Effects of a cognitive behavioral self-help program and a computerized structured writing intervention on depressed mood for HIV-infected people:A pilot randomized controlled trial

Objective: The aim of the present study was to examine whether low-resource, cost-effective intervention programs can be effective in improving depressed mood in people with HIV. The efficacy of a cognitive-behavioral self-help program (CBS) and a computerized structured writing intervention (SWI) were tested in a pilot randomized controlled trial. Methods: Participants were members of a patient organization. They completed a pretest and posttest. The questionnaire included the HADS. Participants were randomly allocated to CBS (n=24), SWI (n=25) or a waiting list condition (WLC, n=24). To evaluate changes in the continuous outcome measure, a 3 × 2 (group × time) repeated measures ANCOVA was performed. Also, an ANCOVA was performed using change scores. Results: Respondents who followed the CBS improved significantly compared to the WLC. However, for people in the SWI condition no significant improvement on depression was found. Conclusion: This pilot study suggests that a low-resource, cost-effective CBS program seems to be effective in reducing depressed mood in people living with HIV. Practice implications: Because self-help programs can be delivered through regular mail or the internet, a high number of people could be reached while overcoming geographical and social barriers to treatment. © 2009 Elsevier Ireland Ltd

Modelling ruptures of buried high pressure dense phase CO2 pipelines in carbon capture and storage applications - Part I. Validation

Carbon dioxide (CO2) capture and storage presents a short-term option for significantly reducing the amount of CO2 released into the atmosphere and mitigating the effects of climate change. To this end, National Grid initiated the COOLTRANS research programme to consider the pipeline transportation of high pressure dense phase CO2, including the development and application of a mathematical model for predicting the sonic near-field dispersion of pure CO2 following the venting or failure of such a pipeline. Here, the application of this model to the rupture of a buried pipeline is considered and compared to experimental data obtained through the COOLTRANS programme. The rupture experiment was performed on a 230 m length of 152 mm external diameter pipeline with 300 mm soil cover, equivalent to approximately 1/4 scale when compared to the proposed full-scale 600 mm (24-inch) diameter pipelines with 1.2 m soil cover on average proposed in the UK. The experiment was performed in a pre-formed crater based on experimentally formed craters in other experiments. The comparison demonstrates reasonable quantitative and qualitative agreement. Such validated dispersion flow, to be applied to full-scale rupture modelling in Part II, defines novel, robust, thermodynamically accurate multi-phase source conditions, that enable far-field computational fluid dynamics studies and feed into pragmatic quantified risk assessment models

Durvalumab for the Treatment of Locally Advanced, Unresectable, Stage III Non-Small Cell Lung Cancer:An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of the Single Technology Appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer (AstraZeneca) of durvalumab (IMFINZI(TM)) to submit evidence for the clinical and cost effectiveness of durvalumab for the treatment of patients with locally advanced, unresectable, stage III non-small cell lung cancer whose tumours express programmed death-ligand 1 (PD-L1) on >= 1% of tumour cells and whose disease has not progressed after platinum-based chemoradiation therapy. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Centre, was commissioned to act as the independent Evidence Review Group (ERG). This paper summarises the company submission (CS), presents the ERG's critical review on the clinical- and cost-effectiveness evidence in the CS, highlights the key methodological considerations, and describes the development of the NICE guidance by the Appraisal Committee. The CS included a systematic review that identified one randomised controlled trial, comparing durvalumab with SoC. Participants with tumours expressing PD-L1 on >= 1% of tumour cells accounted for approximately 40% of the total participants. In this subgroup, a benefit in progression-free survival (PFS) [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.31-0.63] and overall survival (HR 0.54, 95% CI 0.35-0.81) was reported. Adverse events were comparable between both treatments, but more serious adverse events were reported for durvalumab (64/213 [30%] vs. 18/90 [20%]). The ERG's concerns regarding the economic analysis included a likely overestimation of PFS for the durvalumab arm, the choice of timepoint for treatment waning, as well as the way treatment waning was incorporated in the model, and potential overestimation of utility values without applying an age- or treatment-related decrement. The revised ERG base-case resulted in a deterministic incremental cost-effectiveness ratio of 50,238 pound per quality-adjusted life-year gained, with substantial remaining uncertainty. NICE recommended durvalumab as an option for use within the Cancer Drugs Fund only in a subpopulation (concurrent platinum-based chemoradiation therapy) with a commercially managed access agreement in place

High pressure CO2 CCS pipelines: Comparing dispersion models with multiple experimental datasets

Carbon capture and storage (CCS) presents the short-term option for significantly reducing the amount of carbon dioxide (CO2) released into the atmosphere from the combustion of fossil fuels, thereby mitigating the effects of climate change. Enabling CCS requires the development of capture, storage and transport methodologies. The safe transport of CO2 in CCS scenarios can be achieved through pipelines or by shipping. Either way, transport and temporary storage of pressurised liquid CO2 will be required and subject to quantitative risk assessment, which includes the consideration of the low-risk, low-probability puncture or rupture scenario of such a pipeline, ship or storage facility. In this work, we combine multiple experimental datasets all concerned with the atmospheric free release of pure and impure liquid CO2 from CCS-transport-chain-relevant high pressure reservoirs and perform the first multiple dataset comparison to numerical models for both pure and impure jets in dry ambient air with no water vapour. The results validate the numerical approach adopted and for the prediction of such releases, highlight the significance of the mixture fraction at the release point, over the mixture composition itself. A new method for impure CO2 dispersion modelling is introduced and limited preliminary comparisons of impure CO2 data and predictions are performed. No clear difference between pure and impure releases is found for the cases considered

Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): Study protocol for a randomised controlled trial

Background: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. Methods: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. Discussion: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU. Trial registration: Australian New Zealand Clinical Trial Registry (ANZCTR) number: ACTRN12616000436471. Registered on 20 December 2015