Results from studies evaluating the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in humanitarian settings in low-income and middle-income ...countries have been inconsistent, showing varying results by setting and subgroup (eg, age or gender). We aimed to assess the effectiveness of these interventions, and to explore which children are likely to benefit most.
We did a systematic review and meta-analysis of individual participant data (IPD) from 3143 children recruited to 11 randomised controlled trials of focused psychosocial support interventions versus waiting list. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycArticles, Web of Science, and the main local low-income and middle-income countries (LMICs) databases according to the list of databases relevant to LMIC developed collaboratively by Cochrane and WHO Library, up to November, 2016. We included randomised controlled trials that assessed the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in LMICs, compared with waiting lists (eg, inactive controls). We excluded quasi-randomised trials, studies that did not focus on psychosocial support interventions, and studies that compared two active interventions without control conditions. We requested anonymised data from each trial for each of the prespecified variables for each child who was randomly assigned. The main outcomes considered were continuous scores in post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and anxiety symptoms assessed with rating scales administered immediately (0–4 weeks) after the intervention. We harmonised all individual items from rating scales using item response theory methods. This study is registered with PROSPERO, number CRD42013006960.
We identified a beneficial effect of focused psychosocial support interventions on PTSD symptoms (standardised mean difference SMD −0·33, 95% CI −0·52 to −0·14) that was maintained at follow-up (–0·21, −0·42 to −0·01). We also identified benefits at the endpoint for functional impairment (–0·29, −0·43 to −0·15) and for strengths: coping (–0·22, −0·43 to −0·02), hope (–0·29, −0·48 to −0·09), and social support (–0·27, −0·52 to −0·02). In IPD meta-analyses focused on age, gender, displacement status, region, and household size we found a stronger improvement in PTSD symptoms in children aged 15–18 years (–0·43, −0·63 to −0·23), in non-displaced children (–0·40, −0·52 to −0·27), and in children living in smaller households (<6 members; −0·27, −0·42 to −0·11).
Overall, focused psychosocial interventions are effective in reducing PTSD and functional impairment, and in increasing hope, coping, and social support. Future studies should focus on strengthening interventions for younger children, displaced children, and children living in larger households.
European Commission FP7th Framework Programme for Research (Marie Curie International Outgoing Fellowship) and the National Institute on Aging.
There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.
To ...develop consensus statements for all domains of DAT.
A protocol-driven, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) a consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted the consensus were strictly followed.
A total of 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and three patients, where consensus was achieved in additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low-risk disease, and the role of multiparametric magnetic resonance imaging in determining disease stage and aggressiveness as a criterion for inclusion and exclusion.
Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials.
We undertook a project aimed at standardising the elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.
The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations has developed comprehensive consensus statements for deferred active treatment for localised prostate cancer covering all domains, aimed at guiding and informing routine clinical practice and research.
Uncemented tibial components of total knee replacements have lower survival rates than cemented components. Radiostereometric analysis is a highly accurate, effective tool for investigating new ...implant designs. The purpose of this study was to compare an uncemented Trabecular Metal tibial component with a conventional cemented stemmed tibial component of the same design.
Seventy subjects undergoing total knee replacement were randomized to receive either the Trabecular Metal or the cemented tibial component. Radiostereometric analysis of micromotion of the tibial components was performed postoperatively at six, twelve, and twenty-four months, and the maximum total point motion of the implant and three-dimensional translations and rotations were recorded.
Follow-up was complete for twenty-eight subjects in the Trabecular Metal group and twenty-one subjects in the cemented group. A subset of the Trabecular Metal components migrated extensively in the postoperative period, but all stabilized by one year and the proportion considered to be at risk for early aseptic loosening was 0.0 (95% confidence interval, 0.0 to 0.12) in the group as a whole. Four cemented components were considered to be at risk for early aseptic loosening (proportion at risk, 0.19; 95% confidence interval, 0.08 to 0.4).
This study suggests that the Trabecular Metal component may be an effective alternative to the standard cemented tibial component.
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed to assess the health-related economic externalities of air pollution ...resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North seas, since special regulatory actions on sulfur emissions, called SECA (sulfur emission control area), have been introduced in these areas. We conclude that, despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem for human health. Hence the related external costs are considerable. The total health-related external costs for the whole of Europe are estimated at 803 bn euros yr−1 for the year 2000, decreasing to 537 bn euros yr−1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr−1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulfur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant positive impact on human health in Europe.
