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Internet cognitive–behavioural therapy (iCBT) for panic disorder of up to 10 lessons is well established. The utility of briefer programmes is unknown.
To determine the efficacy and effectiveness of a five-lesson iCBT programme for panic disorder.
Study 1 (efficacy): Randomised controlled trial comparing active iCBT (n=27) and waiting list control participants (n=36) on measures of panic severity and comorbid symptoms. Study 2 (effectiveness): 330 primary care patients completed the iCBT programme under the supervision of primary care practitioners.
iCBT was significantly more effective than waiting list control in reducing panic (g=0.97, 95% CI 0.34 to 1.61), distress (g=0.92, 95% CI 0.28 to 1.55), disability (g=0.81, 95% CI 0.19 to 1.44) and depression (g=0.79, 95% CI 0.17 to 1.41), and gains were maintained at 3 months post-treatment (iCBT group). iCBT remained effective in primary care, but lower completion rates were found (56.1% in study 2 v. 63% in study 1). Adherence appeared to be related to therapist contact.
The five-lesson Panic Program has utility for treating panic disorder, which translates to primary care. Adherence may be enhanced with therapist contact.
Compact object mergers are promising candidates for the progenitor system of short gamma-ray bursts (GRBs). Using gravitational wave (GW) triggers to identify a merger, any electromagnetic (EM) counterparts from the jet can be used to constrain the dynamics and structure of short GRB jets. GW triggered searches could reveal a hidden population of optical transients associated with the short-lived jets from the merger object. If the population of merger-jets is dominated by low-Lorentz-factors, then a GW triggered search will reveal the on-axis orphan afterglows from these failed GRBs. By considering the EM counterparts from a jet, with or without the prompt GRB, the jet structure and dynamics can be constrained. By modelling the afterglow of various jet structures with viewing angle, we provide observable predictions for the on- and off- axis EM jet counterparts. The predictions provide an indication for the various features expected from the proposed jet structure models.
This study estimates the symptomatology of attention deficit–hyperactivity disorder (ADHD) in adult mental health services (AMHS) outpatient clinics.
All consecutive patients attending any of the outpatients’ clinics in Sligo/Leitrim AMHS were invited to participate. Participants completed the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) self-report. Clinical notes were reviewed to identify those with a pre-existing ADHD diagnosis.
From 822 attending the clinics, 62 did not meet inclusion criteria, 97 declined to participate and 29 had incomplete data in either of the screening scales, leaving 634 (77%) eligible for full study analysis. Mean age was 40.38 (s.d.: 12.85), and 326 (51.4%) were females. In total, 215 (33.9%) screened positive on the WURS for childhood onset ADHD and 219 (34.5%) participants scored positive on the ASRS. Applying a more stringent criteria of scoring above cut-offs on both scales, suggested 131 (20.7%) screened positive on both. Only three (2.3%) had a prior clinical diagnosis.
This preliminary study suggests the possibility of relatively higher rates of ADHD in a general AMHS than previously thought, however, given the possibility of overlapping symptoms with other major psychiatric disorders in adulthood and recall bias further research is needed before drawing firm conclusions.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
The dating of alluvial deposits is frequently hampered by a lack of good-quality charcoal or other material for radiocarbon samples. We have dated two sites in southeastern Australia using traditional radiometric methods with minimal pretreatment. Results yielded an inconsistent chronology, affected by contamination with younger humic materials. A more consistent and older chronology was achieved using AMS dating of rigorously pretreated samples of fine-grained charcoal. The results have important implications for the radiocarbon dating of many Late Quaternary stratigraphic sequences with low charcoal abundance.
The radiocarbon dating of volcanic ash (tephra) deposits in New Zealand has been difficult on sites remote from the eruption, which contain either little carbon or degraded and contaminated charcoal. Although many studies of contamination removal from macroscopic charcoals from tephra sequences have been made, little attention has been paid to those containing no visible charcoal, because of the difficulty of obtaining sufficient carbon for radiometric dating. We report here experiments using accelerator mass spectrometry to establish a reliable method for dating a low-carbon aeolian and peat deposit containing a tephra horizon. Results so far demonstrate that improvements to existing chemical pretreatment methods are possible, and that dates obtained on oxidized fine-grained residues can approach the maximum age determined on good quality charred wood samples.
Distribution profiles of radiocarbon in dissolved inorganic carbonate have been measured along two transects in the southern Pacific, east of New Zealand. Use of accelerator mass spectrometry, with its small-sample-size capability, made it possible to sample near-surface waters with a depth resolution of a few tens of meters. Sampling of deeper water was guided by salinity and temperature data transmitted by a conductivity-temperature-depth probe. The measurements, taken over the Chatham Rise, show highly structured profiles that can be correlated with known circulation patterns in this region.
14C measured in trace gases in clean air helps to determine the sources of such gases, their long-range transport in the atmosphere, and their exchange with other carbon cycle reservoirs. In order to separate sources, transport and exchange, it is necessary to interpret measurements using models of these processes. We present atmospheric 14CO2 measurements made in New Zealand since 1954 and at various Pacific Ocean sites for shorter periods. We analyze these for latitudinal and seasonal variation, the latter being consistent with a seasonally varying exchange rate between the stratosphere and troposphere. The observed seasonal cycle does not agree with that predicted by a zonally averaged global circulation model. We discuss recent accelerator mass spectrometry measurements of atmospheric 14CH4 and the problems involved in determining the fossil fuel methane source. Current data imply a fossil carbon contribution of ca 25%, and the major sources of uncertainty in this number are the uncertainty in the nuclear power source of 14CH4, and in the measured value for δ14C in atmospheric methane.
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).
Before-after intervention study.
Fifteen-bed surgical trauma intensive care unit (ICU).
We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.
The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.
Use of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.
We present results from a Mopra 7 mm-wavelength survey that targeted the dense gas-tracing CS(1-0) transition towards the young γ-ray-bright supernova remnant, RX J1713.7–3946 (SNR G 347.3−0.5). In a hadronic γ-ray emission scenario, where cosmic ray (CR) protons interact with gas to produce the observed γ-ray emission, the mass of potential CR target material is an important factor. We summarise newly discovered dense gas components, towards Cores G and L, and Clumps N1, N2, N3, and T1, which have masses of 1 – 104 M⊙. We argue that these components are not likely to contribute significantly to γ-ray emission in a hadronic γ-ray emission scenario. This would be the case if RX J1713.7–3946 were at either the currently favoured distance of ~1 kpc or an alternate distance (as suggested in some previous studies) of ~6 kpc.
This survey also targeted the shock-tracing SiO molecule. Although no SiO emission corresponding to the RX J1713.7–3946 shock was observed, vibrationally excited SiO(1-0) maser emission was discovered towards what may be an evolved star. Observations taken 1 yr apart confirmed a transient nature, since the intensity, line-width, and central velocity of SiO(J = 1-0,v = 1,2) emission varied significantly.