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Implementation of perinatal collaborative care: a health services approach to perinatal depression care
Emily S. Miller, Rebekah Jensen, M. Camille Hoffman, Lauren M. Osborne, Katherine McEvoy, Nancy Grote, Eydie L. Moses-Kolko
Journal: Primary Health Care Research & Development / Volume 21 / 2020
Published online by Cambridge University Press: 10 September 2020, e30
Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation.
Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base.
Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic.
The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.
Effect of various decontamination procedures on disposable N95 mask integrity and SARS-CoV-2 infectivity
Jeffrey S. Smith, Haley Hanseler, John Welle, Rogan Rattray, Mary Campbell, Tacy Brotherton, Tarsem Moudgil, Thomas F. Pack, Keith Wegmann, Shawn Jensen, Justin Jin, Carlo B. Bifulco, Scott A. Prahl, Bernard A. Fox, Nicholas L. Stucky
Journal: Journal of Clinical and Translational Science , First View
Published online by Cambridge University Press: 11 June 2020, pp. 1-5
The COVID-19 pandemic has created a high demand on personal protective equipment, including disposable N95 masks. Given the need for mask reuse, we tested the feasibility of vaporized hydrogen peroxide (VHP), ultraviolet light (UV), and ethanol decontamination strategies on N95 mask integrity and the ability to remove the infectious potential of SARS-CoV-2.
Disposable N95 masks, including medical grade (1860, 1870+) and industrial grade (8511) masks, were treated by VHP, UV, and ethanol decontamination. Mask degradation was tested using a quantitative respirator fit testing. Pooled clinical samples of SARS-CoV-2 were applied to mask samples, treated, and then either sent immediately for real-time reverse transcriptase–polymerase chain reaction (RT-PCR) or incubated with Vero E6 cells to assess for virucidal effect.
Both ethanol and UV decontamination showed functional degradation to different degrees while VHP treatment showed no significant change after two treatments. We also report a single SARS-CoV-2 virucidal experiment using Vero E6 cell infection in which only ethanol treatment eliminated detectable SARS-CoV-2 RNA.
We hope our data will guide further research for evidenced-based decisions for disposable N95 mask reuse and help protect caregivers from SARS-CoV-2 and other pathogens.
FOSTERING PROTOTYPING MINDSETS IN NOVICE DESIGNERS WITH THE PROTOTYPING PLANNER
C. A. Hansen, L. S. Jensen, A. G. Özkil, N. M. Martins Pacheco
Journal: Proceedings of the Design Society: DESIGN Conference / Volume 1 / May 2020
Published online by Cambridge University Press: 11 June 2020, pp. 1725-1734
Prototyping is an essential activity in product development, but novice designers lack awareness and purpose when they prototype. To foster prototyping mindsets in novice designers, we introduce a prototyping support tool that structures prototyping activities. This paper outlines the Prototyping Planner's development, evolution, and evaluation by 125 novice designers. The majority of novice designers' experienced that the Prototyping Planner helped them create purposeful prototypes and evaluate results from prototyping.
U–Pb dating of calcite in ancient carbonates for age estimates of syn- to post-depositional processes: a case study from the upper Ediacaran strata of Finnmark, Arctic Norway
Guido Meinhold, Nick M. W. Roberts, Arzu Arslan, Sören Jensen, Jan Ove R. Ebbestad, Anette E. S. Högström, Magne Høyberget, Heda Agić, Teodoro Palacios, Wendy L. Taylor
Journal: Geological Magazine / Volume 157 / Issue 8 / August 2020
Results of in situ U–Pb dating of calcite spherulites, cone-in-cone (CIC) calcite and calcite fibres from a calcareous concretion of the upper Ediacaran of Finnmark, Arctic Norway, are reported. Calcite spherulites from the innermost layers of the concretion yielded a lower intercept age of 563 ± 70 Ma, which, although imprecise, is within uncertainty of the age of sedimentation based on fossil assemblages. Non-deformed CIC calcite from the bottom part of the concretion yielded an age of 475 ± 25 Ma, which is interpreted as the age of CIC calcite formation during a period of fluid overpressure induced during burial of the sediments. Deformed CIC calcite from the top part of the concretion yielded an age of 418 ± 23 Ma, which overlaps with a known Caledonian tectono-metamorphic event, and indicates a potential post-depositional overprint at this time. Calcite fibres that grew in small fissures along spherulite rims, which are interpreted as a recrystallization feature during deformation and formation of a cleavage, gave an imprecise age of 486 ± 161 Ma. Our results show that U–Pb dating of calcite can provide age constraints for ancient carbonates and syn- to post-depositional processes that operated during burial and metamorphic overprinting.