An estimated 38% of US adults are obese. Obesity is associated with socioeconomic disparities and increased rates of comorbidities, and is a known risk factor for development of pancreatic cancer. As ...a fourth leading cause of death in the United States, pancreatic cancer is commonly treated with a pancreatico-duodenectomy (PD), or Whipple procedure. Data regarding the effects of obesity on post-operative complication rate primarily comes from specialized centers, however the results are mixed. Our aim is to elucidate the effects that obesity has on outcomes after PD for pancreatic head cancer using a national prospectively maintained clinical database.
The 2010–2015 American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Files (PUF) were used as the data source. We identified cases in which PD was performed (CPT code 48150) in the setting of a postoperative diagnosis of pancreatic cancer (ICD9 code 157.0). We excluded cases that had emergency admissions, BMI ≤18.5 kg/m2, intraoperative wound classification of III or IV, and disseminated cancer. Cases with missing BMI, preoperative albumin, operative time, LOS data were also excluded. Multiple imputation for missing sex, race, functional status, and ASA classification using chained equations was performed.16 Patients that had BMI ≥30 kg/m2 were considered obese, and patients with BMI <30 kg/m2 were used as control.
3484 patients underwent pancreaticoduodenectomy for pancreatic cancer. 860 patients were identified as obese. Propensity score analysis was performed matching age, sex, race, functional status, presence of dyspnea, diabetes, hypertension, acute renal failure, dialysis dependence, ascites, steroid use, bleeding disorders, history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), weight loss, American Society of Anesthesiologists (ASA) classification, and preoperative albumin levels. After matching, obese patients had higher risk of 30-day postoperative complications compared to control, including organ space wound infections (OR 1.38, 95% CI 1.07–1.79, p = 0.0128), returning to the operating room (OR 1.39, 95% CI 1.01–1.91, p = 0.0461), failure to extubate for greater than 48 h (OR 1.60, 95% CI 1.09–2.34, p = 0.0153), death (OR 1.68, 95% CI 1.01–2.78, p = 0.0453), septic shock (OR 2.22, 95% CI 1.46–3.38, p = 0.0002), pulmonary embolism (OR 2.42, 95% CI 1.07–5.45, p = 0.0332), renal insufficiency (OR 2.67, 95% CI 1.33–5.38, p = 0.0058). Sensitivity analysis yielded similar results with the exception of risk for return to the operating room, death, and pulmonary embolism, P > .05.
In this large observational study using a national clinical database, obese patients undergoing PD for head of pancreas cancer had increased risk of postoperative complications and mortality in comparison to controls.
•Large observational study based on national clinical database comparing outcomes of obese patients undergoing Whipple procedure.•Obesity linked to decreased survival following Whipple procedure.•Obesity in patients undergoing Whipple procedure for malignancy is associated with increased risk of major postoperative complications.
This in vivo study evaluated the influence of the sequence of all restorative steps during Class V preparation and restoration in human premolars on pulp temperature (PT).
Intact premolars with ...orthodontic extraction indication of 13 volunteers received infiltrative anesthesia and isolation with rubber dam. An occlusal preparation was made with a high-speed diamond bur under air-water spray until the pulp was minimally exposed, then a thermocouple probe was inserted within the pulp. A deep, 2.0-mm depth Class V preparation was made using a high-speed diamond bur under air-water spray. Three restorative techniques were performed (n=7): Filtek Z250 placed in two increments (10-second exposure, shade:A2, 3M ESPE, St. Paul, MN, USA), Filtek Z350 XT (40-second exposure, shade:A3D, 3M ESPE) and Tetric N Ceram Bulk Fill (10-second exposure, shade:IVA, Ivoclar Vivadent, Schaan, Liechtenstein), both placed in a single layer. Bonding layer and resin composite were exposed to light from the same Polywave LCU (Bluephase 20i, Ivoclar Vivadent). The peak PT and the difference between peak PT and baseline (ΔT) values were subjected to two-way, repeated measures analysis of variance (ANOVA), followed by the Bonferroni post-hoc test (α=0.05).
Cavity preparation and etch & rinse procedures decreased the PT values (p<0.001). The 40-second exposure of Filtek Z350 caused the highest peak PT values (38.7±0.8°C) and the highest ΔT values (3.4±0.8°C), while Tetric N Ceram Bulk Fill showed the lowest values (-1.6±1.3°C; p=0.009).
