The MATISSE study: a randomised trial of group art therapy for people with schizophrenia.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: Art Therapy has been promoted as a means of helping people who may find it difficult to express themselves verbally engage in psychological treatment. Group Art Therapy has been widely used as an adjunctive treatment for people with schizophrenia but there have been few attempts to examine its effects and cost effectiveness has not been examined. The MATISSE study aims to evaluate the clinical and cost effectiveness of group Art Therapy for people with schizophrenia. METHOD/DESIGN: The MATISSE study is a three-arm, parallel group, pragmatic, randomised, controlled trial of referral to group Art Therapy plus standard care, referral to an attention control 'activity' group plus standard care, or standard care alone. Study participants were recruited from inpatient and community-based mental health and social care services at four centres in England and Northern Ireland. Participants were aged over 18 years with a clinical diagnosis of schizophrenia, confirmed by an examination of case notes using operationalised criteria. Participants were then randomised via an independent and remote telephone randomisation service using permuted stacked blocks, stratified by site. Art Therapy and activity groups were made available to participants once a week for up to 12 months. Outcome measures were assessed by researchers masked to allocation status at 12 and 24 months after randomisation. Participants and care givers were aware which arm of the trial participants were allocated to. The primary outcomes for the study are global functioning (measured using the Global Assessment of Functioning scale) and mental health symptoms (measured using the Positive and Negative Syndrome Scale) assessed at 24 months. Secondary outcomes were assessed at 12 and 24 months and comprise levels of group attendance, social function, satisfaction with care, mental wellbeing, and costs. DISCUSSION: We believe that this is the first large scale pragmatic trial of Art Therapy for people with schizophrenia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN46150447.Published versio

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

Objectives To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment

Functional imaging and circulating biomarkers of response to regorafenib in treatment-refractory metastatic colorectal cancer patients in a prospective phase II study

Objective: Regorafenib demonstrated efficacy in patients with metastatic colorectal cancer (mCRC). Lack of predictive biomarkers, potential toxicities and cost-effectiveness concerns highlight the unmet need for better patient selection. Design: Patients with RAS mutant mCRC with biopsiable metastases were enrolled in this phase II trial. Dynamic contrast-enhanced (DCE) MRI was acquired pretreatment and at day 15 post-treatment. Median values of volume transfer constant (Ktrans), enhancing fraction (EF) and their product KEF (summarised median values of Ktrans× EF) were generated. Circulating tumour (ct) DNA was collected monthly until progressive disease and tested for clonal RAS mutations by digital-droplet PCR. Tumour vasculature (CD-31) was scored by immunohistochemistry on 70 sequential tissue biopsies. Results: Twenty-seven patients with paired DCE-MRI scans were analysed. Median KEF decrease was 58.2%. Of the 23 patients with outcome data, >70% drop in KEF (6/23) was associated with higher disease control rate (p=0.048) measured by RECIST V. 1.1 at 2 months, improved progression-free survival (PFS) (HR 0.16 (95% CI 0.04 to 0.72), p=0.02), 4-month PFS (66.7% vs 23.5%) and overall survival (OS) (HR 0.08 (95% CI 0.01 to 0.63), p=0.02). KEF drop correlated with CD-31 reduction in sequential tissue biopsies (p=0.04). RAS mutant clones decay in ctDNA after 8 weeks of treatment was associated with better PFS (HR 0.21 (95% CI 0.06 to 0.71), p=0.01) and OS (HR 0.28 (95% CI 0.07–1.04), p=0.06). Conclusions: Combining DCE-MRI and ctDNA predicts duration of anti-angiogenic response to regorafenib and may improve patient management with potential health/economic implications

On-line Randomized Controlled Trial of an Internet Based Psychologically Enhanced Intervention for People with Hazardous Alcohol Consumption

Background: Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost, with potentially major public health implications. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol. DYD-RCT Trial registration: ISRCTN 31070347.Methodology/Principal Findings: A two-arm randomised controlled trial was conducted entirely on-line through the Down Your Drink (DYD) website. A total of 7935 individuals who screened positive for hazardous alcohol consumption were recruited and randomized. At entry to the trial, the geometric mean reported past week alcohol consumption was 46.0 (SD 31.2) units. Consumption levels reduced substantially in both groups at the principal 3 month assessment point to an average of 26.0 (SD 22.3) units. Similar changes were reported at 1 month and 12 months. There were no significant differences between the groups for either alcohol consumption at 3 months (intervention: control ratio of geometric means 1.03, 95% CI 0.97 to 1.10) or for this outcome and the main secondary outcomes at any of the assessments. The results were not materially changed following imputation of missing values, nor was there any evidence that the impact of the intervention varied with baseline measures or level of exposure to the intervention.Conclusions/Significance: Findings did not provide support for the hypothesis that access to a psychologically enhanced website confers additional benefit over standard practice and indicate the need for further research to optimise the effectiveness of Internet-based behavioural interventions. The trial demonstrates a widespread and potentially sustainable demand for Internet based interventions for people with hazardous alcohol consumption, which could be delivered internationally

