The evolution of depressive symptoms following bariatric surgery for purposes of substantial weight loss

Depression is the most prevalent psychiatric condition among individuals seeking bariatric surgery for severe obesity (BMI ≥ 40.0 kg/m2; 35.0 with weight-related comorbidities). Following bariatric surgery, depression prevalence and symptom severity are drastically reduced. That said, depression that persists or worsens after bariatric surgery is associated with poorer weight loss outcomes. Psychiatric conditions, e.g., depression, are routinely evaluated during a preoperative psychosocial evaluation when determining suitability for a bariatric procedure. This includes a clinical interview that may be supplemented with screening tools for assessing psychiatric symptoms, e.g., depression. Screening tools are more frequently administered after bariatric surgery in order to monitor how well individuals are adjusting after the procedure. Despite the ubiquity of depressive symptom screening tools, there is a limited understanding of their use in a bariatric population. The current dissertation sought to address the current gaps in the literature regarding depressive symptom screening tools in the bariatric population. The first study consisted of a systematic review and meta-analysis that included 46 studies that examined the evolution of depressive symptoms after individuals had undergone bariatric surgery. Results from the meta-analysis determined that the magnitude that depressive symptoms decreased was similar at 6-, 12-, and 24-months after surgery. The second study examined whether the responses to items within a common depressive symptom screening tool clustered together in a bariatric cohort. This study performed both exploratory and confirmatory factor analyses within two groups and found a model consisting of three subscales was the most appropriate for screening depressive symptoms pre- and post-surgery. The final study examined whether reductions of depressive symptoms overall or within specific subscales were associated with weight loss outcomes. The total and subscale change-scores were tested separately in the association with percent excess-body weight loss. Only the reduction of negative perception features of depression was linked to greater weight loss. Taken together, these studies can inform healthcare professionals about the typical evolution of depressive symptoms up to 24 months after surgery, as well as the depressive symptoms that might be potential targets for intervention if weight loss following bariatric surgery is suboptimal

Predation of wildlife by domestic cats Felis catus

ABSTRACT 1. A questionnaire survey of the numbers of animals brought home by domestic cats Felis catus was conducted between 1 April and 31 August 1997. A total of 14 370 prey items were brought home by 986 cats living in 618 households. Mammals made up 69% of the items, birds 24%, amphibians 4%, reptiles 1%, fish < 1%, invertebrates 1% and unidentified items 1%. A minimum of 44 species of wild bird, 20 species of wild mammal, four species of reptile and three species of amphibian were recorded. 2. Of a sample of 696 individual cats, 634 (91%) brought home at least one item and the back-transformed mean number of items brought home was 11.3 (95% CI 10.4-12.2). The back-transformed means and number of cats retrieving at least one item from each prey group were: 8.1 (7.4-8.9) mammals for 547 (79%) cats, 4.1 (3.8-4.5) birds for 506 (73%) cats, 2.6 (2.2-3.0) herpetofauna for 145 (21%) cats and 2.2 (1.8-2.7) other items for 98 (14%) cats. 3. The number of birds and herpetofauna brought home per cat was significantly lower in households that provided food for birds. The number of bird species brought home was greater in households providing bird food. The number of birds and herpetofauna brought home per cat was negatively related to the age and condition of the cat. The number of mammals brought home per cat was significantly lower when cats were equipped with bells and when they were kept indoors at night. The number of herpetofauna brought home was significantly greater when cats were kept in at night. 4. Based on the proportion of cats bringing home at least one prey item and the backtransformed means, a British population of approximately 9 million cats was estimated to have brought home in the order of 92 (85-100) million prey items in the period of this survey, including 57 (52-63) million mammals, 27 (25-29) million birds and 5 (4-6) million reptiles and amphibians. 5. An experimental approach should be taken to investigate the factors found by this descriptive survey to influence the numbers of prey brought home by cats. In particular, investigation of potential management practices that could reduce the numbers of wild animals killed and brought home by cats will be useful for wildlife conservation, particularly in suburban areas

