Relationship of depression screening in cardiometabolic disease with vascular events and mortality: findings from a large primary care cohort with 4 years follow-up

Aims: Benefits of routine depression screening for cardiometabolic disease patients remain unclear. We examined the association between depression screening and all-cause mortality and vascular events in cardiometabolic disease patients. Methods and results: 125 143 patients with cardiometabolic diseases (coronary heart disease, diabetes or previous stroke) in the UK participated in primary care chronic disease management in 2008/09, which included depression screening using the Hospital Anxiety and Depression Score. 10 670 receiving depression treatment exempted, 35 537 screened, while 78 936 not screened. We studied all-cause mortality and vascular events at 4 years, by electronic data linkage of 124 414 patients (99.4%) on primary care registers to hospital discharge and mortality records and used Cox proportional hazards on matched data using propensity score. Mean age for the screened and not screened population was 69 years (standard deviation—SD 11.9) and 67 years (SD 14.3), respectively; 58% (20 658) of the screened population were men and 65.3% (22 726) were socioeconomically deprived, compared with 54.2% (42 727) and 67.4% (51 686), respectively, in the not screened population. The screened population had lower all-cause mortality (Hazard Ratio—HR 0.89) and vascular events (HR 0.85) in the matched data of N = 21 893 patients each in the screened and the unscreened groups. Conclusion: Depression screening was associated with a reduction in all-cause mortality and vascular events in patients with cardiometabolic diseases. The uptake of screening was poor for unknown reasons. Reverse causality and confounding by disease severity and quality of care are important possible limitations. Further research to determine reproducibility and explore underlying mechanisms is merited

Baitshop Survey Report 2008: With a focus on the supply and demand for bait-worms in South Australia

Recreational fishing is an increasingly popular hobby both locally and globally. This rise in popularity has increased the global demand for bait and has resulted in a higher demand for bait-worms than can be supplied. Bait-worms are a highly valued resource with a price tag, which is often higher per kg than that of human food. Evidence from overseas indicates that recently three main avenues have been adopted to fill this deficit 1) the culture of bait-worms, 2) the importation of live or preserved bait-worms or 3) by increasing the intensity of wild harvest (which has led to the development of a black market in Europe). None of these avenues has thus far proven sufficient to meet the current bait-worm deficit. Australia is currently mirroring the worldwide bait-worm situation, but to a much lesser extent, so is in the enviable position of being able to address the issue before it becomes dire, as has occurred in many parts of Europe and the USA. Of the three main avenues attempted overseas, only two realistic options are available for Australia and indeed South Australia as our strict quarantine laws preclude the importation of live bait-worms. The two remaining options are to increase the intensity of wild harvest and/or to culture bait-worms. There appears little chance of increasing commercial wild harvest for various reasons discussed in this report, so the development of a culture industry may be the most viable means of addressing the bait-worm deficit. Before considering the development of such an industry, it is imperative, and pertinent, to assess the current and potential markets for both live and preserved bait-worms within South Australia to assess the need for the end product. To this end, a survey was developed, distributed and the findings reported here. This survey was distributed to 92 retailers and 25 (27%) surveys were returned.This survey has identified that: • there is likely to be a market for aquaculture derived worms: 64% of baitshop owners would use a regular source of live worms with >85% of shop owners may prefer cultured worms to wild harvested • approximately 73% of anglers buy their worms from baitshops - which could equate to approximately 225,000 South Australian recreational anglers based on the 2000 - 2001 SA regional version of the National Recreational and Indigenous Fisheries Survey and ~$100 million of funds for fishing related expenses • the responding baitshop owners estimated potential sales of live worms was approximately 1.25 tonnes in the first year. The survey respondent’s sales accounted for only 15% of the total wild harvested bait–worms in the year surveyed, so the above estimate is probably conservative. The potential sales for preserved bait-worms was not assessed

Quantum measurements of spatial conjugate variables: Displacement and tilt of a Gaussian beam

