The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

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Self-help cognitive-behavioral therapy for insomnia (CBT-1): a systematic review of randomized controlled trials

Abstract Theme: Insomnia - new insight into development and manageThis study aimed to review current literature, examine the efficacy, adherence, acceptability, and attrition rate of self-help CBT-I, and to explore possible factors that might contribute to the effectiveness of the treatment. A systematic review was performed up to June 2012 on studies published in 6 major electronic databases. Two researchers performed study identification, data extraction, and methodological quality evaluation. Meta-analyses of self-help CBT-I vs. waiting-list, routine care, or no treatment, therapist-administered CBT-I, and placebo treatment were performed. We identified 20 randomized controlled trials (RCT) that met inclusion criteria. When compared to waiting-list control, self-help CBT-I achieved a moderate to large effect size on improving sleep and reducing sleep-related cognitions and anxiety and depressive symptoms. Therapist-administered CBT-I was slightly better than self-help CBT-I. Subgroup analyses supported the beneficial effect of telephone consultation, but not for “full” multi-component CBT and programs lasting for 6 or more weeks. Treatment adherence, acceptability, perceived usefulness, and credibility were reported as satisfactory. Based on the results of the systematic review, we have designed a Chinese-language self-help CBT-I and now conducting a RCT to evaluate the efficacy of Internet-based self-help CBT-I in Chinese population.postprin

Mammography screening in general practice - a pilot study

Objectives: To evaluate the acceptability, feasibility and performance of a mammography screening programme for female patients in general practice. Design: A cross sectional study. Setting: A general practice clinic and a resiona/ hospital in Hong Kong. Subjects: 500 Chinese women aged 45 years or older attending a university teaching general practice clinic on Hong Kong Island. Main outcome measures: The rates of uptake of screening, retakes, recall for further evaluation and fine needle aspiration (FNA), and participants' opinion on mammography. Results: The uptake rate of screening was 37%. Mammography was feasible for all participants, 12% had additional films and 7% required retakes. Sixteen percent were recalled for further evaluation, 4% had FNA, one had an excisional biopsy which revealed no cancer. Most women rated pain of mammography mild to moderate and did not find it embarrassing, 98% said that they would recommend it to their friends and 87% indicated that they would do it again. Conclusions: Mammography screening for Chinese women presenting to general practice was technically feasible. Most women found the experience of mammography screening acceptable. The uptake rate of mammography screening was much lower than what would be required to benefit the overall breast cancer mortality. There was also room for improvement in our retake and recall rates. We need to weigh the possible benefit of mammography screening against the stress and resources associated with additional films, retakes, recalls for further evaluation, FNA and excisional biopsy in individuals with false positive results.published_or_final_versio

Stenting in small coronary arteries: initial experience with the Gianturco-roubin II stent

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An evolutionary video assignment optimization technique for VOD system in heterogeneous environment

2009-2010 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Acupressure, reflexology, and auricular acupressure for insomnia: A systematic review of randomized controlled trials

Previous randomized controlled trials (RCTs) have shown that acupuncture may be efficacious for insomnia. Instead of needling, acupressure, reflexology, and auricular acupressure are procedures involving physical pressure on acupoints or reflex areas. These variants of acupuncture are gaining popularity, perhaps due to their non-invasive nature. A systematic review has therefore been conducted to examine their efficacy and safety for insomnia. Two independent researchers searched five English and 10 Chinese databases from inception to May 2010. Forty RCTs were identified for analysis. Only 10 studies used sham controls, four used double-blind design, nine studies scored three or more by the Jadad scale, and all had at least one domain with high risk of bias. Meta-analyses of the moderate-quality RCTs found that acupressure as monotherapy fared marginally better than sham control. Studies that compared auricular acupressure and sham control showed equivocal results. It was also found that acupressure, reflexology, or auricular acupressure as monotherapy or combined with routine care was significantly more efficacious than routine care or no treatment. Owing to the methodological limitations of the studies and equivocal results, the current evidence does not allow a clear conclusion on the benefits of acupressure, reflexology, and auricular acupressure for insomnia. © 2012 Elsevier B.V.postprin