Αξιολόγηση καταλληλότητας εμπλουτισμού του υδροφορέα του Γεροπόταμου στην περιοχή Μεσσαρά της νήσου Κρήτης

Summarization: Throughout the Mediterranean region, semi-arid climate in conjunction with intensive agriculture are stressing scarce groundwater supplies which are over-exploited to cover irrigation water demands. Such a case is the Messara Basin in the island of Crete. This has led to increased costs associated with groundwater extraction, seawater intrusion along the coastal zone, and negative environmental impacts (disappearance of wetlands). As a result, and in order to stabilize groundwater levels, managerial measures on groundwater withdrawals were imposed by the government in 2017. These regulations prohibit, among others, the drilling of new wells, the groundwater withdrawals above certain limits and the modification of current infrastructure related to groundwater production. According to the recent Water Resources Management Plan (WRMP) for the Water District of Crete targets for the improvement of the quality and quantity of the degraded groundwater bodies in the Geropotamos Basin have been set based on the EU Water Framework Directive. According to the regional authorities, groundwater pumping is not expected to stop and it was suggested within the WRMP the consideration of appropriate managed aquifer recharge, suitability studies and assessments. The present study was developed in the framework of the postgraduate studies of the Department of Environmental Engineering at the Technical University of Crete and deals with the identification of the areas that are most suitable for the aquifer recharge, in the area of the Geropotamos basin, using GIS multi-criteria decision analysis (GIS-MCDA) method to identify suitable sites for implementing MAR (Managed Aquifer Recharge) type spreading method. The criteria combining a high relevance and high data availability, and providing unique information , selected to assess the suitability of MAR spreading methods in Geropotamos basin are slope, land use, hydrogeology, rainfall, groundwater level, soil texture and distance to source water. This study uses the ‘Pairwise comparison’ to assign criteria weights, developed by Saaty (1980) as part of the AHP. In this study were examined 4 scenarios. In the first scenario was not taken into account the criterion of distance to the water source. In the second scenario was added to the criteria the distance to the dam of Faneromeni. In the third scenario was added the criterion of distance to the river of Geropotamos. Finally, in the fourth scenario, was added to the criteria both, distance to the dam of Faneromeni and the river of Geropotamos. In all 4 scenarios the areas that are west of the study area and close to the river Geropotamos, coincide as the most suitable for aquifer recharge.Περίληψη: Σε ολόκληρη την περιοχή της Μεσογείου, το ημι-άνυδρο κλίμα σε συνδυασμό με την εντατική γεωργία επιβαρύνει την έλλειψη εμπλουτισμού των υπόγειων υδάτων τα οποία έχουν υποστεί υπερεκμετάλλευση ώστε να καλυφθούν οι ανάγκες σε άρδευση.Μια τέτοια περίπτωση είναι η λεκάνη της Μεσσαράς στο νησί της Κρήτης, όπου αυτό έχει οδηγήσει σε αυξημένο κόστος όσον αφορά την άντληση των υπόγειων υδάτων, την εισβολή θαλασσινού νερού κατά μήκος της παράκτιας ζώνης και αρνητικές περιβαλλοντικές επιπτώσεις (εξαφάνιση υγροτόπων). Ως αποτέλεσμα, για τη σταθεροποίηση των επιπέδων των υπόγειων υδάτων, η κυβέρνηση επέβαλε διαχειριστικά μέτρα για την σταθεροποίηση των υπόγειων υδάτων το 2017. Αυτοί οι κανονισμοί απαγορεύουν μεταξύ άλλων, τη διάτρηση νέων πηγαδιών, την άντληση υπόγειων υδάτων πάνω από ορισμένα όρια και την τροποποίηση της τρέχουσας υποδομής που σχετίζεται με την παραγωγή υπόγειων υδάτων. Σύμφωνα με το πρόσφατο Διαχειριστικό Σχέδιο Υδάτινων Πόρων για την Περιφέρεια Υδάτων της Κρήτης , οι στόχοι για τη βελτίωση της ποιότητας και της ποσότητας των υποβαθμισμένων υπογείων υδάτων στη λεκάνη του Γεροπόταμου έχουν τεθεί βάσει της Οδηγίας-πλαίσιο της ΕΕ για τα ύδατα. Σύμφωνα με τις περιφερειακές αρχές, η άντληση των υπόγειων υδάτων δεν αναμένεται να σταματήσει και προτάθηκε στο πλαίσιο του Διαχειριστικού Σχεδίου η εξέταση του κατάλληλου τεχνητού εμπλουτισμού, μελέτες καταλληλότητας και αξιολογήσεις. Η παρούσα μελέτη αναπτύχθηκε στο πλαίσιο των μεταπτυχιακών σπουδών του Τμήματος Μηχανικών Περιβάλλοντος του Πολυτεχνείου Κρήτης και ασχολείται με τον εντοπισμό των περιοχών που είναι πιο κατάλληλες για τον τεχνιτό εμπλουτισμό του υδροφόρου ορίζοντα, στην περιοχή της λεκάνης του Γεροπόταμου, χρησιμοποιώντας την Πολυκριτιριακή Μέθοδο Ανάλυσης Αποφάσεων με χρήση GIS (GIS-MCDA) για τον προσδιορισμό κατάλληλων τοποθεσιών για την εφαρμογή της μεθόδου διασποράς (spreading method) τύπου MAR (Managed Aquifer Recharge). Τα κριτήρια που συνδυάζουν υψηλή συνάφεια και υψηλή διαθεσιμότητα δεδομένων και παρέχουν μοναδικές πληροφορίες, τα οποία επιλέχθηκαν για την αξιολόγηση της καταλληλότητας των μεθόδων διασποράς τύπου MAR στη λεκάνη του Γεροποτάμου είναι η κλίση, η χρήση γης, η υδρογεωλογία, οι βροχοπτώσεις, η στάθμη των υπόγειων υδάτων, η μορφολογία του εδάφους και η απόσταση από κάποια πηγή νερού. Αυτή η μελέτη χρησιμοποιεί την «Σύγκριση Pairwise» για να καθορίσει τα βάρη κριτηρίων, που αναπτύχθηκαν από την Saaty (1980) ως μέρος του AHP. Σε αυτή τη μελέτη εξετάστηκαν 4 σενάρια. Στο πρώτο σενάριο δεν ελήφθη υπόψη το κριτήριο της απόστασης από την πηγή νερού. Στο δεύτερο σενάριο προστέθηκε στα κριτήρια η απόσταση από το φράγμα της Φανερωμένης. Στο τρίτο σενάριο προστέθηκε το κριτήριο της απόστασης από τον ποταμό Γεροπόταμο. Τέλος, στο τέταρτο σενάριο, προστέθηκαν στα κριτήρια και τα δύο, η απόσταση από το φράγμα της Φανερωμένης και τον ποταμό Γεροπόταμο. Και στα 4 σενάρια οι περιοχές που βρίσκονται δυτικά της περιοχής μελέτης και κοντά στον ποταμό Γεροπόταμο, συμπίπτουν ως οι πιο κατάλληλες περιοχές για τεχνητό εμπλουτισμό του υδροφορέα

