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This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence.
Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579).
Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs).
Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.
Adjectives are essential for describing and differentiating concepts. However, they have a protracted development relative to other word classes. Here we measure three- and four-year-olds’ exposure to adjectives across a range of interactive and socioeconomic contexts to: (i) measure the syntactic, semantic, and pragmatic variability of adjectives in child-directed speech (CDS); and (ii) investigate how features of the input might scaffold adjective acquisition. In our novel corpus of UK English, adjectives occurred more frequently in prenominal than in postnominal (predicative) syntactic frames, though postnominal frames were more frequent for less-familiar adjectives. They occurred much more frequently with a descriptive than a contrastive function, especially for less-familiar adjectives. Our findings present a partial mismatch between the forms of adjectives found in real-world CDS and those forms that have been shown to be more useful for learning. We discuss implications for models of adjective acquisition and for clinical practice.
Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.
To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS
American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.
Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
The primary outcome of interest was 30-day SSI rate.
A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.
Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.
Feature tracking of approximately annually separated Landsat-7 ETM+ imagery acquired from 1999 to 2010 and speckle tracking of 24-day separated RADARSAT-2 imagery acquired from 2009 to 2015 reveal that motion of the major tidewater glaciers of Devon Ice Cap is more variable than previously described. The flow of almost half (six of 14) of the outlet glaciers slowed over the observation period, while that of the terminus regions of three of 14 of the glaciers sped up in the most recent years of observation. The North Croker Bay Glacier of southern Devon Ice Cap showed the greatest variability in motion, oscillating between multi-year (three or more) periods of slower and faster flow and exhibited a pattern of velocity variability that is different from that of the rest of the ice cap's outlet glaciers. Comparisons between areas of dynamic variability and glacier bed topography indicate that velocity variability is largely restricted to regions where the glacier bed is grounded below sea level. Derived velocities are combined with measurements of ice thickness at the fronts of tidewater glacier to determine a mean annual (2009; 2011–15) dynamic ice discharge of 0.41 ± 0.11 Gt a−1 for Devon Ice Cap. The Belcher Glacier is becoming a larger source of mass loss via ice discharge.
Controversy exists surrounding the health effects of added sugar (AS) and sugar-sweetened beverage (SSB) intakes, primarily due to a reliance on self-reported dietary intake. The purpose of the current investigation was to determine if a 6-month intervention targeting reduced SSB intake would impact δ13C AS intake biomarker values.
A randomized controlled intervention trial. At baseline and at 6 months, participants underwent assessments of anthropometrics and dietary intake. Fasting fingerstick blood samples were obtained and analysed for δ13C value using natural abundance stable isotope MS. Statistical analysis included descriptive statistics, correlational analyses and multilevel mixed-effects linear regression analysis using an intention-to-treat approach.
Rural Southwest Virginia, USA.
Adults aged ≥18 years who consumed ≥200 kcal SSB/d (≥837 kJ/d) were randomly assigned to either the intervention (n 155) or a matched-contact group (n 146). Participants (mean age 42·1 (sd 13·4) years) were primarily female and overweight (21·5 %) or obese (57·0 %).
A significant group by time difference in δ13C value was detected (P<0·001), with mean (sd) δ13C value decreasing in the intervention group (pre: −18·92 (0·65) ‰, post: −18·97 (0·65) ‰) and no change in the comparison group (pre: −18·94 (0·72) ‰, post: −18·92 (0·73) ‰). Significant group differences in weight and BMI change were also detected. Changes in biomarker δ13C values were consistent with changes in self-reported AS and SSB intakes.
The δ13C sugar intake biomarker assessed using fingerstick blood samples shows promise as an objective indicator of AS and SSB intakes which could be feasibly included in community-based research trials.
Benchmarks for antimicrobial consumption measured in antimicrobial days are beginning to emerge. The relationship between the traditional measure of days of therapy and antimicrobial days is unclear. We observed a high intermethod correlation (R2=0.99): antimicrobial days were 1.9-fold lower than days of therapy across agents. Individual institutions should correlate these measures.
