Do adverts increase the probability of finding online cognitive behavioural therapy for depression? Cross-sectional study

Objective To estimate the effect of online adverts on the probability of finding online cognitive behavioural therapy (CBT) for depression. Design Exploratory online cross-sectional study of search experience of people in the UK with depression in 2011. (1) The authors identified the search terms over 6 months entered by users who subsequently clicked on the advert for online help for depression. (2) A panel of volunteers across the UK recorded websites presented by normal Google search for the term ‘depression’. (iii) The authors examined these websites to estimate probabilities of knowledgeable and naive internet users finding online CBT and the improved probability by addition of a Google advert. Participants (1) 3868 internet users entering search terms related to depression into Google. (2) Panel, recruited online, of 12 UK participants with an interest in depression. Main outcome measures Probability of finding online CBT for depression with/without an advert. Results The 3868 users entered 1748 different search terms but the single keyword ‘depression’ resulted in two-thirds of the presentations of, and over half the ‘clicks’ on, the advert. In total, 14 different websites were presented to our panel in the first page of Google results for ‘depression’. Four of the 14 websites had links enabling access to online CBT in three clicks for knowledgeable users. Extending this approach to the 10 most frequent search terms, the authors estimated probabilities of finding online CBT as 0.29 for knowledgeable users and 0.006 for naive users, making it unlikely CBT would be found. Adding adverts that linked directly to online CBT increased the probabilities to 0.31 (knowledgeable) and 0.02 (naive). Conclusions In this case, online CBT was not easy to find and online adverts substantially increased the chance for naive users. Others could use this approach to explore additional impact before committing to long-term Google AdWords advertising budgets

Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

Aim: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors – the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. Background: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. Methods: The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. Findings: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients

Simultaneous Projectile-Target Excitation in Heavy Ion Collisions

We calculate the lowest-order contribution to the cross section for simultaneous excitation of projectile and target nuclei in relativistic heavy ion collisions. This process is, to leading order, non-classical and adds incoherently to the well-studied semi-classical Weizs\"acker-Williams cross section. While the leading contribution to the cross section is down by only $1/Z_P$ from the semiclassical process, and consequently of potential importance for understanding data from light projectiles, we find that phase space considerations render the cross section utterly negligible.Comment: 9 pages, LA-UR-94-247

An investigation into self-reported foot and lower limb problems associated with systemic lupus erythematosus (SLE): a research proposal

Systemic lupus erythematosus (SLE) can manifest in the lower limb with joint and muscle pains and in severe cases, disorganisation of the joints and tendon rupture. In the foot and lower limb, Raynaud’s phenomenon and other circulatory problems have been reported and may be associated with loss of sensation or altered pain perception. Associated with impaired peripheral neurovascular function are changes in tissue viability leading to either callus formation or thinning of the skin and ulceration. Many medications used to manage SLE can impact on the person’s resistance to infections and consequently fungal, bacterial or viral infections can spread rapidly and persist. Although there is some evidence for this range of problems occurring in the foot, it is not known how prevalent they are, what interaction there is between problems, and how these impact upon a person’s health related quality of life (HRQoL). Thus, the main aim of this study is to determine the self-reported foot and lower limb problems experienced by people with SLE. A secondary aim is to explore the impact that the identified foot and lower complications may have upon patients with SLE. It is anticipated that this research will highlight areas of potential health care need and thus can be used to inform recommendations about foot health care for this patient group and the focus of future research

Accuracy and Limitations of Fitting and Stereoscopic Methods to Determine the Direction of Coronal Mass Ejections from Heliospheric Imagers Observations

Using data from the Heliospheric Imagers (HIs) onboard STEREO, it is possible to derive the direction of propagation of coronal mass ejections (CMEs) in addition to their speed with a variety of methods. For CMEs observed by both STEREO spacecraft, it is possible to derive their direction using simultaneous observations from the twin spacecraft and also, using observations from only one spacecraft with fitting methods. This makes it possible to test and compare different analyses techniques. In this article, we propose a new fitting method based on observations from one spacecraft, which we compare to the commonly used fitting method of Sheeley et al. (1999). We also compare the results from these two fitting methods with those from two stereoscopic methods, focusing on 12 CMEs observed simultaneously by the two STEREO spacecraft in 2008 and 2009. We find evidence that the fitting method of Sheeley et al. (1999) can result in significant errors in the determination of the CME direction when the CME propagates outside of 60deg \pm 20 deg from the Sun-spacecraft line. We expect our new fitting method to be better adapted to the analysis of halo or limb CMEs with respect to the observing spacecraft. We also find some evidence that direct triangulation in the HI fields-of-view should only be applied to CMEs propagating approximatively towards Earth (\pm 20deg from the Sun-Earth line). Last, we address one of the possible sources of errors of fitting methods: the assumption of radial propagation. Using stereoscopic methods, we find that at least seven of the 12 studied CMEs had an heliospheric deflection of less than 20deg as they propagated in the HI fields-of-view, which, we believe, validates this approximation.Comment: 17 pages, 6 figures, 2 tables, accepted to Solar Physic

Microscopic Study of Slablike and Rodlike Nuclei: Quantum Molecular Dynamics Approach

Structure of cold dense matter at subnuclear densities is investigated by quantum molecular dynamics (QMD) simulations. We succeeded in showing that the phases with slab-like and rod-like nuclei etc. can be formed dynamically from hot uniform nuclear matter without any assumptions on nuclear shape. We also observe intermediate phases, which has complicated nuclear shapes. Geometrical structures of matter are analyzed with Minkowski functionals, and it is found out that intermediate phases can be characterized as ones with negative Euler characteristic. Our result suggests the existence of these kinds of phases in addition to the simple ``pasta'' phases in neutron star crusts.Comment: 6 pages, 4 figures, RevTex4; to be published in Phys. Rev. C Rapid Communication (accepted version

An Electron Paramagnetic Resonance (EPR) spectroscopy study on the γ-irradiation sterilization of the pharmaceutical excipient l-histidine: Regeneration of the radicals in solution

The effects of γ-radiation sterilization on the parenteral excipient L-histidine were analysed by means of EPR spectroscopy. The irradiation process was found to induce the formation of a deamination radical which was persistent in the solid state. The nature and reactivity of the radicals following dissolution in water was evaluated using spin-trapping EPR experiments. The deamination radical was found to regenerate in solution in the presence of trace metals, potentially leading to radical induced degradation reactions occurring up to an hour after the dissolution process. Understanding this process is significant for the improved design of parental pharmaceutical formulations in which unwanted radical reactions after γ radiation sterilization could lead to degradation of active ingredients

A Quantum-Mechanical Equivalent-Photon Spectrum for Heavy-Ion Physics

In a previous paper, we calculated the fully quantum-mechanical cross section for electromagnetic excitation during peripheral heavy-ion collisions. Here, we examine the sensitivity of that cross section to the detailed structure of the projectile and target nuclei. At the transition energies relevant to nuclear physics, we find the cross section to be weakly dependent on the projectile charge radius, and to be sensitive to only the leading momentum-transfer dependence of the target transition form factors. We exploit these facts to derive a quantum-mechanical ``equivalent-photon spectrum'' valid in the long-wavelength limit. This improved spectrum includes the effects of projectile size, the finite longitudinal momentum transfer required by kinematics, and the response of the target nucleus to the off-shell photon.Comment: 19 pages, 5 figure