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Cognitive Behaviour Therapy (CBT) is an effective psychological intervention for children and young people with anxiety disorders (James et al, 2013). This has led to interest in whether CBT programmes can be widely provided in schools to prevent or ameliorate anxiety symptoms in children.
Results from school based anxiety prevention trials are encouraging (Neil & Christensen 2009; Fisak, Richard, Mann 2011). Before the widespread use of school based preventive programmes can be advocated methodologically robust evaluations are required to demonstrate that they are effective when transported to everyday settings.
To undertake a pragmatic randomised controlled trial (RCT) of a universal school based CBT programme (Friends for Life) for children aged 9-10 years of age .
Three arm RCT comparing Friends for Life delivered by trained health or school leaders with usual school provision (Stallard et al,2012). Primary outcome the Revised Child Anxiety and Depression Scale (RCADS) at 12 month follow-up.
A total of 1362 children from 40 schools participated with 1257 (92%) being re-assessed at follow-up. There was a difference in adjusted mean child report RCADS scores for health-led versus school-led FRIENDS (−3.94, 95%CI −6.41 to −1.47) and health-led FRIENDS versus usual school provision (2.66, 95%CI −5.22 to −0.09). Health-led CBT resulted in greater reductions in symptoms of anxiety than the other two arms (Stallard et al 2014),
Our pragmatic trial demonstrates that universally delivered anxiety prevention programmes can be effective when transported into schools. However, effectiveness varies depending upon who delivers them.
Congenital airway obstruction is rare but potentially fatal. We developed a complex airways interventional delivery team to manage such cases. Antenatal imaging detects airway compromise at an early stage and facilitates the planning of delivery procedures (‘ex utero intrapartum treatment’ and ‘operation on placental support’) which maintain feto-placental circulation whilst an airway is secured.
A retrospective review was performed of cases in which ENT input was required at birth for airway obstruction.
Four neonates were delivered before implementation of the service: two were intubated and another two underwent tracheostomy but died in the peri-natal period. Seven neonates were delivered after implementation of the service: six were intubated and one underwent immediate tracheostomy. Five subsequently underwent tracheostomy (three have since been decannulated). One child with multiple congenital anomalies died due to respiratory failure. Airway obstruction was caused by lymphatic malformation, teratoma, costo-craniomandibular syndrome and choristoma.
In the absence of other anomalies, interventional airway delivery led to reduced mortality and improved outcomes.
We introduce a technique to permit x-ray absorption spectroscopy studies focusing on individual phase-change (Ge2Sb2Te5) memory cells in fully integrated PC-RAM structures. Devices were investigated employing an x-ray nanobeam of only about 300 nm diameter, which could be fully contained within the spatial extent of the active area within a single device cell and enabled us to investigate individual devices without interference from non-switching material surrounding the area of interest. By monitoring the fluorescence signals of tungsten and germanium at a photon energy corresponding to the Ge K-edge absorption edge white line position, we were successful in producing 2D area maps of the active cell region, which clearly show the imbedded tungsten heater element and the switched region of the phase change material. Additionally, position dependent changes in the phase change material could be traced by taking an array of XANES spectra at the Ge K-edge on and in the vicinity of individual devices.
An unlinked anonymous survey was conducted to measure the prevalence of selected markers for HIV, hepatitis B and C infection in recruits to the UK Armed Forces to inform future screening and hepatitis B vaccination policies. During 2007, nearly 14 000 left-over samples taken from new recruits for blood typing were collected, unlinked from identifiers and anonymously tested for HIV, hepatitis C and current and past cleared hepatitis B infection. Overall, serological evidence of HIV and hepatitis C was found in 0·06% and 0·06% of recruits, respectively. Evidence of past cleared and current hepatitis B infection was found in 3·63% and 0·37% of recruits, respectively. Overall, prevalence rates were broadly consistent with UK population estimates of infection. However, HIV and hepatitis B prevalence was higher in recruits of African origin than in those from the UK (P<0·0001). Screening for these infections is an option that could be considered for those entering Services from high-prevalence countries.
Cognitive-behavioral therapy (CBT) consisting of exposure and response prevention (EX/RP) is efficacious as a treatment for obsessive–compulsive disorder (OCD). However, about half of patients have a partial or poor response to EX/RP treatment. This study examined potential predictors and moderators of CBT augmentation of pharmacotherapy, to identify variables associated with a poorer response to OCD treatment.