There is a growing interest in applying principles of biological morphogenesis to architectural practice. Biological morphogenesis differs from conventional architectonics in several important ways; architecture is teleological, biology has no purpose; architecture is blueprinted and top-down, morphogenesis is bottom-up and emergent; construction uses external agents and skills (builders) whereas embryos build themselves from largely internal information; control of construction sites is hierarchical while morphogenesis uses rich feedback and distributed control; biological systems show adaptation and self-repair. Many materials are, however, common to the two, and both use techniques of scaffolding. There are several ways in which the fields can be brought together, either using biological systems directly (for example in synthetic biological approaches), or by engineering inorganic systems to realize the potentially useful processes characteristic of living things, such as automatic adaptation to the environment, and self-repair.
The SEARCH Nutrition Ancillary Study aims to investigate the role of dietary intake on the development of long-term complications of type 1 diabetes in youth, and capitalise on measurement error (ME) adjustment methodology. Using the National Cancer Institute (NCI) method for episodically consumed foods, we evaluated the relationship between sugar-sweetened beverage (SSB) intake and cardiovascular risk factor profile, with the application of ME adjustment methodology. The calibration sample included 166 youth with two FFQ and three 24 h dietary recall data within 1 month. The full sample included 2286 youth with type 1 diabetes. SSB intake was significantly associated with higher TAG, total and LDL-cholesterol concentrations, after adjusting for energy, age, diabetes duration, race/ethnicity, sex and education. The estimated effect size was larger (model coefficients increased approximately 3-fold) after the application of the NCI method than without adjustment for ME. Compared with individuals consuming one serving of SSB every 2 weeks, those who consumed one serving of SSB every 2 d had 3·7 mg/dl (0·04 mmol/l) higher TAG concentrations and 4·0 mg/dl (0·10 mmol/l) higher total cholesterol and LDL-cholesterol concentrations, after adjusting for ME and covariates. SSB intake was not associated with measures of adiposity and blood pressure. Our findings suggest that SSB intake is significantly related to increased lipid levels in youth with type 1 diabetes, and that estimates of the effect size of SSB on lipid levels are severely attenuated in the presence of ME. Future studies in youth with diabetes should consider a design that will allow for the adjustment for ME when studying the influence of diet on health status.
The δ13C value of human blood is an emerging novel biomarker of added sugar (AS) intake for adults. However, no free-living, community-based assessments of comparative validity of this biomarker have been conducted. The purpose of the present investigation was to determine if Healthy Eating Index-2010 (HEI-2010) score, SoFAAS score (HEI-2010 sub-component for solid fat, alcohol and AS), AS and sugar-sweetened beverage (SSB) intakes were associated with δ13C value of fingerstick blood in a community-based sample of adults, while controlling for relevant demographics.
A cross-sectional analysis of data obtained from assessments of BMI, dietary intake using 24 h recalls and a fingerstick blood sample was completed. Statistical analyses included descriptive statistics, multiple linear regression and one-way ANOVA.
Rural Southwest Virginia, USA.
Adults (n 216) aged >18 years who consumed at least 837 kJ/d (200 kcal/d) from SSB.
This sample of adult participants with low socio-economic status demonstrated a mean HEI-2010 score of 43·4 (sd 12·2), mean SoFAAS score of 10·2 (sd 5·7), mean AS intake of 93 (sd 65) g/d and mean blood δ13C value of −18·88 (sd 0·7) ‰. In four separate regression models, HEI-2010 (R2=0·16), SoFAAS (R2=0·19), AS (R2=0·15) and SSB (R2=0·14) predicted δ13C value (all P≤0·001). Age was also predictive of δ13C value, but not sex or race.
These findings suggest that fingerstick δ13C value has the potential to be a minimally invasive method for assessing AS and SSB intake and overall dietary quality in community-based settings. Strengths, limitations and future areas of research for using an objective δ13C biomarker in diet-related public health studies are discussed.
Psychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)—younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=−.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=−.47; p=.03) and older euthymic groups (r=−.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics. (JINS, 2014, 20, 1–9)
To evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire.
Study participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment.
The multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study.
A subgroup of 172 participants aged 10–24 years with type 1 diabetes.
The mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2–0·3).
While there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.