Acritarchs from the Duolbagáisá Formation (Cambrian Series 2, Miaolingian) on the Digermulen Peninsula, Finnmark, Arctic Norway: towards a high-resolution Cambrian chronostratigraphy
Teodoro Palacios, Anette E. S. Högström, Jan Ove R. Ebbestad, Heda Agić, Magne Høyberget, Sören Jensen, Guido Meinhold, Wendy L. Taylor
Journal: Geological Magazine / Volume 157 / Issue 12 / December 2020
Published online by Cambridge University Press: 24 April 2020, pp. 2051-2066
New information on acritarchs from the Duolbagáisá Formation, Digermulen Peninsula, Arctic Norway, enable recognition of the three Cambrian Series 2 acritarch-based zones: the Skiagia ornata–Fimbriaglomerella membranacea, Heliosphaeridium dissimilare–Skiagia ciliosa and Volkovia dentifera–Liepaina plana Assemblage zones. Acritarchs of the Skiagia ornata–Fimbriaglomerella membranacea Zone (Cambrian Stage 3) appear near the base of the unit, close to an undetermined trilobite. In the Upper Member of the Duolbagáisá Formation, in levels with Kjerulfia n. sp. and Elliptocephala n. sp., appears an assemblage with abundant Skiagia ciliosa, indicative of the Heliosphaeridium dissimilare–Skiagia ciliosa Zone. A few metres higher appear Liepaina plana, Heliosphaeridium notatum and Retisphaeridium dichamerum, which indicate the Volkovia dentifera–Liepaina plana Zone (Cambrian Stage 4). The transition between the Duolbagáisá Formation and the overlying Kistedalen Formation is marked by the appearance of Comasphaeridium longispinosum, Multiplicisphaeridium llynense and Eliasum llaniscum, diagnostic of the Miaolingian Series. This coincides with the disappearance of Skiagia; occurrences of Skiagia in Miaolingian strata consist of reworked material related to the Hawke Bay regression at the Cambrian Stage 4–Wuliuan transition. The absence of Skiagia in higher levels of the Duolbagáisá Formation and Kistedalen Formation suggests that no unconformity formed during the Hawke Bay regression in this area. The chronostratigraphical significance of the Skiagia ornata–Fimbriaglomerella membranacea, Heliosphaeridium dissimilare–Skiagia ciliosa and Volkovia dentifera–Liepaina plana zones is critically analysed. Correlation of the Duolbagáisá Formation with peri-Gondwanan terrains of Avalonia and Iberia is established. The Digermulen Peninsula has great potential as a reference section for establishing a Cambrian chronostratigraphy based on acritarchs.
1800 – Improvement Of Attention Deficit Hyperactivity Disorder Management In The Primary Medical Home Through Psychiatrist-taught Psychopharmacology
L. Wegner, C. Humble, M. Domino, A. Stiles, S. Wegner, C. Kratochvil, P. Jensen
Journal: European Psychiatry / Volume 28 / Issue S1 / 2013
Published online by Cambridge University Press: 15 April 2020, p. 1
US primary care clinicians (PCCs) are increasingly assuming the medical management for psychiatric disorders. Clinical practice guidelines (PCGs) remain gold standard for professional care, yet physician adoption is not universal. We sought identification of methods to increase evidence-based mental health practices for the most commonly diagnosed pediatric behavioral condition, attention deficit hyperactivity disorder (ADHD).
Test two psychiatric interventions of different intensity levels, both designed to increase primary care clinicians' use of PCGs for managing ADHD.
Increase PCCs' use of PCGs for managing ADHD.