Predation of wildlife by domestic cats Felis catus

ABSTRACT 1. A questionnaire survey of the numbers of animals brought home by domestic cats Felis catus was conducted between 1 April and 31 August 1997. A total of 14 370 prey items were brought home by 986 cats living in 618 households. Mammals made up 69% of the items, birds 24%, amphibians 4%, reptiles 1%, fish < 1%, invertebrates 1% and unidentified items 1%. A minimum of 44 species of wild bird, 20 species of wild mammal, four species of reptile and three species of amphibian were recorded. 2. Of a sample of 696 individual cats, 634 (91%) brought home at least one item and the back-transformed mean number of items brought home was 11.3 (95% CI 10.4-12.2). The back-transformed means and number of cats retrieving at least one item from each prey group were: 8.1 (7.4-8.9) mammals for 547 (79%) cats, 4.1 (3.8-4.5) birds for 506 (73%) cats, 2.6 (2.2-3.0) herpetofauna for 145 (21%) cats and 2.2 (1.8-2.7) other items for 98 (14%) cats. 3. The number of birds and herpetofauna brought home per cat was significantly lower in households that provided food for birds. The number of bird species brought home was greater in households providing bird food. The number of birds and herpetofauna brought home per cat was negatively related to the age and condition of the cat. The number of mammals brought home per cat was significantly lower when cats were equipped with bells and when they were kept indoors at night. The number of herpetofauna brought home was significantly greater when cats were kept in at night. 4. Based on the proportion of cats bringing home at least one prey item and the backtransformed means, a British population of approximately 9 million cats was estimated to have brought home in the order of 92 (85-100) million prey items in the period of this survey, including 57 (52-63) million mammals, 27 (25-29) million birds and 5 (4-6) million reptiles and amphibians. 5. An experimental approach should be taken to investigate the factors found by this descriptive survey to influence the numbers of prey brought home by cats. In particular, investigation of potential management practices that could reduce the numbers of wild animals killed and brought home by cats will be useful for wildlife conservation, particularly in suburban areas

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Non-invasive imaging of atherosclerotic plaque macrophage in a rabbit model with F-18 FDG PET: a histopathological correlation

BACKGROUND: Coronary atherosclerosis and its thrombotic complications are the major cause of mortality and morbidity throughout the industrialized world. Thrombosis on disrupted atherosclerotic plaques plays a key role in the onset of acute coronary syndromes. Macrophages density is one of the most critical compositions of plaque in both plaque vulnerability and thrombogenicity upon rupture. It has been shown that macrophages have a high uptake of (18)F-FDG (FDG). We studied the correlation of FDG uptake with histopathological macrophage accumulation in atherosclerotic plaques in a rabbit model. METHODS: Atherosclerosis was induced in rabbits (n = 6) by a combination of atherogenic diet and balloon denudation of the aorta. PET imaging was performed at baseline and 2 months after atherogenic diet and coregistered with magnetic resonance (MR) imaging. Normal (n = 3) rabbits served as controls. FDG uptake by the thoracic aorta was expressed as concentration (μCi/ml) and the ratio of aortic uptake-to-blood radioactivity. FDG uptake and RAM-11 antibody positive areas were analyzed in descending aorta. RESULTS: Atherosclerotic aortas showed significantly higher uptake of FDG than normal aortas. The correlation of aortic FDG uptake with macrophage areas assessed by histopathology was statistically significant although it was not high (r = 0.48, p < 0.0001). When uptake was expressed as the ratio of aortic uptake-to-blood activity, it correlated better (r = 0.80, p < 0.0001) with the macrophage areas, due to the correction for residual blood FDG activity. CONCLUSION: PET FDG activity correlated with macrophage content within aortic atherosclerosis. This imaging approach might serve as a useful non-invasive imaging technique and potentially permit monitoring of relative changes in inflammation within the atherosclerotic lesion

Challenges, solutions and future directions in the evaluation of service innovations in health care and public health

HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.This is the final version of the article. It first appeared from the National Institute for Helath Research via http://dx.doi.org/10.3310/hsdr0416

No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention

Background: Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key ‘active ingredients.’ Discussion: Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the ‘business as usual’ approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature. Summary: We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness

Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis.

BACKGROUND: Many people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions. METHODS: Our search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis. DISCUSSION: The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033869.This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0616-20003). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health

A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Background: Implementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations. Methods: Researchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the a uthors' collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide. Results: We explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis. Conclusions: We offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention

Loneliness in Relation to Depression: The Moderating Influence of a Polymorphism of the Brain Derived Neurotrophic Factor Gene on Self-efficacy and Coping Strategies

Disturbances of brain derived neurotrophic factor (BDNF) signaling, which may occur among those with a polymorphism of the Val66Met gene, comprising a Met substitution for the Val allele, may be associated with depressive cognitions. However, presumed elevated BDNF levels among individuals with the Val/Val genotype, might confer increased responsivity to contextual challenges, thus fostering vulnerability to depression. In Study 1, among undergraduate students (N = 252), increased loneliness perceptions were accompanied with depressive symptoms. This relationship was moderated by self-efficacy and BDNF genotype, such that when individuals appraised high self-efficacy, those with the Val/Val genotype, compared to Met carriers, reported greater depression scores when they perceived feeling lonely. Study 2 revealed that among undergraduate students (N = 178), lower depressive scores were associated with increased problem-focused coping among Val/Val individuals, but not Met carriers. Moreover, with increased perceived loneliness, Val/Val carriers endorsed lower problem-focused coping. Findings suggest that Val/Val individuals may have adverse neurocognitive vulnerability to loneliness experiences