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Placebos are not inert, but exert measurable biological effects. The placebo response in psychiatric illness is important and clinically relevant, but remains poorly understood. In this paper, we review current knowledge about the placebo response in psychiatric medicine and identify research directions for the future. We argue that more research is needed into the placebo response in psychiatric medicine for three broad reasons. First, awareness of factors that cause placebo response, for whom, and when, within clinical trials will allow us to better evidence efficacy of new treatments. Second, by understanding how placebo mechanisms operate in the clinic, we can take advantage of these to optimise the effects of current treatments. Finally, exploring the biological mechanisms of placebo effects might reveal tractable targets for novel treatment development.
To examine participants’ experiences with nutrition education classes that were implemented with and designed to complement a cost-offset community-supported agriculture (CSA) programme.
Qualitative analysis of data from twenty-eight focus groups with ninety-six participants enrolled in Farm Fresh Foods for Healthy Kids (F3HK). Transcribed data were coded and analysed by a priori and emergent themes.
Rural and micropolitan communities in New York, North Carolina, Vermont and Washington (USA).
Ninety-six F3HK participants.
Participants found recipes and class activities helpful and reported improvements in nutrition knowledge, food preservation skills and home cooking behaviours for themselves and their children; they also reported that classes promoted a sense of community. Some educators better incorporated CSA produce into lessons, which participants reported as beneficial. Other obligations and class logistics were barriers to attendance; participants recommended that lessons be offered multiple times weekly at different times of day. Other suggestions included lengthening class duration to encourage social engagement; emphasising recipes to incorporate that week’s CSA produce and pantry staples and offering additional strategies to incorporate children in classes.
Complementing a cost-offset CSA with nutrition education may enhance programme benefits to low-income families by improving nutrition knowledge and cooking behaviours. However, future interventions will benefit from ongoing coordination between educators and local growing trajectories to maximise timely coverage of unfamiliar produce in lessons; synchronous scheduling of CSA pick-up and classes for participant convenience and creative strategies to engage children and/or provide childcare.
Development of transparent electrodynamic screens (EDS) printed on ultrathin
flexible glass film substrates for retrofitting on solar panels and solar
mirrors to perform self cleaning function is reviewed. Large-scale solar plants
are generally installed in semi-arid and desert areas where dust layers build up
on solar collectors causes major energy-yield loss. Maintaining designed plant
capacities requires more than 90% reflectivity for CSP mirrors and 90%
transmission efficiency for PV modules; solar collectors must therefore be
cleaned at a frequency depending on the rate of dust deposition. Scarcity of
water in these regions requires a cleaning method that drastically reduces or
eliminates water and the associated labor costs for high efficiency operation of
large-scale solar plants. An EDS film consists of rows of interdigitated,
transparent conducting parallel electrodes embedded within a flexible ultrathin
glass film and an optically clear adhesive film used for retrofitting the film
on the surface of solar collectors. When phased voltage pulses activate the
electrodes, the dust particles are first electrostatically charged, then
repelled and removed from the surface of the solar collectors by Coulomb force,
restoring transmission efficiency greater than 90%. The electrodes of EDS are
either made from silver nanowire or another conductive transparent material
printed on a highly transparent, ultrathin (100-μm thick), flexible
borosilicate glass film. Applications of different conducting transparent
electrodes and methods of printing are reviewed for optimizing self-cleaning
function of solar panels and mirrors.
Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children.
We carried out a retrospective review of patients <19 years of age who received digoxin and had serum digoxin concentrations assessed between January, 2007 and June, 2013. Data collection included patient demographics, digoxin indication, serum digoxin concentrations, signs and symptoms of digoxin toxicity, electrocardiograms, and co-morbidities. Reviewers performing chart review and electrocardiogram analysis were blinded to digoxin levels. Descriptive statistical methods were used and comparisons were made between patients with and without toxic serum digoxin concentrations (>2 ng/ml).
There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05).
Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.
Simulation models can offer valuable insights into the effectiveness of different control strategies and act as important decision support tools when comparing and evaluating outbreak scenarios and control strategies. An international modelling study was performed to compare a range of vaccination strategies in the control of foot-and-mouth disease (FMD). Modelling groups from five countries (Australia, New Zealand, USA, UK, The Netherlands) participated in the study. Vaccination is increasingly being recognized as a potentially important tool in the control of FMD, although there is considerable uncertainty as to how and when it should be used. We sought to compare model outputs and assess the effectiveness of different vaccination strategies in the control of FMD. Using a standardized outbreak scenario based on data from an FMD exercise in the UK in 2010, the study showed general agreement between respective models in terms of the effectiveness of vaccination. Under the scenario assumptions, all models demonstrated that vaccination with ‘stamping-out’ of infected premises led to a significant reduction in predicted epidemic size and duration compared to the ‘stamping-out’ strategy alone. For all models there were advantages in vaccinating cattle-only rather than all species, using 3-km vaccination rings immediately around infected premises, and starting vaccination earlier in the control programme. This study has shown that certain vaccination strategies are robust even to substantial differences in model configurations. This result should increase end-user confidence in conclusions drawn from model outputs. These results can be used to support and develop effective policies for FMD control.
