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Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression:The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial
Get PDFIMPORTANCE: Depression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required.OBJECTIVE: To determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH.DESIGN, SETTING, AND PARTICIPANTS: This was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021.INTERVENTIONS: Participants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner.MAIN OUTCOMES AND MEASURES: The preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked.RESULTS: Of 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of -1.5 PHQ-9 points (95% CI, -2.6 to -0.4; P = .009; d = -0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related.CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services.TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN13495752.</p
A mixed method, phase 2 clinical evaluation of a novel device to treat postpartum haemorrhage
Get PDFBackgroundWe evaluated the safety, efficacy, and acceptability of a new device designed to facilitate uterine compression in women with postpartum haemorrhage (PPH).MethodsA prospective, phase two clinical device trial with concurrent qualitative study, conducted in a UK consultant obstetric unit. The device was used in addition to standard care in women unresponsive to initial oxytocin therapy. The primary effectiveness outcome was additional blood loss of over 1000mls, whilst safety was assessed through adverse events. Interviews assessed device feasibility and acceptability, and were analysed using framework analysis.ResultsWe recruited 57 women with clinical PPH after vaginal birth; 67% were primiparous and 47% had undergone operative birth. All but two (96%) had atony as a cause of the haemorrhage; in addition, 30% also had bleeding from lacerations and 11% had retained tissue.After device use, only one woman had additional blood loss over 1000mls, although 3 women (7%) needed a Bakri balloon and 14% received a blood transfusion. All but one clinician felt that the device was easy to use. Clinicians stated that the device assisted management in 85% of cases. All 56 women who responded stated that if they bled in a future birth they would want the device to be used again.There were no serious adverse events related to the device. However, 3 events were judged as ‘possibly’ being caused by the device − 2 minor vaginal grazes and one postnatal episiotomy infection and breakdown. Lax vaginal tissue complicated the use of the device in three women. In 47 interviews, participants, birth partners, clinician users and attending midwives viewed the device positively. Clinicians found it useful as a way of stopping blood loss and as an aid to diagnose the source of bleeding.ConclusionsThe PPH Butterfly may provide a rapid, acceptable and effective treatment for postpartum haemorrhage. Clinical Trial Registration prospective with ISRCTN15452399 11/09/2017 (www.isrctn.com/ISRCTN15452399)
Enrichment of Chromium at Grain Boundaries in Chromia Doped UO2
Get PDFAssessment of grain boundaries in chromia (Cr2O3) doped fuels has been carried out using high resolution transmission electron microscopy to assess the structure compared to undoped fuel produced via the same process. Chemical analysis of the grain boundary was carried out using Energy Dispersive X-ray Spectroscopy (EDS). It was shown that a relatively disordered phase is formed along the grain boundaries in the doped fuel and that they were chemically enriched in chromium. This has implications for the prediction and understanding of fuel manufacture and in-reactor behaviour as many processes are highly dependant on grain boundary mechanisms
Characterizing the Marine Energy Test Area (META) in Wales, UK
Get PDFWith lack of convergence on any single wave or tidal technology, test centres have a unique role in the marine renewable energy industry. Test centres facilitate real testing at sea for devices and components at various TRLs (Technology Readiness Level), reducing the time, cost, and risks faced by marine energy developers. META (Marine Energy Test Area) is a £2.7M project managed by Marine Energy Wales (MEW), consisting of eight test areas in the Milford Haven Waterway and surrounding waters (Pembrokeshire, Wales). Although various datasets have been collected from the META test areas over the last decade, and some aspects of these data have been published in various reports, the data has not been gathered together, systematically analyzed and critically assessed – the aim of this study. Here, we describe and interpret the various META datasets, including multibeam, ADCP (acoustic Doppler current profiler), and wave buoy data. We report the key parameters of relevance to testing at META, including bathymetry, the nature and magnitude of the tidal currents, turbulence, and wave climates. We make recommendations on future priorities for data collection at META, and discuss the future of the test areas, including expansion into floating wind and other evolving marine energy technologies
Tree species richness increases spatial variation but not overall wood decomposition
