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Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.
Methods
Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.
Results
The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).
Conclusions
Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.
We present the first geochemical data of archaeological obsidian for Isla Victoria, Nahuel Huapi National Park in Patagonia. XRF analyses were performed on 15 samples of obsidian-like rocks from the Puerto Tranquilo 1 site. Only five of the artifacts—all of which come from upper levels of the site—correspond to obsidian as a raw material. The provenance analysis indicates the use of obsidian sources located in the Andean Forest area of southern Neuquen Province. Based on these preliminary results, we propose a north–south circulation axis for this raw material. These geographic results are discussed in relation to the information available regionally.
Insomnia in depression is common and difficult to resolve. Music is commonly used as a sleep aid, and clinical trials pointing to positive effects of music as a sleep aid are increasing adding to the evidence base. There is little knowledge on the effectiveness of music for depression related insomnia.
Objectives
A recent RCT study conducted in psychiatry at Aalborg University Hospital examined effects of a music intervention for insomnia in depression. The intervention group listened to music at bedtime for four weeks, controls were offered music intervention post-test. Primary outcome measure was Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included Actigraphy, The Hamilton depression Rating Scale (HAMD-17) and World Health Organisation well-being questionnaires (WHO-5, WHOQOL-BREF).
Methods
A two-armed randomized controlled trial (n=112) and a qualitative interview study (n=4)
Results
The RCT study showed signficant improvements for the music intervention group in sleep quality and quality of life at four weeks according to global PSQI scores (effect size= -2.1, 95%CI -3.3; -0.9) and WHO-5 scores (effect size 8.4, 95%CI 2.7; 14.0). Actigraphy measures showed no changes and changes in depression symptoms (HAMD-17) were not detected.
The interview study unfolded examples of the influences of music on sleep and relaxation. Music distracted, affected mood and arousal positively and supported formation of sleep habits.
Results from the trial are discussed and merged with findings from the interview study. The results from the trial suggested moderate effects of music listening for the population while findings from the interview study showed examples of individual and highly varying outcomes.
Conclusions
Music is suggested as a low-cost, side-effect free and safe intervention in supplement to existing treatments improving sleep in depression.
Inclusion in nasogastric tube feeds (NGTF) of acid-sensitive, seaweed-derived alginate, expected to form a reversible gel in the stomach, may create a more normal intragastric state and modified gastrointestinal responses. This may ameliorate NGTF-associated risk of diarrhoea, upper gastrointestinal symptoms and appetite suppression. In a randomised, crossover, comparison study, undertaken in twelve healthy males, an alginate-containing feed (F + ALG) or one that was alginate-free (F-ALG) (300 ml) was given over 1 h with a 7–14-d washout period between treatments. Baseline and for 4-h post-feed initiation, MRI measurements were made to establish small bowel water content (SBWC), gastric contents volume (GCV) and appearance, and superior mesenteric artery blood flux. Blood glucose and gut peptides were measured. Subjective appetite and upper gastrointestinal symptoms scores were obtained. Ad libitum pasta consumption 3-h post-feeding was measured. F + ALG exhibited a gastric appearance consistent with gelling surrounded by a freely mobile water halo. Significant main effects of feed were seen for SBWC (P = 0·03) and peptide YY (PYY) (P = 0·004) which were attributed to generally higher values for SBWC with F + ALG (max difference between adjusted means 72 ml at 210 min) and generally lower values for PYY with F + ALG. GCV showed a faster reduction with F + ALG, less between-participant variation and a feed-by-time interaction (P = 0·04). Feed-by-time interactions were also seen with glucagon-like-peptide 1 (GLP-1) (P = 0·02) and glucose-dependent insulinotropic polypeptide (GIP) (P = 0·002), both showing a blunted response with F + ALG. Apparent intragastric gelling with F + ALG and subsequent differences in gastrointestinal and endocrine responses have been demonstrated between an alginate-containing and alginate-free feed.
Wild badgers (Meles meles) in Wytham woods, Oxfordshire, are routinely trapped, transported to a central field laboratory, studied and released as part of an on-going population study. These procedures have been carefully developed to minimise impact on the badgers' welfare; however they are potentially stressful, and, as part of our on-going welfare refinements, and our exploration to develop methods for quantifying stress in wild mammals, we studied the effects of transport stress on neutrophil activation in wild trapped badgers. Blood samples were obtained from 28 badgers. We compared three transport regimes: transported (n = 9), transported and rested for at least 30 mins (n = 11), and not transported (n = 8). Total and differential white cell counts were carried out and neutrophil activation was measured by the nitroblue tetrazolium test. Our goal was primarily to validate neutrophil activity as an indicator of stress, on the basis that the transport treatment was expected to be more stressful than the non-transport treatment. There were significant increases in % activated circulating neutrophils in response to transport. This study supports the proposition that stress affects circulating neutrophil numbers and the state of their activation, as determined by the nitroblue tetrazolium reduction assay, and therefore adds weight to the idea that neutrophil activation is a potential measure of stress in wild animals.
