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Clinical and cost‐effectiveness of eye movement desensitization and reprocessing for treatment and prevention of post‐traumatic stress disorder in adults: A systematic review and meta‐analysis
Get PDFThe objective was to provide up-to-date clinical and cost-effectiveness evidence investigating eye movement desensitization and reprocessing (EMDR) for treatment or prevention of adult post-traumatic stress disorder (PTSD). We conducted a systematic review of randomized controlled trials (RCTs) and cost-effectiveness studies assessing PTSD symptoms in adults, published since the NICE 2018 guidelines. EMDR was compared with trauma-focused-cognitive behavioural therapy (TF-CBT), waitlist or usual care. Six databases were searched in September 2023. Risk of bias was assessed. Data synthesis included Bayesian meta-analyses of standardized mean differences if sufficient data were available from at least three RCTs. From 2038 records, 17 studies met the eligibility criteria. One modelling-based study reported cost-effectiveness, finding EMDR the most cost-effective intervention compared to 10 others, including TF-CBT. Sixteen RCTs (n = 1031) providing clinical PTSD outcome data were identified. Most studies had small sample sizes, and all but one was at high/moderate risk of bias. Additionally, 13 RCTs from NICE 2018 guidelines contributed to meta-analyses. EMDR treatment was generally of shorter duration with a lower burden on patient time. Meta-analyses found EMDR was statistically significantly better than waitlist/usual care. There was no significant difference in treatment effect between EMDR and TF-CBT, both reported significantly improved PTSD symptoms
Impact of same day emergency care services on urgent and emergency care delivery outcomes: a systematic review
Get PDFIntroduction: Same day emergency care (SDEC) describes an ambulatory service designed to provide an alternative to ED management, reduce admission rates and improve emergency care system performance. This systematic review aimed to identify and synthesise the evidence base for SDEC and its impact on urgent and emergency healthcare delivery.
Methods: Eight bibliographic databases were searched, including: MEDLINE, EMBASE, PsycInfo, CINAHL, the Science and Social Science Citation Indices in the Web of Science Core Collection, Health Management Information Consortium, the Cochrane Library and Epistemonikos. Study selection, extraction and quality assessment were conducted independently by two reviewers. Given the clinical heterogeneity and weakness of the evidence base to determine intervention effect, a narrative synthesis was performed. Formal assessment of implementation was undertaken using the Quality Improvement Minimum Quality Criteria Set.
Results: We identified 1283 citations, with 21 publications reporting 20 evaluations (18 UK and 2 Australia). SDEC services were heterogeneous in terms of referral sources, patient selection and specialties provided. Studies were mostly single centre and compared SDEC care with alternative services (such as ED) or compared outcomes before and during SDEC implementation. Patients receiving SDEC demonstrated same-day discharge ranging from 38.3% to >92%. 30-day mortality varied between <1% and 6% (four studies). Change in 30-day ED or SDEC reattendance was not examined. A learning curve was indicated in two studies, with inappropriate or ‘rejected’ referrals reducing from 31% to 18% in one SDEC service. Where reported, triage was led by senior clinical decision-makers, however, the appropriateness of SDEC referrals was also complicated by contextual factors. Comparative evaluation, including inpatient admissions, generally favoured SDEC care, but study designs carried a high risk of bias and confounding.
Conclusions: Limited evidence suggests that implementing SDEC services is feasible and may increase same-day discharge but with variable 30-day mortality (very-low or low confidence) and unexamined change in 30-day ED or SDEC reattendance. Clinical heterogeneity and limited reporting make it difficult to characterise SDEC services. Implementation, although with varied referral criteria, proved feasible given the involvement of senior clinical decision-makers
PIEZO1 mechanical insensitivity in generalized lymphatic dysplasia with the potential for pharmacological rescue
Get PDFPIEZO1 variants have been associated with generalized lymphatic dysplasia (GLD) through mechanisms involving reduced PIEZO1 expression. Here, we report variants where the mechanism involves reduced channel mechanical sensitivity. Two of the variants encode amino acid changes in the channel’s cap structure (Ile2270Thr and Arg2335Gln), one in the ninth transmembrane helical unit (THU) below the cap (Gly1978Asp) and one in the fifth THU distant from the cap (Glu829Val). Patch-clamp studies of the cap and sub-cap variant channels revealed abolished or reduced channel mechanical sensitivity with the possibility to activate the channels and partly rescue mechanical sensitivity by the small molecule Yoda1. The potency of Yoda1 at the variant channels was less than at the wild-type channel, but chemical synthesis of Yoda1 analogs revealed a molecule with improved potency. The data suggest cases of GLD in which there is decreased channel mechanical sensitivity and the potential to reduce dysfunction pharmacologically
Glutathione oxidation in cerebrospinal fluid as a biomarker of oxidative stress in amyotrophic lateral sclerosis
Get PDF3513: ATM inhibition with AZD1390 and conventional radiotherapy in non-small cell lung cancer: interim report from the CONCORDE phase Ib trial (NCT04550104)
Get PDFGeographical storytelling: towards digital landscapes in the footsteps of Cuchlaine King
