Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: The PALMS study protocol

Background Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. Methods/Design In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. Discussion This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions

You are Not Welcome: Social Exchanges between Female Spider Monkeys (Ateles geoffroyi)

Group living leads to competition for food between group members. Two types of intragroup food competition may occur: scramble competition, in which all group members use the same resource, such that feeding opportunities are equal for everyone; and contest competition, in which some group members monopolize resources through aggression and dominance. In species in which females disperse from the natal group and immigrate into other groups, immigrant females increase group size and thus possibly food competition. Under these circumstances, other females may use aggression to discourage new females from joining the group. We assessed the distribution of aggression, embraces, and kisses among female spider monkeys (Ateles geoffroyi) in relation to group tenure. We recorded social interactions during 1688 10-min focal animal samples on 11 females in Santa Rosa, Costa Rica. We found that aggression was rare between long-term resident females and aggression rates were not higher during feeding than in other contexts, suggesting there was little contest competition. Long-term residents and less recently immigrant females showed higher aggression rates toward the most recent immigrants than toward other females, especially during the first months after a female immigrated, which coincided with the dry season. We did not find similar patterns for embrace and kiss. These results suggest that other females target aggression toward the most recent immigrants to reduce scramble competition. This finding suggests that group tenure should be included in socioecological models for species with female dispersal. © 2017 Springer Science+Business Media, LL

Standardisation framework for the Maudsley staging method for treatment resistance in depression

Background: Treatment-resistant depression (TRD) is a serious and relatively common clinical condition. Lack of consensus on defining and staging TRD remains one of the main barriers to understanding TRD and approaches to intervention. The Maudsley Staging Method (MSM) is the first multidimensional model developed to define and stage treatment-resistance in “unipolar depression”. The model is being used increasingly in treatment and epidemiological studies of TRD and has the potential to support consensus. Yet, standardised methods for rating the MSM have not been described adequately. The aim of this report is to present standardised approaches for rating or completing the MSM. Method: Based on the initial development of the MSM and a narrative review of the literature, the developers of the MSM provide explicit guidance on how the three dimensions of the MSM–treatment failure, severity of depressive episode and duration of depressive episode– may be rated. Result: The core dimension of the MSM, treatment failure, may be assessed using the Maudsley Treatment Inventory (MTI), a new method developed for the purposes of completing the MSM. The MTI consists of a relatively comprehensive list of medications with options for rating doses and provisions treatment for multiple episodes. The second dimension, severity of symptoms, may be assessed using simple instruments such as the Clinical Global Impression, the Psychiatric Status Rating or checklist from a standard diagnostic checklist. The standardisation also provides a simple rating scale for scoring the third dimension, duration of depressive episode. Conclusion: The approaches provided should have clinical and research utility in staging TRD. However, in proposing this model, we are fully cognisant that until the pathophysiology of depression is better understood, staging methods can only be tentative approximations. Future developments should attempt to incorporate other biological/ pathophysiological dimensions for staging

Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults

Background: Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. Methods: We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥40 kgm−2 (or ≥35 kgm−2 with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. Results: Of 183 bariatric patients enrolled, 150 (81.9 %) completed the programme. Mean age of completers was 47.9 ± 11.2 years. 34.7 % were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm−2, p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3 % (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9 %, p = 0.02. (Continued on next page)Conclusions: Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted. Keywords: Bariatric, Structured lifestyle modification, Cardiovascular risk, CLANN (Changing Lifestyle with Activity and Nutrition) Programme, Nurse-led, Diabete

Tailoring metal halide perovskites through metal substitution: Influence on photovoltaic and material properties

Mixed-metal compositional screening identifies Co2+ as capable of partial B-site substitution in CH3NH3PbI3, which supplies new dimensions of material tunability.</p

Tailoring metal halide perovskites through metal substitution: influence on photovoltaic and material properties

We present herein an experimental screening study that assesses how partially replacing Pb in methylammonium lead triiodide perovskite films with nine different alternative, divalent metal species, B = {Co, Cu, Fe, Mg, Mn, Ni, Sn, Sr, and Zn}, influences photovoltaic performance and optical properties. Our findings indicate the perovskite film is tolerant to most of the considered homovalent metal species with lead-cobalt compositions yielding the highest power conversion efficiencies when less than 6% of the Pb2+ ions are replaced. Through subsequent materials characterisation, we demonstrate for the first time that partially substituting Pb2+ at the B-sites of the perovskite lattice is not restricted to Group IV elements but is also possible with at least Co2+. Moreover, adjusting the molar ratio of Pb:Co in the mixed-metal perovskite affords new opportunities to tailor the material properties while maintaining stabilised device efficiencies above 16% in optimised solar cells. Specifically, crystallographic analysis reveals that Co2+ incorporates into the perovskite lattice and increasing its concentration can mediate a crystal structure transition from the cubic to tetragonal phase at room-temperature. Likewise, Co2+ substitution continually modifies the perovskite work function and band edge energies without either changing the band gap or electronically doping the intrinsic material. By leveraging this orthogonal dimension of electronic tunability, we achieve remarkably high open-circuit voltages up to 1.08 V with an inverted device architecture by shifting the perovskite into a more favourable energetic alignment with the PEDOT:PSS hole transport material

Monolithic route to efficient dye-sensitized solar cells employing diblock copolymers for mesoporous TiO2

We present a material and device based study on the fabrication of mesoporous TiO2 and its integration into dye-sensitized solar cells. Poly(isoprene-block-ethyleneoxide) (PI-b-PEO) copolymers were used as structure directing agents for the sol–gel based synthesis of nanoporous monolithic TiO2 which was subsequently ground down to small particles and processed into a paste. The TiO2 synthesis and the formation of tens of micrometre thick films from the paste is a scalable approach for the manufacture of dye sensitised solar cells (DSCs). In this study, we followed the self-assembly of the material through the various processing stages of DSC manufacture. Since this approach enables high annealing temperatures while maintaining porosity, excellent crystallinity was achieved. Internal TiO2 structures ranging from the nanometre to micrometre scale combine a high internal surface area with the strong scattering of light, which results in high light absorption and an excellent full-sun power conversion efficiency of up to 6.4% in a robust, 3 μm thick dye-sensitized solar cell