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Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
It is recognised that a limited cohort of patients receive open partial laryngeal surgery in specific centres within the UK, so sharing information around key clinical issues and recommendations for practice is necessary to improve outcomes.
This position statement provides practice recommendations based on a synthesis of the available evidence presented at the 12th Evidence Based Management day on ‘Laryngeal Cancer’ and the ensuing discussions. Literature searches and critical analysis of available evidence were undertaken and triangulated with the clinical experience of the authors to develop these recommendations.
Results and conclusion
This paper presents a comprehensive overview of challenges that the multidisciplinary team may encounter. It provides recommendations for swallow and speech rehabilitation after open partial laryngectomy, and suggests practical ways that these issues may be addressed pre- and post-operatively.
The development of nutritional strategies to improve microbial homeostasis and gut health of piglets post-weaning is required to mitigate the high prevalence of post-weaning diarrhea and subsequent growth checks typically observed during the weaning transition. Therefore the objective of this study was to determine the effect of supplementing piglet creep and nursery feed with a yeast-derived mannan-rich fraction (MRF) on piglet growth performance, cecal microbial profiles, and jejunal morphology and gene expression. Ten litters of piglets (n=106) were selected on postnatal day (PND) 7 and assigned to diets with or without MRF (800 mg/kg) until weaning (n=5 litters/treatment; initial weight 3.0±0.1 kg). On PND 21, 4 piglets per litter (n=40) were selected and weaned into the nursery where they remained on their respective diets until PND 42. A two-phase feeding program was used to meet nutrient requirements, and pigs were switched from phase 1 to phase 2 on PND 28. Feed intake and piglet weights were recorded on PND 7, 14, 21, 28, 35 and 42. On PND 28 and 42, ten piglets per treatment were euthanized to collect intestinal tissue and digesta. Piglets supplemented with MRF had 21.5% greater (P<0.05) average daily feed intake between PND 14-21. However, MRF supplementation did not affect piglet growth performance compared to control. On PND 28, jejunal villus height was 16.8% greater (P<0.05) in piglets consuming MRF supplemented diets. Overall microbial community structure in cecal digesta on PND 28 tended to differ in pigs supplemented with MRF (P=0.076; analysis of similarities (ANOSIM)) with increased (P<0.05) relative abundance of Paraprevotellaceae genera YRC22 and CF231, and reduced (P<0.05) relative abundance of Sutterella and Prevotella. Campylobacter also tended to reduce (P<0.10) in MRF supplemented piglets. On PND 28 differential gene expression in jejunal tissue signified an overall effect of supplementing MRF to piglets. Downstream analysis of gene expression data revealed piglets supplemented with MRF had enriched biological pathways involved in intestinal development, function and immunity, supporting the observed improvement in jejunal villus architecture on PND 28. On PND 42 there was no effect of MRF supplementation on jejunal morphology or overall cecal microbial community structure. In conclusion, supplementing Actigen™, a MRF, to piglets altered cecal microbial community structure and improved jejunal morphology early post-weaning on PND 28, which is supported by enrichment of intestinal development pathways.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
An experiment was carried out to examine the effects of offering beef cattle five silage diets. These were perennial ryegrass silage (PRGS) as the sole forage, tall fescue/perennial ryegrass silage (FGS) as the sole forage, PRGS in a 50:50 ratio on a dry matter (DM) basis with lupin/triticale silage (LTS), lupin/wheat silage (LWS) and pea/oat silage (POS). Each of the five silage diets was supplemented with 4 and 7 kg of concentrates/head/day in a five silages × two concentrate intakes factorial design. A total of 90 cattle were used in the 121-day experiment. The grass silages were of medium digestibility and were well preserved. The legume/cereal silages had high ammonia N, high acetic acid, low lactic acid, low butyric acid and low digestible organic matter concentrations (542, 562 and 502 g/kg DM for LTS, LWS and POS, respectively). Silage treatment did not significantly affect liveweight gain, carcass gain, carcass characteristics, the instrumental assessment of meat quality or fatty acid composition of the M. longissimus dorsi muscle. In view of the low yields of the legume/cereal crops, it is concluded that the inclusion of spring-sown legume/cereal silages in the diets of beef cattle is unlikely to be advantageous.
An experiment was carried out to examine the effects of offering beef steers grass silage (GS) as the sole forage, lupins/triticale silage (LTS) as the sole forage, a mixture of LTS and GS at a ratio of 70:30 on a dry matter (DM) basis, vetch/barley silage (VBS) as the sole forage, a mixture of VBS and GS at a ratio of 70:30 on a DM basis, giving a total of five silage diets. Each of the five silage diets was supplemented with 2 and 5 kg of concentrates/head/day in a 5 × 2 factorial design to evaluate the five silages at two levels of concentrate intake and to examine possible interactions between silage type and concentrate intake. A total of 80 beef steers were used in the 122-day experiment. The GS was well preserved while the whole crop cereal/legume silages had high ammonia-nitrogen (N) concentrations, low lactic acid concentrations and low butyric acid concentrations For GS, LTS, LTS/GS, VBS and VBS/GS, respectively, silage DM intakes were 6.5, 7.0, 7.2, 6.1 and 6.6 (s.e.d. 0.55) kg/day and live weight gains were 0.94, 0.72, 0.63, 0.65 and 0.73 (s.e.d. 0.076) kg/day. Silage type did not affect carcass fatness, the colour or tenderness of meat or the fatty acid composition of the intramuscular fat in the longissimus dorsi muscle.
