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Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Americans consume Na in excess of daily recommendations. Most dietary Na comes from packaged foods, and bread is a major contributor. In the UK, national Na reduction strategies contributed to lower Na levels in packaged foods and lower population Na intake. Similar initiatives are emerging in the USA and require surveillance to assess effectiveness. We aimed to examine Na levels in bread products in the USA and compare levels with similar UK products.
Na data for bread products were obtained from the US Label Insight Open Data Initiative (n 4466) and the FoodSwitch UK database (n 1651). Mean, median and range of Na content, and proportion of products meeting Na targets established by the National Salt Reduction Initiative (NSRI) and the UK Department of Health (DH) were calculated overall, by bread type and by country.
Mean (sd) Na content in bread was 455 (170) mg/100 g in the USA and 406 (179) mg/100 g in the UK. In both countries, savoury bread had the highest mean Na (USA=584 mg/100 g, UK=543 mg/100 g) and fruit bread the lowest mean Na (USA=345 mg/100 g, UK=277 mg/100 g). Na content of US bread products was 12 % higher than in the UK, with 21 % of US bread products and 31 % of UK bread products meeting the NSRI and DH targets, respectively.
US bread products have, on average, 12 % more Na than similar products in the UK. Variation in Na content within product categories, and between countries, suggests the feasibility of manufacturing products with lower Na to lower dietary Na intake.
Background. Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes.
Method. In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n=112); a combination of the DRP program with psychiatric consultation (PC+DRP, n=39); a combination with brief cognitive behavior therapy (CBT+DRP, n=44); and care as usual (CAU, n=72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%).
Results. Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D.=9·78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period.
Conclusion. Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.
Background. We developed a comprehensive, 20-hour training programme for primary-care
physicians, that sought to improve their ability to detect, diagnose and manage depression. We
evaluated the effects of physician training on patient outcomes, using a pre-post design.
Methods. In the pre-training phase of the study, we sampled 1834 consecutive patients of 17
primary-care physicians and evaluated 518 of these patients for the presence of depression. We
measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures
were: severity of psychopathology; duration of depressive episode; and level of daily functioning.
After the 17 physicians completed the training, we drew a new sample from their practices (498 of
1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed
Results. We found an effect of the training on short-term outcome, particularly for patients with a
recent-onset depression. At 3-month follow-up depressed patients whose physicians had received
training had less severe psychopathology and patients with recent-onset depression also showed
higher levels of daily functioning than patients of the same physicians prior to the training. The
patients with a recent-onset depression that was recognized by trained physicians had shorter
depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects
had faded away.
Conclusions. Training primary-care physicians to recognize, diagnose and manage depression can
improve short-term patient outcomes, especially for patients with a recent onset of depression.
Patients suffering from a recurrent or chronic depression may need more specific interventions, both
for acute treatment and long-term management.
Computerized axial tomography was used to compare sex and age-matched groups of controls and long-term benzodiazepine users for evidence of cerebral atrophy. No statistically significant differences were found.
Control subjects voluntarily overbreathed to produce end-tidal PCO2 levels similar to those found in patients suffering from neurotic or endogenous non-retarded depression. Red cell sodium content was found to decrease during overbreathing in all the subjects. The changes were similar to those usually reported for depressed patients.
The results imply that red cell sodium levels are in part dependent on respiratory behaviour. They suggest a need for considerable caution in interpreting red cell sodium values from psychiatric patients.
The breathing rate and PCO2 in end-tidal air have been studied in controls and in patients with endogenous depression (retarded and non-retarded), with neurotic depression, and with schizophrenia. It has been shown that breathing rate goes up and PCO2 down in non-retarded and neurotic depression. Schizophrenia gives more anomalous results. The fact is emphasized that such changes must lead to alterations in pH and other variables. Studies showing some small chemical differences between these clinical entities and control subjects might therefore be explained by these findings.
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