Implementation of an anonymisation tool for clinical trials using a clinical trial processor integrated with an existing trial patient data information system

To present an adapted Clinical Trial Processor (CTP) test set-up for receiving, anonymising and saving Digital Imaging and Communications in Medicine (DICOM) data using external input from the original database of an existing clinical study information system to guide the anonymisation process. Two methods are presented for an adapted CTP test set-up. In the first method, images are pushed from the Picture Archiving and Communication System (PACS) using the DICOM protocol through a local network. In the second method, images are transferred through the internet using the HTTPS protocol. In total 25,000 images from 50 patients were moved from the PACS, anonymised and stored within roughly 2 h using the first method. In the second method, an average of 10 images per minute were transferred and processed over a residential connection. In both methods, no duplicated images were stored when previous images were retransferred. The anonymised images are stored in appropriate directories. The CTP can transfer and process DICOM images correctly in a very easy set-up providing a fast, secure and stable environment. The adapted CTP allows easy integration into an environment in which patient data are already included in an existing information system. Store DICOM images correctly in a very easy set-up in a fast, secure and stable environment Allows adaptation of the software to perform a certain task based on specific needs Allows easy integration into an existing environment Reduce the possibility of inappropriate anonymisation

Ecology of the Missouri River: Missouri River Creel Survey, Bellevue Bridge to Camp Creek, 3 April through 29 May 2004

The Nebraska Game and Parks Commission\u27s strategic plan has stated the following management goal for the Missouri River: Restore, protect, and maintain the diversity of historic Missouri River habitats, resources, and ecosystem functions in order that present and future generations may enjoy consumptive and non-consumptive outdoor recreational opportunities (NGPC 1996). To accomplish this goal the Nebraska Game and Parks Commission identified the following five objectives: • To restore terrestrial and aquatic floodplain habitat types by 2008. This would include old oxbows, chutes, side channels, sand bars, backwaters, wetlands, and other shallow water habitats. To restore ftows that reflect the natural hydrograph of the Missouri River by the year 2008. • To inform and educate the general public and constituency about Missouri River ecosystem functions and management. To double the number of total recreational use days by the year 2008. To investigate and manage native fish, wildlife, waterfowl, and fur bearers on a sustainable basis. Even though several of these objectives fall outside of NGPC management authority, this project has and will provide the data necessary to plan, implement and evaluate them. This strategic plan is currently being reviewed and updated. Creel surveys on large rivers with numerous public and private access points are difficult and expensive to design and conduct. The first creel survey conducted on the channelized Missouri River in Nebraska was a roving creel during 1972 t01973 (Groen 1973). Segments of the channelized river covered included, Sioux City to Blair, Blair to Nebraska City and Nebraska City to Rulo. These same segments were surveyed again in 1978 and 1979 (Hesse 1980). The Missouri Department of Conservation conducted a recreational use survey on the channelized Missouri River from the mouth to the Iowa-Missouri state line in four segments over a four year period from 1983 through 1987 (Fleener 1989). The segment adjacent to Nebraska was sampled in 1985 and 1986 and extended from the lowaMissouri state line downstream to St Joseph, Missouri. The present project examining several reaches of the channelized Missouri River had several objectives: Develop a creel survey design that when repeated over time would measure changes in recreational fishing activity and success and allow us to estimate the effects of large scale restoration efforts on recreational fishing. Estimate recreational fishing use. Estimate the number and species of fish harvested and released by recreational anglers. Estimate recreational fishing effort on public and private lands and by boating anglers using public and private boat ramps Correlate fishing effort and success with a combination of season, physical habitat variables (location, macrohabitat, microhabitat, water temperature and secchi disk transparency) and fishing methods (bait) Develop recreational fishing educational information based on survey result

Adolescent self-control predicts midlife hallucinatory experiences:40-year follow-up of a national birth cohort

Associations between self-control in adolescence and adult mental health are unclear in the general population; to our knowledge, no study has investigated self-control in relation to psychotic-like symptoms

Systematic monitoring of needs for care and global outcomes in patients with severe mental illness

<p>Abstract</p> <p>Background</p> <p>It was hypothesised that the introduction of tools that allow clinicians to assess patients' needs and to negotiate treatment (Cumulative Needs for Care Monitor; CNCM), would be associated with global outcome improvements in patients diagnosed with severe mental illness.</p> <p>Methods</p> <p>The CNCM was introduced in one region in South Limburg (the Netherlands) in 1998 (REGION-1998) and in the rest of South Limburg in 2004 (REGION-2004). By comparing these two regions, changes after the introduction of the CNCM could be assessed (between-region comparison). In addition, a pre-post within-patient comparison was conducted in both regions.</p> <p>Results</p> <p>The within-patient comparison revealed that global outcomes of psychopathology and impairment improved in the first 3-5 years after the introduction of the CNCM. The between-region comparison revealed an improvement in global psychopathology but not in global impairment in REGION-2004 after 2004, while there was no such improvement in REGION-1998.</p> <p>Conclusion</p> <p>Systematic clinical monitoring of individual severe mental illness patients, in combination with provision of feedback, is associated with global improvement in psychopathology. More research is needed to determine the degree to which this association reflects a causal effect.</p

Childhood abuse v. neglect and risk for major psychiatric disorders

Background. Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.Methods. Three longitudinal studies of major depressive disorder (MDD, N = 1240), bipolar disorder (BD, N = 1339), and schizophrenia (SCZ, N = 577), each including controls (N = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (N = 143 473).Results. Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17-5.67) and neglect for BD (OR 2.69, 95% CI 2.09-3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55-3.01) and suicide attempts (OR 2.16, 95% CI 1.55-3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02-1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08-2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVWforward = 0.13, 95% CI 0.01-0.24).Conclusions. Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies

A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

PMCID: PMC3732280This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Genome-wide association analyses of symptom severity among clozapine-treated patients with schizophrenia spectrum disorders

Clozapine is the most effective antipsychotic for patients with treatment-resistant schizophrenia. However, response is highly variable and possible genetic underpinnings of this variability remain unknown. Here, we performed polygenic risk score (PRS) analyses to estimate the amount of variance in symptom severity among clozapine-treated patients explained by PRSs (R2) and examined the association between symptom severity and genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activity. Genome-wide association (GWA) analyses were performed to explore loci associated with symptom severity. A multicenter cohort of 804 patients (after quality control N = 684) with schizophrenia spectrum disorder treated with clozapine were cross-sectionally assessed using the Positive and Negative Syndrome Scale and/or the Clinical Global Impression-Severity (CGI-S) scale. GWA and PRS regression analyses were conducted. Genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activities were calculated. Schizophrenia-PRS was most significantly and positively associated with low symptom severity (p = 1.03 × 10−3; R2 = 1.85). Cross-disorder-PRS was also positively associated with lower CGI-S score (p = 0.01; R2 = 0.81). Compared to the lowest tertile, patients in the highest schizophrenia-PRS tertile had 1.94 times (p = 6.84×10−4) increased probability of low symptom severity. Higher genotype-predicted CYP2C19 enzyme activity was independently associated with lower symptom severity (p = 8.44×10−3). While no locus surpassed the genome-wide significance threshold, rs1923778 within NFIB showed a suggestive association (p = 3.78×10−7) with symptom severity. We show that high schizophrenia-PRS and genotype-predicted CYP2C19 enzyme activity are independently associated with lower symptom severity among individuals treated with clozapine. Our findings open avenues for future pharmacogenomic projects investigating the potential of PRS and genotype-predicted CYP-activity in schizophrenia