Textural and chemical data are reviewed for amphiboles occurring in Cr-diopside series and Al-augite series xenoliths; as megacrysts in a variety of igneous environments; and also as minor phases in tectonic slices of upper-mantle peridotite. New data are given for pargasite and associated phases in a lherzolite from Tanzania and in kelyphite replacing garnet in a S. African kimberlite xenolith. It is concluded that only pargasites and titaniferous pargasites occurring in Cr-diopside series blocks have formed under upper-mantle conditions. Although amphibole is present in the upper mantle, as suggested by Oxburgh (1964), its relative paucity suggests it is not a major alkali and water storage site; phlogopite is a more likely candidate, particularly in the deeper parts of the upper mantle.
The study objective was to determine the prevalence of Staphylococcus aureus colonisation in the nares and oropharynx of healthy persons and identify any risk factors associated with such S. aureus colonisation. In total 263 participants (177 adults and 86 minors) comprising 95 families were enrolled in a year-long prospective cohort study from one urban and one rural county in eastern Iowa, USA, through local newspaper advertisements and email lists and through the Keokuk Rural Health Study. Potential risk factors including demographic factors, medical history, farming and healthcare exposure were assessed. Among the participants, 25.4% of adults and 36.1% minors carried S. aureus in their nares and 37.9% of adults carried it in their oropharynx. The overall prevalence was 44.1% among adults and 36.1% for minors. Having at least one positive environmental site for S. aureus in the family home was associated with colonisation (prevalence ratio: 1.34, 95% CI: 1.07–1.66). The sensitivity of the oropharyngeal cultures was greater than that of the nares cultures (86.1% compared with 58.2%, respectively). In conclusion, the nares and oropharynx are both important colonisation sites for healthy community members and the presence of S. aureus in the home environment is associated with an increased probability of colonisation.
Vaccination remains a mainstay of companion animal population health. However, how vaccine use at a population level complies with existing guidelines is unknown. Here we use electronic health records to describe vaccination in dogs, cats and rabbits attending a large sentinel network of UK veterinary practices. In total, 77.9% (95% CI: 77.6–78.1) of animals had recorded vaccinations. The percentage of animals with recorded vaccinations was higher in dogs, neutered animals, in insured dogs and cats and in purebred dogs. Vaccination rates varied in different regions of Great Britain in all species. Dogs and cats belonging to owners living in less deprived areas of England and Scotland were more likely to be recorded as vaccinated. In the vaccinated population, cats received more core vaccines per year of life (0.86) than dogs (0.75), with feline leukaemia vaccines almost as frequent as core vaccines. In dogs, leptospira vaccines were more frequent than core vaccines. This descriptive study suggests a substantial proportion of animals are not benefiting from vaccine protection. For the first time, we identify potential factors associated with variations in recorded vaccination frequency, providing a critical baseline against which to monitor future changes in companion animal vaccination and evidence to inform future targeted health interventions.
A considerable proportion of beef produced in the UK is a byproduct of the dairy industry. Young animals from this source are generally regarded as low in quality and meat from animals of this type is usually destined for the commodity minced beef market. The objective of the present study was to evaluate the effect of slaughter weight on sensory characteristics of meat from Holstein-Friesian bulls and steers offered a cereal-based ration.
Data from the US (Van Amburgh et al., (2001)) suggests that the current UK recommendations for feeding the neonatal calf (˜500g milk replacer/d, at ˜230 g crude protein per kg fresh milk powder) are inadequate to sustain high growth rates in early life. It has been suggested that increasing nutrition during the first 6-8 weeks of the calf’s life will improve lifetime production, health and fertility. An experiment was therefore initiated to investigate the influence of level of milk replacer feeding and the crude protein content of the milk replacer on calf performance during the first 8 weeks of life, under UK conditions.
Adipose tissue becomes more saturated and less unsaturated with age (Kemp et al., 1981). Desaturation of stearic acid to the oleic acid is catalysed by stearoyl-CoA desaturase (SCD) and increasing the degree of desaturation of lamb is likely to be beneficial in terms of human nutrition. By altering the levels of ovine SCD mRNA, the supply of oleic acid to the tissue could be manipulated, resulting in a practical method of changing the fatty acid profile of the animals meat. Previous work in our laboratory has shown variability between adipose tissue depots in their expression of SCD and that this variability is associated with changes in oleic acid content (Daniel et al, 2004). Such differences in SCD expression between depots implies that there may be even larger variation in SCD expression between breeds. A sheep breed with particularly high level of SCD mRNA could then be exploited through breeding programmes to produce animals with increased desaturase activity and therefore increased oleic acid content. Three sheep breeds, Texel, Beulah and Soay, were therefore used to study the influence of breed and age on SCD expression.