In the presented study, a new application for distyrylbenzene oligoelectrolyte, named DSBN+, as a marker for bioimaging is presented. DSBN+ is a water-soluble, conjugated oligoelectrolyte (COE) with novel photophysical and solvatochromatic properties. Previous studies have shown that this compound spontaneously inserts into bilayer membranes in both synthetic and microbial living systems and can facilitate visualization of cell membranes through fluorescence imaging. In the presented research, we seek to further study and exploit the multifunctional nature of DSBN+ in terms of membrane interactions and photophysical properties for visualization of membranous structures of more complex mammalian cells, namely a human cervical carcinoma (HeLa) cell line. Obtained results confirm the possibility of applying DSBN+ as a fluorescent dye for bioimaging of membranes in human cell cultures systems, both in live-cell imaging and in the studies required formaldehyde fixation. Due to the defined structure of this conjugated oligoelectrolyte we suspect that it will display organelle membrane selectivity, but this has to be further investigated.
We report an outbreak of serious infections with Serratia marcescens in patients on a neurosurgery ward. The epidemiological investigations undertaken are described. Features of outbreaks of infection with serratia and control measures are discussed.
A hospital outbreak of multiply-resistant Salmonella heidelberg infection, which affected 17 patients and 2 staff, is described. The tangible cost of the outbreak was estimated at £21 151, £17989 (85·1%) of which was borne by the hospital. The cost to the Microbiology Department was £3596 (17·0% of the total). A detailed analysis of the costs and implications for staffing disruption is given and a comparison is made with the costs of preventive activities. Ways of containing expenses in the event of an outbreak and the economic implications for clinical budgeting and privatization of the laboratory service are considered.
Aims: To gain structured feedback on a qualitative research methods training programme delivered to primary care researchers over a period of ten years. To examine dilemmas and challenges and how these had been resolved. To examine how the programme could be further developed. Background: The Wolds Primary Care Research Network's (WoReN) qualitative research methods training programme was developed and evolved in response to the needs of primary care practitioners and researchers and the NHS Research Agenda. Methods: Information on participants' professional backgrounds: which workshops they attended; their evaluation sheets, comments; and personal appraisals were collected from 1996 to 2006. Structured telephone conversations with a number of participants and ongoing informal feedback from participants added to this information. Numbers and ranges of professionals attending workshops were ascertained, how far they travelled to workshops and further degrees obtained by them, within the decade, were also noted. Findings: We found a lack of similar training elsewhere. A wide range of people attended workshops, especially general practitioners (GP) and academic researchers. Other practitioners were a significant presence however, and included nurses, pharmacists, health visitors and professions allied to medicine. Participants were prepared to attend extended workshops and to travel significant distances to them. Participants preferred a continuous cycle of workshops rather than discreet sessions, in order for them to consolidate their learning and to develop at their own pace. Practical exercises reflecting the qualitative research process were considered very conducive to learning and participants also appreciated one-to-one consultations about their work and longer-term, ongoing support as they progressed through their projects. Workshop design needed to continually reflect the changing requirements of participants, employers, funders, potential trainers and national NHS requirements. A new audience for training was identified in supervisors not versed in the qualitative paradigm.
Generative specifications have been used to systematically codify
established styles in several design fields including architecture and
product design. We examine how designers explore new designs in the early
stages of product development as they manipulate and interpret shape
representations. A model of exploration is proposed with four types of
shape descriptions (contour, decomposition, structure, and design) and the
results of the exploration are presented. Generative rules are used to
provide consistent stylistic changes first within a given decomposition
and second through changing the structure. Style expresses both the
analytical order of explanation and the synthetic complexity of
exploration. The model of exploration is consistent with observations of
design practice. The application of generative design methods demonstrates
a logical pattern for early stage design exploration. The model provides
the basis for tools to assist designers in exploring families of designs
in a style and for following new interpretations that move the exploration
from one family to another.
Though various textbooks describe clinical manoeuvres that help detect subtle motor deficits, their sensitivity, specificity and predictive values have not been determined. We investigated the sensitivity, specificity and predictive values of various manoeuvres in order to determine the most sensitive and reliable test or combination thereof.