Data were drawn from a large randomized controlled trial that compared the augmenting effects of EX/RP to stress management training (SMT; an active CBT control) among 108 participants receiving a therapeutic dose of a serotonin reuptake inhibitor (SRI). Stepwise regression was used to determine the model specification.
Pretreatment OCD severity and gender were significant moderators of outcome: severity affected SMT (but not EX/RP) outcome; and gender affected EX/RP (but not SMT) outcome. Adjusting for treatment type and pretreatment severity, significant predictors included greater co-morbidity, number of past SRI trials, and lower quality of life (QoL). Significant moderators, including their main-effects, and predictors accounted for 37.2% of the total variance in outcome, comparable to the impact of treatment type alone (R2=30.5%). These findings were replicated in the subgroup analysis of EX/RP alone (R2=55.2%).
This is the first randomized controlled study to examine moderators and predictors of CBT augmentation of SRI pharmacotherapy. Although effect sizes for individual predictors tended to be small, their combined effect was comparable to that of treatment. Thus, future research should examine whether monitoring for a combination of these risk factors and targeting them with multi-modular strategies can improve EX/RP outcome.
We observed several H ii regions in the dwarf irregular galaxy NGC 6822 using the infrared spectrograph on the Spitzer Space Telescope. Our aim is twofold: first, to examine the neon to sulfur abundance ratio in order to determine how much it may vary and whether or not, it is fairly ‘universal’; second, to discriminate and test the predicted ionizing spectral energy distribution between various stellar atmosphere models by comparing with our derivation of the ratio of fractional ionizations involving neon and sulfur. This work extends our previous similar studies of H ii regions in M83 and M33 to lower metallicities.
The efficacy of sodium hypochlorite was assessed against human immunodeficiency virus type 1 suspended in low (8% v/v) or high (80% v/v) concentrations of serum or in a high (80%) concentration of blood. In the presence of 8% serum. 100 p.p.m. available chlorine in the disinfectant test mixture inactivated 3·75 log TCID50 HIV/ml within 30 s. When the test mixture contained 80% serum. 500 p.p.m. available chlorine inactivated more than 4 log TCID50 HIV/ml in 1–2 min. Lower concentrations of available chlorine were unable to inactivate the virus completely. In the presence of 80% blood. 1000 p.p.m. available chlorine in the disinfectant test mixture was unable to inactivate 3·75 log TCID50 HIV/ml. although 2500 p.p.m. available chlorine was able to inactivate at least 1·5 log TCID50 HIV/ml. In all test mixtures, the chlorine rapidly became combined and thus less active. Our results emphasise the importance of cleaning prior to disinfection with sodium hypochlorite since it may prove to be ineffective in the presence of high levels of organic matter. In cases where prior cleaning is impossible, care must be taken to use the higher recommended concentration (a minimum of 10000 p.p.m. available chlorine).
Aperture arrays were fabricated in 1.0µm thick gold films supported on 20nm thick silicon nitride membranes. Lithographic milling strategies in gold were evaluated through the use of in-situ sectioning and high resolution SEM imaging with the UWO CrossBeam FIB/SEM. A successful strategy for producing a 250nm diameter hole with sidewalls approaching vertical is summarized.
Solar blind detectors based on AlGaN heterostructures grown on sapphire by
Molecular Beam Epitaxy and with a dielectric interference filter deposited
on the back side are demonstrated to provide record spectral selectivity.
Rejection ratios of 2 × 104, and better than 5 × 104,
measured between 280 and 320 nm, are achieved in Metal Semiconductor Metal
detectors and Schottky diodes respectively. The whole detector process is
fully compatible with low cost array fabrication.
Through-holes of diameter 35nm and larger were milled in 100nm thick silicon nitride windows by focused ion beam milling. The holes were sized to optimize capture of gold nanoparticles from a liquid suspension. The colloidal suspensions of gold particles were deposited onto the membrane and drawn through the holes by capillary forces. Efficient, single particle filling is demonstrated for both 100nm and 250nm diameter particles indicating that once a hole is filled, flow can be effectively blocked. We show that lithographically defined arrays of colloidal gold can be achieved with >98% filling.