Participants: 70 North Carolina (NC) PCCs ; 70 case managers; 35 to 40 pediatric resident physicians; 420 pediatric government-insured patients ages 6-18 years (chart abstraction only).
Procedures: PCCs were randomized to:
(1) PCC training and follow-up support only; or
(2) PCC, case manager, and office staff training (collaborative) and follow-up support interventions.
Differences in knowledge, skills, attitudes, and ADHD assessment and treatment practices assessed by participant selfcompleted surveys at baseline, 6, and 12 months. Six of their patient charts were abstracted to determine the extent they followed American Academy of Pediatrics (AAP) treatment guidelines. NC Medicaid (government insurance) claims for children and adolescents of participating practices and a group of control practices were reviewed for diagnostic documentation.
For collaborative trained PCCs:
(1) increased use of ADHD symptom screeners and greater frequency of F/U visits;
(2) greater identification of children with ADHD, but decrease in the probability of receiving an ADHD medication
(3) lower rate of prescribing above dosing guidelines.
Detection of norovirus infections in Denmark, 2011–2018
M. R. Korcinska, K. Dalsgaard Bjerre, L. Dam Rasmussen, E. Tvenstrup Jensen, T. K. Fischer, A. Barrasa, S. Ethelberg
Journal: Epidemiology & Infection / Volume 148 / 2020
Published online by Cambridge University Press: 17 February 2020, e52
Norovirus (NoV) infections occur very frequently yet are rarely diagnosed. In Denmark, NoV infections are not under surveillance. We aimed to collect and describe existing laboratory-based NoV data. National NoV laboratory data were collected for 2011–2018, including information on patient identification number, age and sex, requesting physician, analysis date and result. We defined positive patient-episodes by using a 30-day time window and performed descriptive and time series analysis. Diagnostic methods used were assessed through a survey. We identified 15 809 patient-episodes (11%) out of 142 648 tested patients with an increasing trend, 9366 in 2011 vs. 32 260 in 2018. This corresponded with a gradual introduction of polymerase chain reaction analysis in laboratories. The highest positivity rate was in patients aged <5 years (15%) or >85 years (17%). There was a large difference in test performance over five Danish geographical regions and a marked seasonal variation with peaks from December to February. This is the first analysis of national NoV laboratory data in Denmark. A future laboratory-based surveillance system may benefit public health measures by describing trend, burden and severity of seasons and possibly pinpoint hospital outbreaks.
Effect of straw amount on feed intake and weight gain in growing pigs housed in pens with partly slatted floor
M. B. Jensen, M. S. Herskin, N. Canibe, B. Forkman, L. J. Pedersen
Journal: animal / Volume 14 / Issue 8 / August 2020
Published online by Cambridge University Press: 23 December 2019, pp. 1659-1666
The provision of straw to pigs kept in conventional pens with concrete floor improves animal welfare, but the effects of straw on pigs' performance are unclear. In two steps, we investigated the relationship between amount of straw provided to pigs and measures of performance in a set-up maintaining constant space allowance and controlled room temperature. From approximately 30- to 85-kg BW, pigs were housed in groups of 18 in pens (5.48 m × 2.48 m) with concrete floor (1/3 solid, 1/3 drained and 1/3 slatted). The pens were cleaned manually twice a week, and the designated amount of fresh uncut wheat straw was provided daily onto the solid part of the floor. In the first step, 48 pens were assigned to 10-, 500- or 1000-g straw per pig per day, while in the second step, 90 pens were assigned to 10-, 80-, 150-, 220-, 290-, 360-, 430- or 500-g straw per pig per day. Pigs were weighed at the start of the experimental period at approximately 30 kg and again at approximately 85-kg BW. The average daily gain increased 8.1 g (SEM 17) for every extra 100-g straw added daily (P < 0.001) resulting in 40 g higher average daily gain with 500 compared to 10-g straw per pig per day. The feed conversion ratio was not affected by the amount of straw provided, as the feed intake tended to be higher with increasing amounts of straw. Thus, between 10 and 500 g, the more straw provided, the higher the daily weight gain. As the nutritional value of straw is considered minimal, this result is likely due to improved gut health from the increasing amounts of straw ingested and increased feed intake due to increased stimulation of exploratory behaviour with increasing amounts of straw available, or a combination of these. The observed tendency for a higher feed intake supports this suggestion, but studies are needed to establish the impact of these two contributing factors.