None of the evaluated procedures resulted in a PT rise near to values that could offer any risk of thermal damage to the pulp.
The Danish Eulerian Hemispheric Model (DEHM) is a 3D long-range atmospheric chemistry-transport model with a horizontal domain covering the Northern Hemisphere. For the AQMEII (Air Quality Modelling ...Evaluation International Initiative) inter-comparison exercise, the model was set up with two two-way nested domains simultaneously – one covering Europe and one covering North America. In this paper, the model configuration used in AQMEII will be described, including a discussion of model results and evaluation for the year 2006 against available measurements in Europe for different chemical species. The evaluation of DEHM for Europe shows that the model gives satisfying results for species such as ozone, nitrogen-dioxide, sulphur-dioxide and secondary inorganic aerosols. The evaluation also points to certain processes where DEHM can be improved, such as biogenic emissions of isoprene, mass closure for particulate matter, wet deposition, and description of vertical mixing during winter. Furthermore, special attention is given to the intercontinental transport of air pollution between North America (NA) and Europe (EU). We estimate the contributions to the total air pollution levels at continental scale from the anthropogenic emissions in the two areas, with a focus on ozone and particulate matter using a tagging method, taking into account the non-linear effects of atmospheric chemistry. We conclude that for this specific year, the intercontinental transport between NA and EU is small for the annual or seasonal mean values – for ozone the contributions are typically around 3% (∼1 ppb) from NA to EU and around 1% (∼0.3 ppb) from EU to NA. For particles the contributions from NA to EU is around 0.9% (∼0.05 μg m−3) and from EU to NA around 1.4% (∼0.05 μg m−3).
► We model the air pollution in North America and Europe for the year 2006 using DEHM. ► We evaluate the model results against measurements for Europe for all available species. ► The evaluation leads to conclusions on where to improve the model. ► We calculated the intercontinental transport of air pollution between North America and Europe. ► We found that the exchange of air pollution between the two continents is small on the annual basis.
SignificanceThe modulation of growth hormone secretagogue receptor-1a (GHSR
) signaling is a promising strategy for treating brain conditions of metabolism, aging, and addiction. GHSR
activation ...results in pleiotropic physiological outcomes through distinct and pharmacologically separable G protein- and β-arrestin (βarr)-dependent signaling pathways. Thus, pathway-selective modulation can enable improved pharmacotherapeutics that can promote therapeutic efficacy while mitigating side effects. Here, we describe the discovery of a brain-penetrant small molecule, N8279 (NCATS-SM8864), that biases GHSR
conformations toward Gα
activation and reduces aberrant dopaminergic behavior in mice. N8279 represents a promising chemical scaffold to advance the development of better treatments for GHSR
-related brain disorders involving the pathological dysregulation of dopamine.
Honeybees
Apis mellifera
(European honeybee) and
Apis cerana
(Asian honeybee) are cosmopolitan, having colonized continents beyond their natural ranges. In tropical Australia, these alien species ...have recently become sympatric. The environmental and economic impacts of these species when in sympatry remain to be seen; however, any interspecific competition may be of significance. We examined conspecific and heterospecific interactions between honeybees foraging at the nectar- and pollen-providing flowers of
Antipogon leptopus
(Polygonaceae). We cross-classified 554 encounters by three variables; incoming bee species, resident bee species, and one of four potential responses: (1) incoming defers to resident; (2) incoming procures the flower from resident; (3) incoming and resident share the flower; or (4) both incoming and resident abandon the flower. We also measured aggression and foraging rates of workers at flowers. Both species visited similar numbers of flowers in a foraging bout and spent similar foraging times on individual flowers. Incoming
A. mellifera
were more likely to procure flowers from resident
A. cerana
, and incoming
A. cerana
were more likely to defer to resident
A. mellifera
.
A. mellifera
were more aggressive toward heterospecifics than conspecifics, with heterospecifics 4.5 times more likely to provoke an aggressive response. However, no significant difference between conspecific and heterospecific aggression was observed for incoming
A. cerana
.
A. mellifera
were less abundant, yet overall more likely to acquire flowers and use aggression to do so. Costs of aggression may help explain the population-scale dominance of
A. cerana
over
A. mellifera
in this study.
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