(Cost)effectiveness of life review for Older Adults: Design of a randomized controlled trial

Background Depression in older adults is a serious health problem with a poor prognosis. There is a need for indicated preventive psychological interventions for older adults, that show to be promising in preventing depressive disorders. Methods/design This manuscript describes the design of a study evaluating 'Looking for Meaning', a newly developed prevention course for older adults with depressive symptoms, based on life-review. Both clinical and economic effectiveness are evaluated in a pragmatic randomized controlled trial. The control condition of this 12-session preventive intervention is a 20-minute video movie. The primary outcome is symptoms of depression at post-treatment and follow-up (6 months after post-treatment). Secondary outcomes are symptoms of anxiety, satisfaction with life, mastery, reminiscence styles, quality of life, and health care costs. An additional result of this study is the insight into the working elements of the course, provided by the qualitative study. The qualitative data, mainly based on 20 open-ended interviews with participants, are to be analyzed with an emphasis on newly emerging insight. Discussion This study will add to the existing scientific knowledge in several ways, especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course, both rather new in the field of life review. Positive results of this study will make an evidence-based intervention to improve public health among older people available

Prevention of depression and anxiety in later life: design of a randomized controlled trial for the clinical and economic evaluation of a life-review intervention

Abstract Background Depressive and anxiety symptoms in older adults could develop into significant health problems with detrimental effects on quality of life and a possibly poor prognosis. Therefore, there is a need for preventive interventions which are at once effective, acceptable and economic affordable. Methods and design This paper describes the design of a study evaluating "The stories we live by", a preventive life-review group intervention, which was recently developed for adults of 55 years and over with depressive and anxiety symptoms. Both clinical and economic effectiveness will be evaluated in a pragmatic randomized controlled trial. The participants in the intervention condition will receive the 8-session preventive intervention. The participants in the control condition will have access to usual care. Clinical end-terms are depressive and anxiety symptoms, current major depressive episode, quality of life and positive mental health post-treatment (3 months after baseline) and at follow-ups (6 and 12 months after baseline). Additional goals of this study are to identify groups for whom the intervention is particularly effective and to identify the therapeutic pathways that are vital in inducing clinical change. This will be done by analyzing if treatment response is moderated by demographics, personality, past major depressive episodes, important life events and chronically disease, and mediated by reminiscence functions, perceived control, automatic positive thoughts and meaning in life. Finally the cost-effectiveness of the intervention relative to care as usual will be assessed by computing incremental costs per case of depression and anxiety avoided (cost-effectiveness) and per quality adjusted life year (QALY) (cost utility). Discussion It is expected that both the life-review intervention and its evaluation will contribute to the existing body of knowledge in several ways. First, the intervention is unique in linking life-review with narrative therapy and in its focus on specific, positive memories. Second, the evaluation is likely to answer questions regarding the acceptability and cost-effectiveness of life-review that have not been addressed thoroughly until now. Positive results of this study will make available a new evidence-based intervention to improve public health among people of 55 years and over

Magnetic Resonance Imaging of the Brains of Three Peramelemorphian Marsupials

Peramelemorphians (bandicoots and bilbies) are a unique and diverse group of digging Australasian marsupials, but their behavioral neurology and neuroanatomy is poorly known. Here, we have used Magnetic Resonance Imaging (MRI) to study the brains of three peramelemorphians: two bandicoots (Perameles nasuta and Isoodon obesulus) and the bilby (Macrotis lagotis), which is endangered. These brains had been stored in formaldehyde solution for more than 80 years and one of our goals was to demonstrate the feasibilty of extracting detailed comparative neuroanatomical information from the long-term preserved brains of rare, endangered, and extinct animals. High resolution anatomical and Diffusion Tensor Imaging was performed using a 9.4-T Bruker BioSpec 94/20 Avance III MRI system (Bruker, Ettlingen, Germany) located at the UNSW in Sydney. We were able to differentiate areal and laminar topography within isocortical areas (primary somatosensory – S1; and visual - V1, V2), as well as subdivisions within olfactory and limbic allocortical regions (cingulate, hippocampal). Resolution of subcortical structures was sufficient to differentiate α and β segments within the visual nucleus of the thalamus. We identified several previously unrecognized longitudinal association fiber systems as well as a rich array of sensory thalamocortical connections. Dense fiber pathways were observed to S1 and in the midbrain auditory pathways (mainly the lateral lemniscus, but also the brachium of the inferior colliculus). Our findings demonstrate the feasibility of using this sort of imaging of archived brains to analyze the neuroanatomy of rare and evolutionarily significant species and to relate these findings to the behavioral neurology of those species.Fil: Gurovich, Yamila. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagóica. Universidad Nacional de la Patagonia "San Juan Bosco". Facultad de Ciencias Naturales - Sede Esquel. Centro de Investigación Esquel de Montaña y Estepa Patagónica; Argentina. University of New South Wales; AustraliaFil: Bongers, Andre. University of New South Wales; AustraliaFil: Ashwell, Ken W. S.. University of New South Wales; Australi

Nanoscale measurements of unoccupied band dispersion in few-layer graphene

The properties of any material are fundamentally determined by its electronic band structure. Each band represents a series of allowed states inside a material, relating electron energy and momentum. The occupied bands, that is, the filled electron states below the Fermi level, can be routinely measured. However, it is remarkably difficult to characterize the empty part of the band structure experimentally. Here, we present direct measurements of unoccupied bands of monolayer, bilayer and trilayer graphene. To obtain these, we introduce a technique based on low-energy electron microscopy. It relies on the dependence of the electron reflectivity on incidence angle and energy and has a spatial resolution ∼10 nm. The method can be easily applied to other nanomaterials such as van der Waals structures that are available in small crystals only