An outbreak of monophasic Salmonella Typhimurium associated with raw pork sausage and other pork products, Denmark 2018–19
I. G. Helmuth, L. Espenhain, S. Ethelberg, T. Jensen, J. Kjeldgaard, E. Litrup, S. Schjørring, L. Müller
Published online by Cambridge University Press: 09 December 2019, e315
In Denmark, outbreaks of salmonella with more than 20 cases have become rare. In November 2018, an outbreak of monophasic Salmonella Typhimurium was detected and an investigation initiated with the aim of identifying the source and controlling the outbreak. Outbreak cases were defined based on core genome multilocus sequence types. We conducted hypothesis-generating interviews, a matched case-control study, food sampling and trace-back investigations. We identified 49 cases distributed across Denmark. In univariable analyses a traditional form of raw Danish pork sausage (medister sausage), pork chops and ground veal/pork showed matched odds ratio of 26 (95% CI 3–207), 4 (95% CI 1–13) and 4 (95% CI 1–10), respectively. In a multivariable analysis, only medister sausage remained significant. Several patients described tasting or eating the sausage raw or undercooked. Samples of medister sausage analysed were negative for salmonella and investigations at the production site did not reveal the mechanism of contamination. In conclusion, in spite of having eliminated salmonella in the egg and broiler industry, Denmark is still at risk of major salmonella outbreaks. We identified a raw pork sausage as a particular risk product that needs to be thoroughly cooked before consumption. Tasting raw meat or eating undercooked pork should be discouraged.
The Triage of Older Adults with Physiologic Markers of Serious Injury Using a State-Wide Prehospital Plan
Matthew H. Meyers, Trent L. Wei, Julianne M. Cyr, Thomas M. Hunold, Frances S. Shofer, Christopher S. Cowden, Chailee F. Moss, Christopher E. Jensen, Timothy F. Platts-Mills, Jane H. Brice
Journal: Prehospital and Disaster Medicine / Volume 34 / Issue 5 / October 2019
Published online by Cambridge University Press: 13 September 2019, pp. 497-505
Print publication: October 2019
In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
Hypothesis/Problem:
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP's physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
Laboratory evidence for the formation of hydrogenated fullerene molecules
J. D. Thrower, G. Pantazidis, M. Scheffler, F. D. S. Simonsen, P. A. Jensen, L. Hornekær
Journal: Proceedings of the International Astronomical Union / Volume 15 / Issue S350 / April 2019
Print publication: April 2019
Experimental evidence for the formation of hydrogenated fullerene molecules is presented. Films of C60 were grown on a highly oriented pyrolytic graphite (substrate) and exposed to a beam of deuterium atoms. Thermal desorption combined with mass spectrometry was used to determine the deuterated fullerene products formed, revealing a maximum degree of deuteration corresponding to C60D36. Release of D2 from the deuterated C60 film occurs at a much higher temperature than for D-saturated graphite.
Deuteration of C60 on a highly oriented pyrolytic graphite surface
G. Pantazidis, M. Scheffler, F. D. S. Simonsen, A. Cassidy, P. A. Jensen, L. Hornekær, J. D. Thrower
Reactions on carbonaceous surfaces play an important role in processes such as H2 formation in the interstellar medium. We have investigated the adsorption of C2 molecules on a highly oriented pyrolytic graphite (HOPG) surface and then exposed them to a beam of deuterium atoms in order to investigate the formation of deuterated fullerenes. Scanning tunneling microscopy (STM) was used to probe the adsorbed molecules and their deuteration. Deuteration of C2 films results in increased thermal stability of the film, relative to films of pristine C2, along with an evolution towards higher deuterated species. The STM data provide confirmatory evidence for the formation of deuterated fullerene species.