The J-triplet Cooper pairing with magnetic dipolar interactions

Recently, cold atomic Fermi gases with the large magnetic dipolar interaction have been laser cooled down to quantum degeneracy. Different from electric-dipoles which are classic vectors, atomic magnetic dipoles are quantum-mechanical matrix operators proportional to the hyperfine-spin of atoms, thus provide rich opportunities to investigate exotic many-body physics. Furthermore, unlike anisotropic electric dipolar gases, unpolarized magnetic dipolar systems are isotropic under simultaneous spin-orbit rotation. These features give rise to a robust mechanism for a novel pairing symmetry: orbital p-wave (L=1) spin triplet (S=1) pairing with total angular momentum of the Cooper pair J=1. This pairing is markedly different from both the $^3$He-B phase in which J=0 and the $^3$He-$A$ phase in which $J$ is not conserved. It is also different from the p-wave pairing in the single-component electric dipolar systems in which the spin degree of freedom is frozen

Phase-slip induced dissipation in an atomic Bose-Hubbard system

Phase slips play a primary role in dissipation across a wide spectrum of bosonic systems, from determining the critical velocity of superfluid helium to generating resistance in thin superconducting wires. This subject has also inspired much technological interest, largely motivated by applications involving nanoscale superconducting circuit elements, e.g., standards based on quantum phase-slip junctions. While phase slips caused by thermal fluctuations at high temperatures are well understood, controversy remains over the role of phase slips in small-scale superconductors. In solids, problems such as uncontrolled noise sources and disorder complicate the study and application of phase slips. Here we show that phase slips can lead to dissipation for a clean and well-characterized Bose-Hubbard (BH) system by experimentally studying transport using ultra-cold atoms trapped in an optical lattice. In contrast to previous work, we explore a low velocity regime described by the 3D BH model which is not affected by instabilities, and we measure the effect of temperature on the dissipation strength. We show that the damping rate of atomic motion-the analogue of electrical resistance in a solid-in the confining parabolic potential fits well to a model that includes finite damping at zero temperature. The low-temperature behaviour is consistent with the theory of quantum tunnelling of phase slips, while at higher temperatures a cross-over consistent with the transition to thermal activation of phase slips is evident. Motion-induced features reminiscent of vortices and vortex rings associated with phase slips are also observed in time-of-flight imaging.Comment: published in Nature 453, 76 (2008

Big conductance calcium-activated potassium channel openers control spasticity without sedation.

BACKGROUND AND PURPOSE: Our initial aim was to generate cannabinoid agents that control spasticity, occurring as a consequence of multiple sclerosis (MS), whilst avoiding the sedative side effects associated with cannabis. VSN16R was synthesized as an anandamide (endocannabinoid) analogue in an anti-metabolite approach to identify drugs that target spasticity. EXPERIMENTAL APPROACH: Following the initial chemistry, a variety of biochemical, pharmacological and electrophysiological approaches, using isolated cells, tissue-based assays and in vivo animal models, were used to demonstrate the activity, efficacy, pharmacokinetics and mechanism of action of VSN16R. Toxicological and safety studies were performed in animals and humans. KEY RESULTS: VSN16R had nanomolar activity in tissue-based, functional assays and dose-dependently inhibited spasticity in a mouse experimental encephalomyelitis model of MS. This effect occurred with over 1000-fold therapeutic window, without affecting normal muscle tone. Efficacy was achieved at plasma levels that are feasible and safe in humans. VSN16R did not bind to known CB1 /CB2 /GPPR55 cannabinoid-related receptors in receptor-based assays but acted on a vascular cannabinoid target. This was identified as the major neuronal form of the big conductance, calcium-activated potassium (BKCa ) channel. Drug-induced opening of neuronal BKCa channels induced membrane hyperpolarization, limiting excessive neural-excitability and controlling spasticity. CONCLUSIONS AND IMPLICATIONS: We identified the neuronal form of the BKCa channel as the target for VSN16R and demonstrated that its activation alleviates neuronal excitability and spasticity in an experimental model of MS, revealing a novel mechanism to control spasticity. VSN16R is a potential, safe and selective ligand for controlling neural hyper-excitability in spasticity