women recruited between 1995 and 1999. Dietary patterns were derived using a k-means cluster analysis from diet data collected using a validated 217 item Food Frequency Questionnaire. Multinomial logit regression was used to test whether the area in which the women live, predicts their dietary pattern consumption. Results show that dietary patterns vary significantly by both spatial measures. The Government Office Region, the North West of England has the highest proportion of individuals consuming the least healthy, monotonous diets, while Greater London has the highest proportion of vegetarian diets. Individuals living in Supergroups ‘Countryside’ and ‘Prospering Suburbs’ consume healthier, more diverse diets. Those in ‘Constrained by Circumstance’ and ‘Blue Collar Communities’ consume monotonous, less healthy diets. Using a combination of spatial scales such as Government Office Region and Output Area Classification Supergroup could have a beneficial impact on targeting of public health dietary interventions and subsequent health

Complete bilayer adsorption of C16TAB on the surface of mica using neutron reflection.

We present neutron reflection data from an alkylammonium surfactant (C16TAB) at the mica/water interface. The system is studied in situ in a noninvasive manner and indicates the formation of a complete adsorbed bilayer with little evidence of defects. A detailed analysis suggests that the data are not consistent with some other previously reported adsorbed structures, such as micelles or cylinders.BPThis is the accepted manuscript. The final version is available at http://pubs.acs.org/doi/full/10.1021/acs.jpcb.5b00397

Non-invasive computer-assisted measurement of knee alignment

The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1° larger than for the rigid model with statistically similar variance (p=0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost ±1°, with up to ±0.5° loss of repeatability for coronal alignment measured before and after stress maneuvers, and a ±0.2° loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were ±1.6° and ±2.3°, respectively. Varus and valgus stress measurements agreed to within ±1.3° and ±1.1°, respectively. Agreement limits for standing MFT angles were ±2.9° (coronal) and ±5.0° (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs

Staphylococcus aureus inactivates daptomycin by releasing membrane phospholipids

Daptomycin is a bactericidal antibiotic of last resort for serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA)1,2. Although resistance is rare, treatment failure can occur in more than 20% of cases3,4 and so there is a pressing need to identify and mitigate factors that contribute to poor therapeutic outcomes. Here, we show that loss of the Agr quorum-sensing system, which frequently occurs in clinical isolates, enhances S. aureus survival during daptomycin treatment. Wild-type S. aureus was killed rapidly by daptomycin, but Agr-defective mutants survived antibiotic exposure by releasing membrane phospholipids, which bound and inactivated the antibiotic. Although wild-type bacteria also released phospholipid in response to daptomycin, Agr-triggered secretion of small cytolytic toxins, known as phenol soluble modulins, prevented antibiotic inactivation. Phospholipid shedding by S. aureus occurred via an active process and was inhibited by the β-lactam antibiotic oxacillin, which slowed inactivation of daptomycin and enhanced bacterial killing. In conclusion, S. aureus possesses a transient defence mechanism that protects against daptomycin, which can be compromised by Agr-triggered toxin production or an existing therapeutic antibiotic

SAT-based Explicit LTL Reasoning

We present here a new explicit reasoning framework for linear temporal logic (LTL), which is built on top of propositional satisfiability (SAT) solving. As a proof-of-concept of this framework, we describe a new LTL satisfiability tool, Aalta\_v2.0, which is built on top of the MiniSAT SAT solver. We test the effectiveness of this approach by demonnstrating that Aalta\_v2.0 significantly outperforms all existing LTL satisfiability solvers. Furthermore, we show that the framework can be extended from propositional LTL to assertional LTL (where we allow theory atoms), by replacing MiniSAT with the Z3 SMT solver, and demonstrating that this can yield an exponential improvement in performance