Digestibility of fractionated green biomass as protein source for monogastric animals
L. Stødkilde, V. K. Damborg, H. Jørgensen, H. N. Lærke, S. K. Jensen
Journal: animal / Volume 13 / Issue 9 / September 2019
Published online by Cambridge University Press: 18 February 2019, pp. 1817-1825
Globally, there is an increased demand for sustainable protein sources for animal feed. Grass and forage legumes have the yield potential to become such alternatives, but the protein needs to be separated from the fibres. Red clover, white clover, lucerne and perennial ryegrass were fractionated into a green juice and a fibrous pulp in a screw-press and protein was subsequently precipitated. The nitrogen (N) and amino acid composition of the produced fractions was analysed and the digestibility of dry matter (DM) and N was evaluated using a rat digestibility trial. The aim was to determine the effect of fractionation on composition and digestibility in order to evaluate the four plants as potential protein sources for monogastrics. Protein concentrates with CP concentrations of 240 to 388 g/kg DM and fibrous pulps with CP concentrations of 111 to 216 g/kg DM were produced. The sum of all analysed amino acids was highest in the protein concentrates corresponding to a low concentration of non-protein nitrogen ranging from 4.9% to 10.4%. Only small variations were seen in the amino acid compositions of the different plants and fractions. The concentration of the essential lysine and methionine in the protein concentrate ranged from 6.27 to 6.67 g/16 g N and 1.54 to 2.09 g/16 g N for lysine and methionine, respectively. For all plants species, total tract digestibility of DM and standardised N digestibility was significantly higher in the protein concentrates (60.8% to 76.5% and 75.4% to 85.0% for DM and N, respectively) compared to pulp (21.2% to 43.4% and 52.1% to 72.5% for DM and N, respectively). Digestibility of lucerne protein concentrate (76.5% and 85.0% for DM and N, respectively) was higher than of the unprocessed plant (39.6% and 74.9% for DM and N, respectively), whereas for red and white clover no difference was found. The amino acids methionine and cysteine were limiting for pigs and broilers in all fractions regardless of plant origin, and low scores were also found for lysine. The study demonstrated great potential of using green plants as a protein source for monogastrics because of high protein content, balanced amino acid composition and high digestibility of DM and N. The effects of processing and protein precipitation were pronounced in lucerne where significantly improved digestibility was observed in the protein concentrate. The results from the study provide valuable and enhanced knowledge to the production of alternative and sustainable protein sources for monogastric feed.
Bioavailability of α-tocopherol stereoisomers in lambs depends on dietary doses of all-rac- or RRR-α-tocopheryl acetate
L. N. Leal, S. K. Jensen, J. M. Bello, L. A. Den Hartog, W. H. Hendriks, J. Martín-Tereso
When supplementing lamb diets with vitamin E, an equivalence factor of 1.36 is used to discriminate between RRR-α-tocopheryl acetate and all-rac-α-tocopheryl acetate. However, more recent studies suggest a need for new equivalence factors for livestock animals. The current study aimed to determine the effect of RRR- and all-rac-α-tocopheryl acetate supplementation on α-tocopherol deposition in lamb tissues. A total of 108 Rasa Aragonesa breed lambs were fed increasing amounts of all-rac-α-tocopheryl acetate (0.25, 0.5, 1.0 and 2.0 g/kg compound feed) or RRR-α-tocopheryl acetate (0.125, 0.25, 0.5 and 1.0 g/kg compound feed) by adding them to a basal diet that contained 0.025 g/kg feed of all-rac-α-tocopheryl acetate as part of the standard vitamin and mineral mixture. The diets were fed for the last 14 days before slaughtering at 25.8±1.67 kg BW. Within 20 min after slaughter samples of muscle, heart, liver, brain and spleen were frozen at −20°C until α-tocopherol analysis. Increased supplementation