As part of a cooperation between several TNO institutes, including TNO Prins Maurits Laboratory, recently a new initiative on nanotechnology was started. The research subjects within this initiative can be roughly divided into two areas: (1) Instrumentation for analysis and manufacture at nano-scale and (2) Nanoscale engineering techniques to create materials and components (including their applications). Currently the research at TNO Prins Maurits Laboratory is focusing on the application of reactive nanomaterials to decontaminate surfaces from e.g. bacteria or toxic chemicals, the use of plasma's to generate nanomaterials like carbon nanotubes, and the application and characterization of nanomaterials in energetic formulations (e.g. explosives, propellants and pyrotechnic compositions). In this paper results on the latter subject will be presented in more detail. Also results will be included of other research projects involved with energetic/reactive nanomaterials.
An energetic material has been routinely manufactured from nano-metric powders of aluminum (Al) and molybdenum trioxide (MoO3). When optimized, the burn-rate of these materials (∼400 m/s) exceeds that of conventional thermites (based on micron-sized powders), but is less than that of conventional explosives. Similar burn-rates around 350 m/s are measured for these “super-thermites” using n-Al powder in the size range between 30 and 90 nm in diameter (20–60 m2/g, 60–80 wt%Al) and an oxygen to fuel (O/F) mass ratio of 1.4. The burn-rate decreases when the surface area of the MoO3 is decreased from 64 to 40 m2/g, or when O/F is changed from 1.2. Thus, for each average particle diameter, there is an optimum burn-rate at an O/F ratio that depends on the wt%Al present in the material and the particle size distribution of the powder. The burn-rate is dependent on several materials and processing factors such as the quality of the nano-metric ingredients, the processing method, and exposure to air and light, so the effect of aging and environmental exposure on the individual ingredients has been investigated. The results of this powder aging study suggests that the surface area of n-MoO3 can decrease two-fold within 10–12 days, and the Al-metal content in n-Al can decrease as much as 50% over two years. Adequate handling and storage procedures must therefore be followed for the effective use of nano-metric powders and their super-thermite mixes.
Freshwater snails belonging to the genus Biomphalaria are intermediate hosts of the trematode Schistosoma mansoni in the Neotropical region and Africa. In Brazil, one subspecies and ten species of Biomphalaria have been identified: B. glabrata, B. tenagophila, B. straminea, B. occidentalis, B. peregrina, B. kuhniana, B. schrammi, B. amazonica, B. oligoza, B. intermedia and B.t. guaibensis. However, only the first three species are found naturally infected with S. mansoni. The classical identification of these planorbids is based on comparison of morphological characteristics of the shell and male and female reproductive organs, which is greatly complicated by the extensive intra-specific variation. Several molecular techniques have been used in studies on the identification, genetic structure as well as phylogenetic relationships between these groups of organisms. Using the randomly amplified polymorphic DNAs (RAPD) analysis we demonstrated that B. glabrata exhibits a remarkable degree of intra-specific polymorphism. Thus, the genetics of the snail host may be more important to the epidemiology of schistosomiasis than those of the parasite itself. Using the simple sequence repeat anchored polymerase chain reaction (SSR-PCR) in intra-populational and intra-specific studies we have demonstrated that snails belonging to the B. straminea complex (B. straminea, B. kuhniana and B. intermedia) clearly presented higher heterogeneity. Using the low stringency polymerase chain reaction (LS-PCR) technique we were able to separate B. glabrata from B. tenagophila and B. tenagophila from B. occidentalis. To separate all Brazilian Biomphalaria species we used the restriction fragment length polymorphism (PCR-RFLP) of the internal transcribed spacer region (ITS) of the DNA gene. The method also proved to be efficient for the specific identification of DNA extracted from snail eggs. Recently we have sequenced the ITS2 region for phylogenetic studies of all Biomphalaria snails from Brazil.
Factors responsible for the onset of dislocation generation in the fields of localized high stresses have been studied in LOCOS-isolated test structures by means of preferential etching, junction leakage analysis, and computer simulation. A strong correlation between densities of stacking faults and dislocations was observed in the experiments. Defect distributions also correlated to leakage currents. 2D simulations of stresses, interstitial injection, and stacking fault growth during field oxidation showed that maximum resolved shear stress in the structures did not exceed the critical level for dislocation generation and that the agglomeration of silicon interstitial atoms did not play a notable role in dislocation nucleation. Dislocation and stacking fault formation was attributed to surface mechanical damage introduced during plasma processing.