A community-based group-guided self-help intervention for low mood and stress: study protocol for a randomized controlled trial

<br>Background: Depression is a mental health condition which affects millions of people each year, with worldwide rates increasing. Cognitive behavioral therapy (CBT) is recommended in the National Institute for Health and Clinical Excellence (NICE) guidelines for the treatment of depression. However, waiting lists can cause delays for face-to-face therapy. Also a proportion of people decline to present for help through the health service – the so-called treatment gap. Self-referral to CBT using community-based group interventions delivered by a voluntary sector organization may serve to resolve this problem. The aim of this randomized controlled trial (RCT) is to determine the efficacy of such a guided CBT self-help course, the ‘Living Life to the Full’ (LLTTF) classes delivered by the charity Action on Depression (AOD). The primary outcome is level of depression at 6 months assessed using the patient health questionnaire-9 (PHQ9) depression scale. Secondary measures include levels of anxiety and social functioning.</br> <br>Methods/design: Participants with symptoms of low mood will be recruited from the community through newspaper adverts and also via the AOD website. Participants will receive either immediate or delayed access to guided CBT self-help classes - the eight session LLTTF course. The primary endpoint will be at 6 months at which point the delayed group will be offered the intervention. Levels of depression, anxiety and social functioning will be assessed and an economic analysis will be carried out.</br> <br>Discussion: This RCT will test whether the LLTTF intervention is effective and/or cost-effective. If the LLTTF community-based classes are found to be cost effective, they may be helpful as both an intervention for those already seeking care in the health service, as well as those seeking help outside that setting, widening access to psychological therapy.</br&gt

Beyond Safe Harbor: Risk of Exposing Location in De-Identified Clinical Data

The use of de-identified EHR data for clinical and translational research has increased significantly since the HIPAA Privacy Rule De-Identification standards went into effect -Inclusion of SDOH measures in de-identified research is increasing as well, which presents an inherent risk of re-identifying PHI (primarily location units smaller than the state) -Data warehouse architecture and institutional policies need to recognize the risk associated with providing multiple location-based indices -Research interests are secondary to privacy concerns throughout biomedical research, but particularly in de-identified research, which is intended to promote more secure access to EHR data while allowing for expedient access (fewer institutional barriers to entry)https://digitalcommons.unmc.edu/com_neuro_pres/1000/thumbnail.jp

Maintenance of ONC Terminology for i2b2 Metadata

ONC terminologies are constantly adding new content and deactivating existing codes. The University of Nebraska Medical Center (UNMC) deploys three primary code sets that require regular updating to support research: SNOMED CT, RXNORM / NDC, and LOINC. A problem across the i2b2 community is keeping these terminologies up-to-date and loading them into i2b2 for timely analysis of EHR data. We have developed tool kits for rapid deployment of SNOMED CT metadata and will be extending the work to RXNORM/NDC and LOINC.https://digitalcommons.unmc.edu/com_emerg_pres/1001/thumbnail.jp

Tectonostratigraphic Evolution of the orange basin, sw Africa

The Orange Basin is a Late Jurassic to present day basin located on the volcanic-rifted passive margin of SW Africa. 2D seismic data and structural restoration techniques were used to develop a tectonostratigraphic model of the basin consisting of a syn-rift and a post-rift megasequences separated by an Early Cretaceous break-up unconformity. The post-rift megasequence is characterised by gravity tectonics where extensional faults transferred displacement downdip into a deep water fold and thrust belt (DWFTB). Gravity gliding tectonics occurred through a combination of cratonic uplift and thermal subsidence and stopped via deltaic progradation and associated differential sedimentary loading

Structural control of inherited salt structures during inversion of a domino basement-fault system from an analogue modelling approach

The geometries of inverted rift systems are different depending on a large variety of factors that include, among others, the presence of decoupling layers, the thickness of the pre- and syn-extension successions, or structural inheritances. Our study focuses on the inversion of an extensional domino-style basement-fault system with a pre-extension salt layer using analogue models to understand the role of pre-existing structural features during inversion. Models investigate how different overburden and salt thicknesses, inherited extensional structures, and salt distributions condition the evolution during inversion. The experimental results show that models with thick salt can partially or totally preserve the extensional ramp-syncline basin geometry independently of the overburden thickness. In contrast, models with a thin salt layer result in a total inversion of the ramp-syncline basins with the development of crestal collapse grabens and extensional faults affecting the overburden. Inversion also triggered the growth or reactivation of salt-related structures such as primary weld reopening and/or obliteration, diapir rejuvenation, salt thickening, or thrust emplacement. The use of analogue modelling allowed us to address the processes that controlled the growth and evolution of these structural elements during the inversion. Experimental results also provide a template of different structural styles resulting from the positive inversion of basins with a pre-extensional salt layer that can help subsurface interpretation in areas with poor seismic imaging

Influence of fault geometries and mechanical anisotropies on the growth and inversion of hanging-wall synclinal basins: insights from sandbox models and natural examples