Εκτίμηση τρωτότητας του υδροφορέα της λεκάνης Μοιρών, Ηρακλείου Κρήτης, με χρήση της μεθόδου DRASTIC-LU

Περίληψη: Η παρούσα διπλωματική εργασία εκπονήθηκε στα πλαίσια των προπτυχιακών σπουδών του τμήματος Μηχανικών Περιβάλλοντος του Πολυτεχνείου Κρήτης και έχει ως θέμα την τρωτότητα του υδροφορέα της λεκάνης των Μοιρών, μέσω της μεθόδου DRASTIC-LU, με χρήση του προγράμματος ArcMap του GIS. Στο 1ο κεφάλαιο γίνεται αρχικά αναφορά στη σημασία του υπόγειου νερού στον υδρολογικό κύκλο και στη συνέχεια αναλύεται το πρόβλημα ρύπανσης των υπόγειων υδάτων, καθώς και οι πηγές ρύπανσης και οι τρόποι αντιμετώπισης της. Στο 2ο κεφάλαιο αναφέρεται η έννοια της τρωτότητας καθώς και οι μέθοδοι εκτίμησης της και αναλύεται η μέθοδος DRASTIC-LU. Στο 3ο κεφάλαιο γίνεται περιγραφή της περιοχής μελέτης και στο 4ο και 5ο παρουσιάζονται τα αποτελέσματα της μελέτης και τα συμπεράσματα αυτής

Test-retest reliability of an online measure of past week alcohol consumption (the TOT-AL), and comparison with face-to-face interview.

OBJECTIVE: This paper reports on the development of a new online measure of beverage-specific past week alcohol consumption (the TOT-AL), its test-retest reliability, and comparability with the face-to-face approach of ascertaining alcohol intake. METHODS: University students participating in the reliability study completed the TOT-AL twice on the same day with at least 3 h apart. Students in the comparability study attended a face-to-face interview and completed the TOT-AL on the same day, in a randomised order, at least 3 h apart. RESULTS: There was a strong correlation between the repeated measurements of the TOT-AL (r=0.99; 95% CI: 0.98, 0.99) and between the units calculated by the TOT-AL and the face-to face interview (r=0.97; 95% CI: 0.95, 0.99). A high level of agreement between measurements was also observed in a Bland-Altman analysis. CONCLUSIONS: The TOT-AL is a reliable, time efficient means of ascertaining alcohol intake, equivalent to that obtained face-to-face. These findings support the use of this approach to online alcohol assessment in populations with access to the Internet

On-line randomized controlled trial of an Internet based psychologically enhanced intervention for people with hazardous alcohol consumption

Abstract Background: Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost, with potentially major public health implications. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol. DYD-RCT Trial registration: ISRCTN 31070347