of either vitamin E sources led to a significant increase (P < 0.001) in α-tocopherol concentration in all tissues studied. The tissue with the highest α-tocopherol concentration was the liver followed by spleen, heart and muscle. At similar supplementation levels (0.25, 0.50 and 1.0 g/kg compound feed), α-tocopherol content in the selected tissues was not affected by α-tocopherol source. However, the ratios between RRR- and all-rac-α-tocopheryl acetate increased with the increasing α-tocopherol supplementation (at 0.25 and 1.0 g/kg compound feed), from 1.06 to 1.16 in muscle, 1.07 to 1.15 in heart, 0.91 to 0.94 in liver and 0.98 to 1.10 in spleen. The highest relative proportion of Ʃ2S (sum of SSS-, SSR-, SRS- and SRR-α-tocopherol)-configured stereoisomers was found in the liver of lambs supplemented with all-rac-α-tocopheryl acetate accounting for up to 35 to 39% of the total α-tocopherol retained, whereas the proportion of Ʃ2S-configured stereoisomers in the other tissues accounted for <14%. Increasing all-rac-α-tocopheryl acetate supplementation was also found to affect the 2R-configured stereoisomer profile in muscle, heart and spleen with increasing proportions of RRS-, RSR- and RSS- at the cost of RRR-α-tocopherol. In all tissues, the relative proportion of all non-RRR-stereoisomers in lambs receiving RRR-α-tocopheryl acetate was lower than RRR-α-tocopherol. These results confirm that the relative bioavailability of RRR- and all-rac-α-tocopheryl acetate is dose- and tissue-dependent and that a single ratio to discriminate the two sources cannot be used.
Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care - CORRIGENDUM
Heidi Frølund Pedersen, Johanne L. Agger, Lisbeth Frostholm, Jens S. Jensen, Eva Ørnbøl, Per Fink, Andreas Schröder
Journal: Psychological Medicine / Volume 48 / Issue 16 / December 2018
Published online by Cambridge University Press: 11 September 2018, p. 2804
The Maia Detector Journey: Development, Capabilities and Applications
C G Ryan, D P Siddons, R Kirkham, A J Kuczewski, P A Dunn, G De Geronimo, A. Dragone, Z Y Li, G F Moorhead, M Jensen, D J Paterson, M D de Jonge, D L Howard, R Dodanwela, G A Carini, R Beuttenmuller, D Pinelli, L Fisher, R M Hough, A Pagès, S A James, P Davey
Published online by Cambridge University Press: 01 August 2018, pp. 720-721
Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care
Journal: Psychological Medicine / Volume 49 / Issue 6 / April 2019
Psychological treatment for functional somatic syndromes (FSS) has been found moderately effective. Information on how much treatment is needed to obtain improvement is sparse. We assessed the efficacy of a brief and extended version of group-based Acceptance and Commitment Therapy (ACT) v. enhanced care (EC) for patients with multiple FSS operationalised as Bodily Distress Syndrome multi-organ type.
In a randomised controlled three-armed trial, consecutively referred patients aged 20–50 with multiple FSS were randomly assigned to either (1) EC; (2) Brief ACT: EC plus 1-day workshop and one individual consultation; or (3) Extended ACT: EC plus nine 3-h group-based sessions. Primary outcome was patient-rated overall health improvement on the five-point clinical global improvement scale 14 months after randomisation. A proportional odds model was used for the analyses.
A total of 180 patients were randomised; 60 to EC, 61 to Brief ACT, and 59 to Extended ACT. Improvement on the primary outcome after Extended ACT was significantly greater than after EC with an unadjusted OR of 2.9 [95% CI (1.4–6.2), p = 0.006]. No significant differences were found between Brief ACT and EC. Of the 18 secondary outcomes, the only significant difference found was for physical functioning in the comparison of Extended ACT with EC.
Patients rated their overall health status as more improved after Extensive ACT than after EC; however, clinically relevant secondary outcome measures did not support this finding. Discrepancies between primary and secondary outcomes in this trial are discussed.