Introduction: Medical transport services are essential in the regionalization of trauma care. Given the limited number of designated trauma centers, transport times can be prolonged, with patient care managed by paramedics for the duration of their transfer. Pain management is a paramount component, but oligoanalgesia can occur. The primary objective of this study was to evaluate pain management practices during transport of trauma patients by air. Methods: We conducted a 12-month review of ORNGE electronic paramedic records. ORNGE is the exclusive provider of air and land transport in Ontario, Canada. Cases from 1 January 2015 to 31 December 2015 were screened. Patients were identified according to inclusion (≥18 years old requiring transportation to designated trauma center) and exclusion criteria (GCS<14; intubation; accompanied by a nurse or physician). Information was collected in a standardized, piloted data form used by a single trained data extractor. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment according to changes on a 10-point numeric rating scale (NRS), patterns of analgesia administration, and analgesia-related adverse events (AEs). Results were reported as mean, (standard deviation), [range], or percentage. Results: Of 600 potential records, 372 patients met our inclusion criteria with the following characteristics: age 47.0 [19-92] years; 70.4% male; 97.0% blunt injury. Duration of transport was 82.4 (46.3) minutes. Pain was initially assessed in 90.0% of patients. Overall, NRS at baseline was 4.9 (2.8). Of the 62.4% who received analgesia, NRS at baseline was 5.9 (2.5). Fentanyl was most commonly administered (78.5%) at 44.3 [25-60] mcg. NRS after the first dose of analgesia decreased by 1.1 (1.6) points. A total of 73.7% of patients received further analgesia, equal to 2.4 [1-19] additional doses. While 23.4% of patients had no change in NRS after the first dose of analgesia, subsequent doses resulted in no change in NRS in over 65% [65.4-71.3] of patients. A total of 43 AEs (6.7%) were recorded after 638 doses of analgesia, and the most common AE was nausea (39.5%). Conclusion: The majority of patients were assessed for pain. Although the first analgesia administration had minimal effect on NRS, subsequent doses appeared to have even less of an impact. AEs were infrequent.
Carbon-13 profiles and radiocarbon dates were obtained from two Canadian kettle basins having similar geological and hydrological characteristics to develop criteria for evaluating the validity of radiocarbon dates on lake sediment from basins in calcareous terrain. Radiocarbon dates from a site in Alberta show a variable hard-water effect related to local hydrological changes during postglacial history of the lake basin, whereas radiocarbon dates from the other site in Ontario show no noticeable influence of old carbon during its history. These differences are mainly related to lake water residence time, which has influenced carbon isotopic exchange between atmospheric CO2 and dissolved inorganic carbon in lake water. δ13C values for bulk organic sediment and terrestrial and aquatic macrofossils reveal that the main component of lake sediment at both sites is autocthonous in origin. Furthermore, each site supported different submerged aquatic plant communities that used different sources of carbon for photosynthesis, thereby imprinting the organic sediments with a characteristic 13C composition. Both sites reflect a clear relationship between 13C values and paleoproductivity. This study shows the individualistic response of the developing lake system to the hydrology, lake biota, and local geology, and demonstrates the problem of using 13C in lake sediments as a single criterion to recognize the validity of radiocarbon dates of lake sediment without supporting paleoecological information.
In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1–75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.
Solid-stemmed varieties of common wheat are more resistant than hollowstemmed varieties to the wheat stem sawfly, Cephus cinctus Nort. If closely related lines of wheat with a considerable range of sawfly-resistance and stem solidness were available, entomologists could use them to analyse some of the mechanisms of resistance.
With modern undulators generating light of an arbitrary polarization state, experiments exploiting this feature in the soft X-ray region are becoming increasingly widespread. Circularly polarized light in the soft X-ray region is of particular interest to investigate of magnetic metals such as Fe, Co and Ni, and the rare earths. A versatile multilayer polarimeter has been designed and developed to characterize the polarization state of the soft X-ray beam. A W/B4C multilayer transmission phase retarder and reflection analyser has been used for polarimetry measurements on the beamline (I06) at Diamond Light Source. The design details of the polarimeter and preliminary polarimetry results are presented.