We consider the problem of measurement of optical transverse profile parameters and their conjugate variable. Using multi-mode analysis, we introduce the concept of detection noise-modes. For Gaussian beams, displacement and tilt are a pair of transverse profile conjugate variables. We experimentally demonstrate their optimal encoding and detection with a spatial homodyning scheme. Using higher order spatial mode squeezing, we show the sub-shot noise measurements for the displacement and tilt of a Gaussian beam.Comment: 3 page

Commercially important species associated with horse mussel (Modiolus modiolus) biogenic reefs: a priority habitat for nature conservation and fisheries benefits

Horse mussel reefs (Modiolus modiolus) are biodiversity hotspots afforded protection by Marine Protected Areas (MPAs) in the NE Atlantic. In this study, horse mussel reefs, cobble habitats and sandy habitats were assessed using underwater visual census and drop-down video techniques in three UK regions. Megafauna were enumerated, differences in community composition and individual species abundances were analysed. Samples of conspicuous megafauna were also collected from horse mussel reefs in Orkney for stable isotope analysis.Communities of conspicuous megafauna were different between horse mussel habitats and other habitats throughout their range. Three commercially important species: whelks (Buccinum undatum), queen scallops (Aequipecten opercularis) and spider crabs (Maja brachydactyla) were significantly more abundant (by as much as 20 times) on horse mussel reefs than elsewhere. Isotopic analysis provided insights into their trophic relationship with the horse mussel reef. Protection of M. modiolus habitat can achieve biodiversity conservation objectives whilst benefiting fisheries also

Process evaluation for complex interventions in primary care: understanding trials using the normalization process model

Background: the Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration.Method: in this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care.Results: application of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions.Conclusion: the model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare setting

Embodied energy and operational energy: Case studies comparing different urban layouts

While significant progress has been made in reducing Operational Energy; Embodied Energy has been largely ignored. However, these topics are strongly linked and should be considered as a “Balance Equation”, where all factors must be carefully measured in order to avoid the excesses of both. A comparative study of urban layout and form utilising VIRVIL plugins (in Sketchup) with HTB2 (Heat Transfer in Buildings) indicates that urban layout have an impact on the Operational and Embodied Energy of buildings. The case studies analysed in this paper suggest that there is an advantage of Mid-rise type of buildings in terms of Operational Energy, however the Embodied Energy scenarios are less clear and seem to depend more on the use of the building

Effects of short-term treatment with atorvastatin in smokers with asthma - a randomized controlled trial

<b>Background</b> The immune modulating properties of statins may benefit smokers with asthma. We tested the hypothesis that short-term treatment with atorvastatin improves lung function or indices of asthma control in smokers with asthma.<p></p> <b>Methods</b> Seventy one smokers with mild to moderate asthma were recruited to a randomized double-blind parallel group trial comparing treatment with atorvastatin (40 mg per day) versus placebo for 4 weeks. After 4 weeks treatment inhaled beclometasone (400 ug per day) was added to both treatment arms for a further 4 weeks. The primary outcome was morning peak expiratory flow after 4 weeks treatment. Secondary outcome measures included indices of asthma control and airway inflammation.<p></p> <b>Results</b> At 4 weeks, there was no improvement in the atorvastatin group compared to the placebo group in morning peak expiratory flow [-10.67 L/min, 95% CI -38.70 to 17.37, p=0.449], but there was an improvement with atorvastatin in asthma quality of life score [0.52, 95% CI 0.17 to 0.87 p=0.005]. There was no significant improvement with atorvastatin and inhaled beclometasone compared to inhaled beclometasone alone in outcome measures at 8 weeks.<p></p> <b>Conclusions</b> Short-term treatment with atorvastatin does not alter lung function but may improve asthma quality of life in smokers with mild to moderate asthma. Clinicaltrials.gov identifier: NCT0046382

The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review

Background: Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence. Methods: Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken. Results: We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14–.45; I(2) = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified. Conclusions: Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection