Bright light therapy in pregnant women with major depressive disorder: Study protocol for a randomized, double-blind, controlled clinical trial

Background: Depression during pregnancy is a common and high impact disease. Generally, 5-10 % of pregnant women suffer from depression. Children who have been exposed to maternal depression during pregnancy have a higher risk of adverse birth outcomes and more often show cognitive, emotional and behavioural problems. Therefore, early detection and treatment of antepartum depression is necessary. Both psychotherapy and antidepressant medication, first choice treatments in a non-pregnant population, have limitations in treating depression during pregnancy. Therefore, it is urgent and relevant to investigate alternative treatments for antepartum depression. Bright light therapy (BLT) is a promising treatment for pregnant women with depressive disorder, for it combines direct availability, sufficient efficacy, low costs and high safety, taking the safety for the unborn child into account as well. Methods: In this study, 150 pregnant women (12-18 weeks pregnant) with a DSM-V diagnosis of depressive disorder will be randomly allocated in a 1:1 ratio to one of the two treatment arms: treatment with BLT (9.000 lux) or treatment with dim red light therapy (100 lux). Both groups will be treated for 6 weeks at home on a daily basis for 30 min, within 30 min of habitual wake-up time. Follow-up will take place after 6 weeks of therapy, 3 and 10 weeks after end of therapy, at birth and 2, 6 and 18 months postpartum. Primary outcome will be the average change in depressive symptoms between the two groups, as measured by the Structured Interview Guide for the Hamilton Depression Scale - Seasonal Affective Disorder version and the Edinburg Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time will be analysed using generalized linear mixed models. Secondary outcomes will be the changes in maternal cortisol and melatonin levels, in maternal sleep quality and gestational age, birth weight, infant behaviour, infant cortisol exposure and infant cortisol stress response. Discussion: If BLT reduces depressive symptoms in pregnant women, it will provide a safe, cheap, non-pharmacological and efficacious alternative treatment for psychotherapy and antidepressant medication in treating antepartum depression, without any expected adverse reactions for the unborn child. Trial registration: Netherlands Trial Register NTR5476. Registered 5 November 2015

Entwicklung eines NO_x-armen Dieselmotors kleiner Leistung durch primaerseitige Massnahmen

With the further development of the long-life Diesel engine developed by the company Fichtel and Sachs for series produced internal combustion engine driven heat pumps of a small heating capacity, a low-NO_x combustion engine for plants of useful energy utilization is to be created through primary measures. The general objective of NO_x-emissions of 400 mg/m"3 could be achieved experimentally by optimization of the elements determining gas exchange and combustion space geometry and a cooled exhaust gas recirculation if the rigid threshold values for other pollutants were reduced. As a result of this research and development project, the constructive concept of a low-NO_x small Diesel engine could be developed which can contribute to a conversion of the energy political aims of CO_2 reduction supported by the Federal Government as a drive in heat pumps and thermal power plants with a simultaneous protection of primary energy resources. (orig./HW)Mit der Weiterentwicklung des fuer seriengefertigte verbrennungsmotorisch angetriebene Waermepumpen kleiner Heizleistung entwickelten langlebigen Dieselmotors der Fichtel und Sachs AG soll ein durch primaerseitige Massnahmen NO_x-armer Verbrennungsmotor fuer Anlagen der rationellen Energieanwendung geschaffen werden. Die generelle Zielsetzung von NO_x-Emissionen von 400 mg/m"3 konnte bei Einschraenkung der Anforderungen an die anderen Schadstoffe versuchstechnisch durch Optimierung der ladungswechselbestimmenden Elemente und der Brennraumgeometrie und einer gekuehlten Abgasrueckfuehrung dargestellt werden. Als Ergebnis dieses F+E-Vorhabens konnte das konstruktive Konzept eines NO_x-armen kleinen Dieselmotors entwickelt werden, der als Antrieb in Waermepumpen und Heizkraftanlagen getestet einen Beitrag zur Umsetzung der von der Bundesregierung bekraeftigten energiepolitischen Ziele der CO_2-Minderung bei gleichzeitiger Schonung der Primaerenergieressourcen leisten kann. (orig./HW)Available from TIB Hannover: F94B970+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Verbrennungsmotor-Kompressor-Aggregat fuer Kleinwaermepumpen Schlussbericht

With 94 figs.Copy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Verbesserung des Leistungsverhaltens und drastische Senkung der Herstellkosten verbrennungsmotorisch angetriebener Heizoel- und Erdgas-Kleinwaermepumpen Schlussbericht

With 3 refs., 50 figs.Copy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Evaluating Quality in Trauma Systems

Trauma remains a major global threat to health and is almost unique in the extent to which patient outcomes depend upon time-sensitive integration of prehospital and critical care services, as well as comprehensive inpatient care and rehabilitation. Evaluating the quality of trauma care is complex, because within such a “system of systems,” performance cannot be predicted solely through analysis of individual clinical services. Institution-level indices necessarily provide an incomplete picture of quality, as outcomes are affected not only by patients’ injuries and comorbidities but also by incident location and time to definitive care. In this chapter, we outline one approach to holistic evaluation of trauma system quality. We demonstrate how familiar measures of quality such as standardized mortality ratios can be applied in conjunction with spatial analysis techniques in order to produce geographically indexed outcome data with respect to patient, environmental, and social risk factors. We also outline how spatial analysis can be augmented by linkage to repositories of routinely collected administrative data. Though a relatively new approach to quality assurance and improvement, data-linkage-facilitated spatial analysis is particularly relevant to trauma, and we predict that it will become a core component of trauma quality evaluation in developed health systems. We encourage all clinicians to move beyond their direct responsibilities for patient care and engage with quality evaluation at the system level so that we may continue to approach the trauma system ideal of providing care to the right patient, at the right place, at the right time