Straight arm raising (Barré), pronator drift, Mingazzini’s manoeuvre, finger tap, forearm roll, segmental strength and deep tendon reflexes were tested in 170 patients with (86) and without (84) a proven lesion in the motor areas confirmed by computed tomography.
Segmental motor strength had good specificity (97.5%) but poor sensitivity (38.9%) and negative predictive value (NPV) (58.7%). The forearm roll had a similar profile. Finger tap had a sensitivity of 73.3% and a specificity of 87.5%. Barré and pronator testing had a sensitivity and specificity of 92.2% and 90.0% respectively. Hyperreflexia had a sensitivity of 68.9% and a specificity of 87.5%. An abnormality of pronator, reflexes or finger tap had a sensitivity of 97%, and when these three tests were positive, specificity was 97%. When all six tests were positive, the positive predictive value was 100%, when all six tests were negative the NPV was 100%.
The detailed segmental examination has very good specificity for detecting motor deficits, but the sensitivity and NPV are unacceptably low. Pronator drift with finger tap and reflexes is the most reliable and time-effective combination of tests for the detection of subtle motor lesions, and could replace the segmental motor examination as a screening for motor lesions.
It has long been recognized that detecting cancers in their early, non-invasive stage is the best strategy to control malignant diseases. This has been best demonstrated by the example of cancer of the uterine cervix. Before screening for early signs of this malignancy, the prevalence of invasive cancer of the uterine cervix in the developed world was as high as 30 women per 100,000 and the mortality was 12-15 per 100,000 women per year, (all figures represent age standardized data). Since the introduction of cervical screening programs by Pap smears, the incidence of invasive cervical cancer and mortality due to this cancer has fallen dramatically. In British Columbia, for example, where population screening was introduced 50 years ago, the incidence and mortality have decreased several-fold and are at present below 6 and 3 per 100,000, respectively (1,2). It is believed that these figures could be even lower by encouraging more women into the program and by improving both sensitivity and specificity of the cytology.
To review the current literature on the effects of soy isoflavones, one class of phyto-oestrogens, on cardiovascular diseases, osteoporosis, cancer and climacteric symptoms.
Many study designs were employed in the reports reviewed here, including prospective human trials, observational human studies, animal experiments and in vitro cell studies that explored the protective or preventive effects of soy isoflavones (genistein, daidzein and glycitein alone or mixed).
Diverse settings were employed, depending on study design.
Human subjects, mostly menopausal or postmenopausal, were included, as were animal models and specific cell types.
The findings were: (i) isoflavones plus soy protein together were needed to obtain the highly significant beneficial results on blood lipids and arterial dimensions; (ii) isoflavone treatments alone at high doses (relative to above) consistently improved bone parameters in rodent ovariectomized models, but not in humans or primates; (iii) isoflavones were not consistent in exerting positive effects regarding the prevention or treatment of cancers of the mammary glands, uterus and colon; and (iv) the effects of isoflavones on climacteric symptoms were not clear-cut.
The promise of soy isoflavones reducing chronic disease risk seems to be non-uniform, with the most conclusive benefits occurring in the prevention of cardiovascular diseases, but other organ systems, such as skeletal and reproductive tissues, may also benefit from the consumption of soy and soy-derived products.
Viral haemorrhagic disease of rabbits (VHD), a potential
biological control for wild rabbits in
Australia and New Zealand, escaped from quarantined field trials on Wardang
spread to the mainland of Australia in October 1995. This study looked
for any evidence of
infection or illness in people occupationally exposed to the virus. Two
hundred and sixty-nine
people were interviewed and 259 blood samples were collected. Exposures
rabbits ranged from nil to very high. No VHD antibodies were detected in
any of the 259 sera
when tested by VHD competitive enzyme immunoassay, which had been validated
VHDV-specific antibody negative sera. A questionnaire designed to elicit
symptoms of disease
in a range of organ systems found no significant differences between illness
in those exposed
and those not exposed to VHD, nor could an association be found between
subsequent episodes of illness. The findings are consistent with the view
that exposure to VHD
is not associated with infection or disease in humans.
The incidence of methicillin-resistant Staphylococcus aureus (MRSA) has increased in communities and in healthcare facilities in the United States since the mid-1970s. Although MRSA often is thought of as a nosocomial infection problem because it is encountered in facilities of all types and sizes, it also causes many community-acquired infections. Approaches to control of MRSA vary widely, and there is lack of agreement on the most appropriate measures to control MRSA in healthcare facilities. The wide variation in approaches is due, in part, to the lack of data establishing the efficacy of specific control measures. As a result, the approaches that have been advocated have resulted in confusing and often conflicting recommendations and control measures. In some settings, there also have been unreasonable barriers and administrative hurdles that delay or prevent the transfer of patients between acute care and nursing (extended care) facilities.