Get PDFEmpirical evidence for the positive relationship between tree species richness and wood decomposition is weak, despite the greater numbers of decomposers in diverse stands. Tree species identity affects decomposition rates strongly by altering soil communities and micro-environments. It is therefore likely that tree species richness influences spatial variation rather than the mean rate of decomposition. We used a neighbourhood approach to test this hypothesis by quantifying decomposition rates and decomposer activities within deadwood, whilst measuring the surrounding micro-environments.Using the BEF-China experimental platform, we placed three fine branches from seven tree species across richness gradients for one and two years. As expected, plot species richness increased the spatial variation of wood decomposition of three species but decreased the mean rate of wood decomposition of two species. Neighbourhood trees altered wood decomposition in two ways. First, increasing amounts of leaf tannins reduced termite activities and the number of fungal fruitbodies. Second, higher species richness increased tree volumes and thus cooled the understory, which reduced the occurrence and feeding intensity of ectothermic termites. Neighbourhood species richness showed positive effects on decomposer activities (i.e. termite occurrence, fruitbody number and mycelium cover) after two years, probably by weakening resource limitation of deadwood biomass and increasing the stages of decay. Neighbourhood metrics had comparable (after 1 year) and even stronger effects (after 2 years) on decomposer activities than wood traits. Our study reveals that tree species richness promotes spatial variation in wood decomposition rates by enhancing environmental heterogeneity. Our results explain how young regenerating species-rich forests, where termites are the dominant decomposers, can maintain deadwood stocks and decomposer activities over relatively longer time spans.<br/
Implicit and explicit language attitudes: mapping linguistic prejudice and attitude change in England", by Robert McKenzie and Andrew McNeil
Get PDFSpillover analysis across FinTech, ESG, and renewable energy indices before and during the Russia–Ukraine war: International evidence
Get PDFThis study is epicentral to analyze the impact of the Russia–Ukraine war on the financial markets, specifically focusing on the connectedness and spillover dynamics of FinTech, Environmental, Social, and Governance (ESG), renewable energy, gold, and Morgan Stanley Capital International (MSCI) indices in developed and emerging countries. Data are collected from Thomson Reuters, ranging from May 8, 2020, to May 11, 2022, and a time-varying parameter vector autoregression (TVP-VAR) and the dynamic conditional correlation (DCC) generalized autoregressive conditional heteroskedasticity (GARCH) t-Copula (DCC-GARCH t-Copula) are used to analyze the data. The results show that FinTech, ESG, and MSCI are net transmitters in developed countries, whereas gold and renewable energy are net receivers pre- and during war periods. ESG and MSCI are net transmitters in emerging countries, while FinTech, renewable energy, and gold become net receivers in both periods. The hedging ratio sheds light on the costs and weights of efficient pair investments that might change in the context of each region and under the combined scenario. The study has important implications for merchant bankers, policymakers, investors, hedgers, and risk managers
Enhancing Security with Superlens-Enabled Laser Direct Marking of Anti-counterfeiting DotCode
Get PDFWe report a novel anti-counterfeiting laser marking technology based on superlens- assisted nanoscale marking of 2D Dotcodes, which replaces conventional TEXT or other 2D code schemes for enhanced security
Defense styles from the perspective of affective neuroscience
Get PDFTo our knowledge, no study has been carried out to observe which subcortical basic affective systems are related to which defense styles. Such a perspective may have the potential to reveal how defenses may interact with subcortical primary emotional systems (PES) and how they contribute to affect regulation. We aimed to analyze the relationship of immature, neurotic, and mature defenses with basic subcortical affects (CARE, PLAY, SEEK, SADNESS, FEAR, ANGER) within an affective neuroscientific perspective. In addition, we sought to explore the effect of psychiatric disorders in relation to PES and defenses, and observe gender effects, if any. The sample consisted of 703 university students, recruited online. The materials included the Turkish translations of the Affective Neuroscience Personality Scales (ANPS) and the Defense Style Questionnaire (DSQ). The correlations between ANPS and DSQ showed that the immature defenses increase as all negative emotions increase, whereas mature defenses increase as all positive emotions (except CARE) increase and all negative affects decrease (except ANGER). On the other hand, as neurotic defenses increase, CARE, FEAR and SADNESS simultaneously increase. Subjects who reported the presence of psychiatric disorders also reported higher FEAR, SADNESS, ANGER accompanied by higher immature defenses. Finally, male subjects reported higher immature defenses, whereas the females reported higher neurotic defenses, accompanied by higher CARE, SEEK, SADNESS, FEAR, and slightly lower PLAY. Investigating defenses through the lens of affective neuroscience offers the opportunity to link the abstract concept of defenses to increasingly well-understood neurobiology