Get PDFAn information content approach is taken to producing a ‘digital description’ of a landscape utilising georeferencing within Digital Earth. A general view of the geomorphology of ‘northern England’ is used as a discussion area. Data points are geolocated using decimal latitude-longitude (dLL) that can be used as recording and search items in the literature, information landscapes, or ‘information fields’. Investigations, whether about landforms, events, sampling points, material properties, or dates, provide an ‘information set’ about geo-referenced points. Using the dLL format, such points also provide the basis for starts of transects and data points on topographic surfaces. The data sites provide an ‘information field’ about the area of interest and examples are given in the information landscape. The work of the late Cuchlaine King, physical geographer and geomorphologist, is used as examples of this information field approach by setting landforms and investigations into digitized physical landscapes. The paper also suggests ways of extending the information field idea to cover previous investigations and the possible implementation of Large Language Geographical Models in the employment of ‘big data’. The FAIR data principles of findability, accessibility, interoperability, and reusability are germane to the development of such models and their use
An overview of reliable and representative DVC measurements for musculoskeletal tissues
Get PDFMusculoskeletal tissues present complex hierarchical structures and mechanical heterogeneity across multiple length scales, making them difficult to characterise accurately. Digital volume correlation (DVC) is a non-destructive imaging technique that enables quantification of internal 3D strain fields under realistic loading conditions, offering a unique tool to investigate the biomechanics of biological tissues and biomaterials. This review highlights recent advancements in DVC, focusing on its applications across scales ranging from organ- to tissue-level mechanics in both mineralised and soft tissues. Instead of a traditional systematic review, we identify key technical challenges including the treatment of tissue interfaces, border effects, and the quantification of uncertainty in DVC outputs. Strategies for improving measurement accuracy and reliability are discussed. We also report on the increasing use of DVC in in vivo applications, its coupling with computational modelling to inform and validate biomechanical simulations, and its recent integration with data-driven methods such as deep learning to directly predict displacement and strain fields. Additionally, we examine its application in tissue engineering and implant–tissue interface assessment. By addressing such areas, we outline current limitations and emerging opportunities for future research. These include advancing precision, enabling clinical translation, and leveraging machine learning to create more robust, automated, and predictive DVC workflows for musculoskeletal health and tissue engineering
Paediatric cranial ultrasound: abnormalities of the brain in term neonates and young infants
Get PDFCranial ultrasound is a critical screening tool in the detection of cerebral abnormalities in term neonates and infants, and is complementary to other imaging modalities. This pictorial review illustrates the diverse central nervous system pathologies which can affect the term neonatal and infantile brain, including vascular abnormalities (hypoxic ischaemic injury, perinatal arterial ischaemic stroke, cerebral sinovenous thrombosis, vein of Galen aneurysmal malformations, subpial haemorrhage, and dural sinus malformations); infections (congenital (cytomegalovirus and toxoplasmosis) and bacterial meningoencephalitis); genetic disorders and malformations (callosal agenesis, tuberous sclerosis, developmental megalencephaly, lissencephaly-pachygyria, and grey matter heterotopia); tumours (choroid plexus papilloma, atypical teratoid/rhabdoid tumour, and desmoplastic infantile glioma) and trauma (birth-related, inflicted injury). Each condition is explored with a focus on its sonographic characteristics—some have rarely, if ever, been described on ultrasound
Sedimentary controls on arsenic distribution in meander-belt deposits of the Po Valley, Italy
Get PDFGeogenic arsenic in soils and aquifers is a threat to public health, which can be mitigated by improving our understanding of arsenic distribution in natural environments. In alluvial plains traversed by meandering rivers, solid- and aqueous-phase arsenic concentrations tend to vary across sedimentary deposits accumulated by different processes linked to river morphodynamics: mud-prone and commonly organic-rich abandoned-channel fills arising from meander cut-off act as local sources of arsenic, which can be transferred to adjacent point-bar deposits related to meander growth. Meanwhile, spatial variability in arsenic contamination may also arise from variations in sediment provenance across a fluvial landscape, and from inherent downstream changes in a fluvial system. Yet, the relative importance of facies and provenance as controls on arsenic concentrations in fluvial sediments still needs to be assessed. Through integrated analyses of geomorphological, sedimentological and geochemical data, this study examines the spatial variability in arsenic distribution from deposits of the late Holocene channel belt of the Po River, Italy. Three study areas were investigated along a >100 km stretch of channel belt to evaluate the possible roles of downstream changes in river behaviour and sediment supply from variably arsenic-rich catchments. Sedimentological controls on solid-phase arsenic concentrations are recognized at the scales of both elementary lithologies (facies) and depositional sub-environments, highlighting the roles of morphologically recognizable abandoned-channel fills as sources of arsenic that can be mobilized via groundwater flow and become trapped in point-bar elements. Although solid-phase arsenic concentrations are dominantly related to the presence of organic matter and clay, local arsenic enrichment may be related to arsenic advection across meander-belt sediments, a process that is itself controlled by petrophysical heterogeneity. No evident relationship is seen between arsenic concentrations and point-bar facies distributions related to styles of meander morphodynamic evolution. Yet, limited variability across the study areas suggests that the facies control remains dominant over a potential provenance control related to catchment integration. The results help elucidate the role of sedimentary heterogeneity in the distribution of arsenic in sediments, soils and aquifers, in the Po Valley and other analogous fluvial environments
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