Origin of last-glacial loess in the western Yukon-Tanana Upland, central Alaska, USA
Daniel R. Muhs, Jeffrey S. Pigati, James R. Budahn, Gary L. Skipp, E. Arthur Bettis, Britta Jensen
Journal: Quaternary Research / Volume 89 / Issue 3 / May 2018
Print publication: May 2018
Loess is widespread over Alaska, and its accumulation has traditionally been associated with glacial periods. Surprisingly, loess deposits securely dated to the last glacial period are rare in Alaska, and paleowind reconstructions for this time period are limited to inferences from dune orientations. We report a rare occurrence of loess deposits dating to the last glacial period, ~19 ka to ~12 ka, in the Yukon-Tanana Upland. Loess in this area is very coarse grained (abundant coarse silt), with decreases in particle size moving south of the Yukon River, implying that the drainage basin of this river was the main source. Geochemical data show, however, that the Tanana River valley to the south is also a likely distal source. The occurrence of last-glacial loess with sources to both the south and north is explained by both regional, synoptic-scale winds from the northeast and opposing katabatic winds that could have developed from expanded glaciers in both the Brooks Range to the north and the Alaska Range to the south. Based on a comparison with recent climate modeling for the last glacial period, seasonality of dust transport may also have played a role in bringing about contributions from both northern and southern sources.
Validation of the register-based lifetime antimicrobial usage measurement for finisher batches based on comparison with recorded antimicrobial usage at farm level
V. D. Andersen, P. Munk, L. V. de Knegt, M. S. Jensen, F. M. Aarestrup, H. Vigre
Journal: Epidemiology & Infection / Volume 146 / Issue 4 / March 2018
Published online by Cambridge University Press: 07 February 2018, pp. 515-523
Assessing the relationship between antimicrobial usage (AMU) and antimicrobial resistance (AMR) requires the accurate and precise utilisation of register data. Therefore, validation of register-based data is essential for evaluating the quality and, subsequently, the internal validity of studies based on the data.
In this study, different smoothing methods for Veterinary Medicine Statistic Program database (VetStat)-records were validated by comparing these with farm-records. Comparison between measurements included accuracy as; completeness and correctness, and precision as; a relative difference of the error, correlation with Fisher's z transformation and reliability coefficient. The most valid methods of those examined were then used in re-analyses of the abundance of AMR genes in 10 finisher batches from a previous study.
Improved accuracy was found when detailed smoothing methods were applied. Although the precision also increased, the effect was not as pronounced, as the usage estimate of all smoothing methods deviated moderately compared with the farm-registrations. Applying the most valid methods to the 10 finisher batches increased estimates of statistical model fit for aminoglycosides, lincosamides, tetracyclines and decreased estimates of statistical model fit for macrolides. The estimates of statistical model fit for sulfonamides and broad-spectrum penicillins remained the same.
Through refined data transformation, VetStat-records can be used to calculate a daily amount of AMU per pig reflecting the true usage accurately and moderately precisely, which is the foundation for calculating lifetime AMU.
The association between measurements of antimicrobial use and resistance in the faeces microbiota of finisher batches
V. D. ANDERSEN, L. V. DE KNEGT, P. MUNK, M. S. JENSEN, Y. AGERSØ, F. M. AARESTRUP, H. VIGRE
Journal: Epidemiology & Infection / Volume 145 / Issue 13 / October 2017
The objectives were to present three approaches for calculating antimicrobial (AM) use in pigs that take into account the rearing period and rearing site, and to study the association between these measurements and phenotypical resistance and abundance of resistance genes in faeces samples from 10 finisher batches. The AM use was calculated relative to the rearing period of the batches as (i) 'Finisher Unit Exposure' at unit level, (ii) 'Lifetime Exposure' at batch level and (iii) 'Herd Exposure' at herd level. A significant effect on the occurrence of tetracycline resistance measured by cultivation was identified for Lifetime Exposure for the AM class: tetracycline. Furthermore, for Lifetime Exposure for the AM classes: macrolide, broad-spectrum penicillin, sulfonamide and tetracycline use as well as Herd Unit Exposure for the AM classes: aminoglycoside, lincosamide and tetracycline use, a significant effect was observed on the occurrence of genes coding for the AM resistance classes: aminoglycoside, lincosamide, macrolide, β-lactam, sulfonamide and tetracycline. No effect was observed for Finisher Unit Exposure. Overall, the study shows that Lifetime Exposure is an efficient measurement of AM use in finisher batches, and has a significant effect on the occurrence of resistance, measured either by cultivation or metagenomics.