Results of a recent study (Wicks et al. 2005) indicate that increasing the protein content of the milk replacer fed to autumn-born Holstein-Friesian calves reduced growth rates in the first 8 weeks of life. Van Amburgh et al., (2001) previously suggested that increasing both milk replacer intake and protein content maximised the growth of calves during this early phase of life. An experiment was undertaken to investigate the influence of level of milk replacer and crude protein content on calf performance during the first 8 weeks of life of spring-born calves.
Wilting of grass prior to ensiling generally produces positive responses in dry matter (DM) intake of cattle, but the responses in animal performance are often small, or even negative. The primary objective of the present study was to compare energy utilization from heavily wilted and unwilted silages by growing cattle when given at equal metabolisable energy (ME) intakes. A secondary objective was to evaluate effects of silage additive type (inoculant v. formic acid) on energy utilization.
Four silages were produced from unwilted and wilted grasses (DM 193 and 450 g/kg) obtained from a perennial ryegrass sward. The wilted grass was dried in the field for 26 hours using rapid wilting techniques involving crop conditioning and spreading. At ensiling both the unwilted and wilted grasses were each treated with two additives, a bacterial inoculant (Ecosyl, Zeneca Bioproducts Limited) and a formic acid additive (ADD-F, BP Chemicals Ltd.).
This study aimed to evaluate levels of beef cow fertility using calving interval (CI; measured in days) as a measure, and investigate the effects of breed, season, year and progeny gender on CI. The CI data included 273 764 records collected between 1997 and 2012 and included the seven most common breeds (and their crosses) in Northern Ireland (Charolais, Limousin, Belgian Blue, Simmental, Blonde d’Aquitaine, Aberdeen Angus and Hereford), accounting for 94.1% of beef dams recorded. Mean CI for all cows was 395 days, 30 days longer than the optimum 365 days. Charolais and Belgian Blue dams had the longest CI (P<0.05). Cows older than 144 months had a longer CI (P<0.05) compared with cows younger than 144 months. Charolais sires had a shorter subsequent CI of 392 days (P<0.05) compared with the other breeds. Cows calving in June had the shortest subsequent CI (376 days; P<0.05), whereas cows calving in November had the longest subsequent CI (410 days). Progeny gender did not significantly affect CI. This study establishes the level of beef cow fertility using CI as a measure in Northern Ireland is sub optimal and there are opportunities for improvement. Factors identified as influencing CI included dam breed, sire breed and month of parturition. This knowledge can be used to direct breeding programmes and inform knowledge transfer protocol to improve sustainability of beef production.
Mark J. Crowley, Associate Professor at the School of History, Wuhan University, China.,
Sandra Trudgen Dawson, Executive Administrator of the Berkshire Conference of Women Historians and the Executive Director of the Coordinating Council on Women in History.
ON 3 September 1939 Britain declared war on Germany. As an imperial power, Britain, like France, Germany and Japan, expected to use the resources and ‘manpower’ of each colony and territory for the war effort, making the war truly global. As Ashley Jackson points out, the ‘[British] Empire and Commonwealth was the world's largest political, economic and military unit, and it went to war as one’. Millions of colonial and dominion troops fought and millions more produced uniforms, exported foodstuffs and military material, served as medical and nursing personnel and provided homes for child evacuees, servicemen and women stationed on their shores. Home fronts around the world were transformed and militarized for use by, and for, the imperial power. Civilians were conscripted as agricultural labourers, workers in munitions factories, shipbuilders and aircraft builders. They would work alongside military personnel. Henceforth, home fronts throughout the empire experienced increased policing, shortages of consumer goods and food rationing, underwent the pressures of Air Raid Precautions (ARP) and lived with curfews, censorship and curtailed travel.
As a scholarly topic of investigation, the British home front during the Second World War has received considerable attention, especially in areas documenting the experiences of women, children and refugees and the work of men and women codebreakers. As Linsey Robb argues in this volume, women's wartime work experience is largely celebrated but, at the same time, the masculinity of men in reserved occupations came under scrutiny, since the ideal masculine image was the man in uniform. This was particularly the case for the men of the Royal Air Force, whose image was immortalized in national memory after the Battle of Britain. Indeed, the Battle of Britain, the devastation of the British home front during the months of bombing and the way civilians and officials responded continue to be the subject of new studies. In this volume, Mark J. Crowley illustrates the ingenuity and technological innovations that allowed the Post Office to continue functioning and even to improve services during the bombing.