Salt is mechanically weaker than other sedimentary rocks in rift basins. It commonly acts as a strain localizer, and decouples supra- and sub-salt deformation. In the rift basins discussed in this paper, sub-salt faults commonly form wide and deep ramp synclines controlled by the thickness and strength of the overlying salt section, as well as by the shapes of the extensional faults, and the magnitudes and slip rates along the faults. Upon inversion of these rift basins, the inherited extensional architectures, and particularly the continuity of the salt section, significantly controls the later contractional deformation. This paper utilizes scaled sandbox models to analyse the interplay between sub-salt structures and supra-salt units during both extension and inversion. Series 1 experiments involved baseline models run using isotropic sand packs for simple and ramp-flat listric faults, as well as for simple planar and kinked planar faults. Series 2 experiments involved the same fault geometries but also included a pre-extension polymer layer to simulate salt in the stratigraphy. In these experiments, the polymer layer decoupled the extensional and contractional strains, and inhibited the upwards propagation of sub-polymer faults. In all Series 2 experiments, the extension produced a synclinal hanging-wall basin above the polymer layer as a result of polymer migration during the deformation. During inversion, the supra-polymer synclinal basin was uplifted, folded and detached above the polymer layer. Changes in thickness of the polymer layer during the inversion produced primary welds and these permitted the sub-polymer deformation to propagate upwards into the supra-salt layers. The experimental results are compared with examples from the Parentis Basin (Bay of Biscay), the Broad Fourteens Basin (southern North Sea), the Feda Graben (central North Sea) and the Cameros Basin (Iberian Range, Spain)

Phase II study of second-line therapy with DTIC, BCNU, cisplatin and tamoxifen (Dartmouth regimen) chemotherapy in patients with malignant melanoma previously treated with dacarbazine

This study assessed response rates to combination dacarbazine (DTIC), BCNU (carmustine), cisplatin and tamoxifen (DBPT) chemotherapy in patients with progressive metastatic melanoma previously treated with DTIC, as an evaluation of DBPT as a second-line regimen, and as an indirect comparison of DBPT with DTIC. Thirty-five consecutive patients received DBPT. The patients were divided into two groups. Group 1 comprised 17 patients with progressive disease (PD) on DTIC + tamoxifen therapy who were switched directly to DBPT. Group 2 comprised 18 patients not immediately switched to DBPT and included patients who had either a partial response (PR; one patient) or developed stable disease (SD; four patients) with DTIC, or received adjuvant DTIC (nine patients). All except four patients had received tamoxifen at the time of initial DTIC treatment. Median times since stopping DTIC were 22 days (range 20–41) and 285 days (range 50–1240) in Groups 1 and 2 respectively. In Group 1, one patient developed SD for 5 months and the remainder had PD. In Group 2, there were two PRs, four patients with SD (4, 5, 6, and 6 months), and 11 with PD. These results indicate that the DBPT regimen is not of value in melanoma primarily refractory to DTIC. There were responses in patients not directly switched from DTIC to DBPT, suggesting combination therapy may be of value in a small subgroup of melanoma patients. © 2000 Cancer Research Campaig

Gene regulatory network subcircuit controlling a dynamic spatial pattern of signaling in the sea urchin embryo

We dissect the transcriptional regulatory relationships coordinating the dynamic expression patterns of two signaling genes, wnt8 and delta, which are central to specification of the sea urchin embryo endomesoderm. cis-Regulatory analysis shows that transcription of the gene encoding the Notch ligand Delta is activated by the widely expressed Runx transcription factor, but spatially restricted by HesC-mediated repression through a site in the delta 5′UTR. Spatial transcription of the hesC gene, however, is controlled by Blimp1 repression. Blimp1 thus represses the repressor of delta, thereby permitting its transcription. The blimp1 gene is itself linked into a feedback circuit that includes the wnt8 signaling ligand gene, and we showed earlier that this circuit generates an expanding torus of blimp1 and wnt8 expression. The finding that delta expression is also controlled at the cis-regulatory level by the blimp1-wnt8 torus-generating subcircuit now explains the progression of Notch signaling from the mesoderm to the endoderm of the developing embryo. Thus the specific cis-regulatory linkages of the gene regulatory network encode the coordinated spatial expression of Wnt and Notch signaling as they sweep outward across the vegetal plate of the embryo

Weld kinematics of synrift salt during basement-involved extension and subsequent inversion: Results from analog models

Scaled analog models based on extensional basins with synrift salt show how basement topography exerts a control factor on weld kinematics during the extension and inversion phases. In the case of basement-involved extension, syn-rift salt thickness differences may lead to variable degrees of extensional decoupling between basement topography and overburden, which in turn have a strong impact on the development of salt structures. With ongoing extension and after welding, the basin kinematics evolves toward a coupled deformation style. The basin architecture of our experimental results record the halokinetic activity related to growing diapirs and the timing of weld formation during extension. Moreover, the structures that result from any subsequent inversion of these basins strongly depends on the inherited welds and salt structures. While those basins are uplifted, the main contractional deformation during inversion is absorbed by the pre-existing salt structures, whose are squeezed developing secondary welds that often evolve into thrust welds. The analysis of our analog models shows that shortening of diapirs is favored by: 1) basement topography changes that induce reactivation of primary welds as thrust welds; 2) reactivation of the salt unit as a contractional detachment; and 3) synkinematic sedimentation during basin inversion. Finally in this article we also compare two natural examples from the southern North Sea that highlight deformation patterns very similar to those observed in our analog models