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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Climate change was the defining issue in the 2022 Australian federal election. As a new administration takes power, all sectors, including the performing arts, need to keep up the pressure. An iconic moment of “coal theatrics” in Parliament House, so labeled by the Australian media, stands in contrast to artistic performances that continue to put pressure on the framers of political and cultural policy.
An accomplished dancer, acrobat, and physical theatre performer, Hanna Cormick became ill in 2014 with a trifecta of rare genetic conditions that make her severely allergic to pollutants in the air — smoke, detergents, and food particles — and her bones and internal organs prone to dislocation. In January 2020, during Australia’s summer of unprecedented bushfires, Cormick staged The Mermaid, risking her life to make a performance about the climate emergency and how we are all vulnerable bodies at risk in a changing environment.
Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
Early career investigators have few opportunities for targeted training in supportive oncology research. To address this need, we developed, implemented, and evaluated an intensive, six-day workshop on methods in supportive oncology research for trainees and junior faculty across multiple disciplines.
Method
A multidisciplinary team of supportive oncology researchers developed a workshop patterned after the clinical trials workshop offered jointly by the American Society of Clinical Oncology and American Association of Cancer Research. The curriculum included lectures and a mentored experience of writing a research protocol. Each year since 2015, the workshop has accepted and trained 36 early career investigators. Over the course of the workshop, participants present sections of their research protocols daily in small groups led by senior researchers, and have dedicated time to write and revise these sections. Primary outcomes for the workshop included the frequency of completed protocols by the end of the workshop, a pre- and posttest assessing participant knowledge, and follow-up surveys of the participants and their primary mentors.
Result
Over three years, the workshop received 195 applications; 109 early career researchers were competitively selected to participate. All participants (109/109, 100%) completed writing a protocol by the end of their workshop. Participants and their primary mentors reported significant improvements in their research knowledge and skills. Each year, participants rated the workshop highly in terms of satisfaction, value, and likelihood of recommending it to a colleague. One year after the first workshop, most respondents (29/30, 96.7%) had either submitted their protocol or written at least one other protocol.
Significance of results
We developed a workshop on research methods in supportive oncology. More early career investigators applied for the workshop than capacity, and the workshop was fully attended each year. Both the workshop participants and their primary mentors reported improvement in research skills and knowledge.
From mid-October to mid-November 2013, Australian performance artist Casey Jenkins sat for twenty-eight days in a gallery in Darwin, far North Australia, knitting a scarf from a ball of wool lodged in her vagina. Parts of the performance of Casting Off My Womb were filmed by the public broadcasting service SBS2, and aired in late November 2013 as a two-minute-and-forty-eight-second video clip re-titled Vaginal Knitting. The clip went viral on YouTube, with over seven million views as of March 2016, and received extensive media attention. Casting Off My Womb attracted global public interest because Jenkins continued to knit throughout the days of her period, weaving her menstrual blood into the artwork. The performance elicited strong responses from its global viewing public. While some people praised the work, many online spectators wrote vicious, derisive and personal attacks on Jenkins for displaying her menstrual blood in a public place. This article uses Matthew Goulish's methodology of ‘slow thinking’ as a counterresponse to the impulsive reactions of the online spectators and as a means to register the powerful and incremental energy and effects of Jenkins's feminist performance.
The Integrated Public Use Microdata Series (IPUMS)-International partnership is a project of the Minnesota Population Center and national statistical agencies, dedicated to collecting and distributing census data from around the world. IPUMS is currently disseminating data on over a half-billion persons enumerated in more than 250 census samples from 79 countries. The data series includes information on a broad range of population characteristics, including fertility, nuptiality, life-course transitions, migration, labor-force participation, occupational structure, education, ethnicity, and household composition. This paper describes sample characteristics and data structure; the data integration process including the creation of constructed family interrelationship variables; the flexible dissemination system that enables researchers to build customized extracts of pooled census samples across time and place; and some of the most significant findings that have emerged from the database.
Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.
The triennial meeting of Commission 4 was attended by 16 people. All of the presentations from the meeting are provided on the commission website at http://www.iaucom4.org/c4docs.html, so this report provides only summaries.
The Commission 4 Organizing Committee began its work for the 2009-2012 triennium by revising the commission's terms of reference, which serve as our “mission statement.” The new terms of reference are:
(a) Maintain cooperation and collaboration between the national offices providing ephemerides, prediction of phenomena, astronomical reference data, and navigational almanacs.
(b) Encourage agreement on the bases (reference systems, time scales, models, and constants) of astronomical ephemerides and reference data in the various countries. Promote improvements to the usability and accuracy of astronomical ephemerides, and provide information comparing computational methods, models, and results to ensure the accuracy of data provided.
(c) Maintain databases, available on the Internet to the national ephemeris offices and qualified researchers, containing observations of all types on which the ephemerides are based. Promote the continued importance of observations needed to improve the ephemerides, and encourage prompt availability of these observations, especially those from space missions, to the science community.
(d) Encourage the development of software and web sites that provide astronomical ephemerides, prediction of phenomena, and astronomical reference data to the scientific community and public.
Promote the development of explanatory material that fosters better understanding of the use and bases of ephemerides and related data.
By
STEVEN D. PASSIK, Memorial Sloan-Kettering Cancer Center,
LARA K. DHINGRA, Beth Israel Medical Center and Albert Einstein College of Medicine,
KENNETH L. KIRSH, University of Kentucky College of Pharmacy
There is a potential risk for substance use problems in cancer patients managed in the palliative care setting, the severity of which varies significantly across subgroups. The potential for substance use problems in cancer patients may be manifested in various case scenarios: Patients may increase their dosages of prescribed drugs without informing their physicians, or use their analgesics to treat symptoms other than those intended; other patients helpfully present to the palliative care team with a known history of, or current addiction to, illicit drugs or prescription medications. Accordingly, efforts to appropriately identify, assess, and clinically manage substance-related problems are critical to the optimal treatment of cancer patients in the palliative care setting. In this chapter, we discuss these important issues and describe how clinicians can assert control over opioid prescriptions by closely monitoring drug use and by using specific strategies to structure drug therapy. By implementing these strategies and methods, clinicians can help address substance use problems in cancer patients while ensuring that pain and other symptoms are not undertreated.
Prevalence rates of drug abuse and addiction: general U.S. population versus cancer population
In 2006, approximately 50% of people aged 12 and older in the United States reported using illegal drugs at some point in their lives, and between 6% and 15% have a current or past substance use disorder. Further, rates of controlled prescription drug abuse have risen dramatically in the United States, with rates nearly doubling between 1992 and 2003 from 7.8 million to 15.1 million.
To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).
Design.
Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).
Setting.
Level III NICU in a tertiary care center.
Participants.
Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.
Interventions.
Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.
Results.
Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.
Conclusion.
An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.
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