Evaluate antimicrobial stewardship interventions targeted to reduce highly active antiretroviral therapy (HAART)– or opportunistic infection (Ol)–related medication errors and increase error resolution.
Retrospective before-after study.
Academic medical center.
Inpatients who were prescribed antiretroviral therapy before the intervention (January 1, 2011, to October 31, 2011) and after the intervention (July 1, 2012, to December 31, 2012). Patients treated with lamivudine or tenofovir monotherapy for hepatitis B were excluded.
Antimicrobial stewardship interventions included education, modification of electronic medication records, collaboration with the infectious diseases (ID) department, and prospective audit and review of HAART and OI regimens by an ID clinical pharmacist.
Data for 162 admissions from the preintervention period and 110 admissions from the postintervention period were included. The number of admissions with a medication error was significantly reduced after the intervention (81 [50%] of 162 admissions vs 37 (34%) of 110 admissions; P < .00)1. A total of 124 errors occurred in the preintervention group (mean no. of errors, 1.5 per admission), and 43 errors occurred in the postintervention group (mean no. of errors, 1.2 per admission). The most common error types were major drug interactions and dosing in the preintervention group and renal adjustment and OI-related errors in the postintervention group. A significantly higher error resolution rate was observed in the postintervention group (36% vs 74%; P < .001). After adjustment for potential confounders with logistic regression, admission in the postintervention group was independently associated with fewer medication errors (odds ratio, 0.4 [95% confidence interval, 0.24-0.77]; P = .005). Overall, presence of an ID consultant demonstrated a higher error resolution rate (32% without a consultation vs 68% with a consultation; P = .002).
Multifaceted, multidisciplinary stewardship efforts reduced the rate and increased the overall resolution of HAART-related medication errors.
The alkoxide and alkylamide complexes [Hf(mmp)4] and [Hf(NMe2)4] 2 are both promising precursors for the MOCVD of HfO2. A comparison has shown that [Hf(NMe2)4] 2 deposits oxide at lower temperatures and over a wider temperature range then [Hf(mmp)4].
Non-compliance with marine protected area (MPA) regulations is a problem worldwide, and this is being addressed through community programmes. Park service and fisheries department personnel, and fishers living adjacent to three parks were studied to determine their perceptions of MPAs. The hypotheses that positive perceptions towards the management of fisheries exclusion and gear-restricted areas would increase with the wealth, education, age and years of employment of the person, the history of community participation and the age of the MPA were tested. The strongest factor was employment, with fishers having significantly less positive perceptions towards areas closed to fishing than government managers, although all groups agreed area management benefited the nation. Government personnel thought that fishers and their communities benefited from area management, while most fishers did not share this view. Increasing wealth or community participation were not significant factors, but secondary education was associated with more positive perceptions of area management. Fishers adjacent to the oldest MPA held significantly more positive perceptions than fishers living adjacent to the newest MPA, although only a slight majority agreed that they and their communities benefited. The results point to a need for patience in expecting change in resource users' perceptions, adopting an approach in which there is more communication between fishers and managers, so that both are more aware of MPA functions, particularly closed areas and the indirect benefits.
Based on a presentation during a Symposium on ‘Phenotypic changes in epithelial development' organised by the Anatomical Society of Great Britain and Ireland held at the Royal Holloway College, Egham, Surrey, in January 2000.
The urinary collecting duct system of the permanent kidney develops by growth and branching of an initially unbranched epithelial tubule, the ureteric bud. Formation of the ureteric bud as an outgrowth of the wolffian duct is induced by signalling molecules (such as GDNF) that emanate from the adjacent metanephrogenic mesenchyme. Once it has invaded the mesenchyme, growth and branching of the bud is controlled by a variety of molecules, such as the growth factors GDNF, HGF, TGFβ, activin, BMP-2, BMP-7, and matrix molecules such as heparan sulphate proteoglycans and laminins. These various influences are integrated by signal transduction systems inside ureteric bud cells, with the MAP kinase, protein kinase A and protein kinase C pathways appearing to play major roles. The mechanisms of morphogenetic change that produce branching remain largely obscure, but matrix metalloproteinases are known to be necessary for the process, and there is preliminary evidence for the involvement of the actin/myosin contractile cytoskeleton in creating branch points.
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