Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial.

Importance: Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives: To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants: This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions: CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master's level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures: The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder-7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire-8. Results: The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, -2.5; 95% CI, -4.5 to -0.8; P = .005) and 3 month (mean difference, -2.3; 95% CI, -4.5 to -0.8; P = .006) and 6 month (mean difference, -3.2; 95% CI, -4.5 to -0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance: In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02700009.

Comparing the detection of iron-based pottery pigment on a carbon-coated sherd by SEM-EDS and by Micro-XRF-SEM.

The same sherd was analyzed using a scanning electron microscope with energy dispersive spectroscopy (SEM-EDS) and a micro X-ray fluorescence tube attached to a scanning electron microscope (Micro-XRF-SEM) to compare the effectiveness of elemental detection of iron-based pigment. To enhance SEM-EDS mapping, the sherd was carbon coated. The carbon coating was not required to produce Micro-XRF-SEM maps but was applied to maintain an unbiased comparison between the systems. The Micro-XRF-SEM analysis was capable of lower limits of detection than that of the SEM-EDS system, and therefore the Micro-XRF-SEM system could produce elemental maps of elements not easily detected by SEM-EDS mapping systems. Because SEM-EDS and Micro-XRF-SEM have been used for imaging and chemical analysis of biological samples, this comparison of the detection systems should be useful to biologists, especially those involved in bone or tooth (hard tissue) analysis.

Understanding E. coli internalization in lettuce leaves for optimization of irradiation treatment.

Irradiation penetrates food tissues and effectively reduces the number of food microorganisms in fresh produce, but the efficacy of the process against internalized bacteria is unknown. The objective of this study was to understand the mechanisms of pathogen colonization of plants relative to lettuce leaf structures so that radiation treatment of fresh leafy vegetables can be optimized. Leaves of iceberg, Boston, green leaf, and red leaf lettuces were cut into pieces, submerged in a cocktail mixture of two isolates of Escherichia coli (Rifampicin resistant), and subjected to a vacuum perfusion process to force the bacterial cells into the intercellular spaces in the leaves. Sixty bags containing 20g of lettuce each were tested. The inoculated leaves were gamma irradiated (Lanthanum-140, 0.16kGy/h) at 0.25-1.0-kGy (surface dose values), with increments of 0.25kGy at 15 degrees C. Microbial analysis was performed right after irradiation, including non-irradiated leaf pieces (controls). A dose uniformity ratio (max/min dose) of 2.8 was set to confirm the effect of non-uniform dose distribution. Calculated D(10)-values varied between 48 and 62% based on the dose distribution from the entrance dose. However, despite the subtle differences in composition and structure among the four lettuce varieties, the D(10)-values were not significantly different. Irradiation up to 1.0-kGy resulted in 3-4-log reduction of internalized E. coli on the lettuce leaves. The SEM images suggest that the contamination sites of pathogens in leafy vegetables are mainly localized on crevices and into the stomata. This study shows that irradiation effectively reduces viable E. coli cells internalized in lettuce, and decontamination is not influenced by lettuce variety. Ionizing irradiation effectively reduced the population of internalized pathogen in a dose-dependent manner and could be used as an effective killing step to mitigate the risk of foodborne disease outbreaks.

Preparticipation cardiovascular screening in young athletes: current guidelines and dilemmas.

How to best screen athletes for conditions predisposing to sudden cardiac death is a topic of debate. The European Society of Cardiology and International Olympic Committee recently endorsed a standardized screening evaluation modeled after the successful Italian system, which utilizes a 12-lead electrocardiogram (ECG) along with a detailed history and physical exam. The ECG increases the power of the history and physical exam to detect underlying causes of sudden cardiac death. In 2007, the American Heart Association (AHA) panel recommended against implementation of such a system in the United States because of a lack of current infrastructure, providers, and expertise. The lack of standardization of the current cardiovascular screening system in the United States hinders its effectiveness and prevents systematic evaluation. The AHA strongly recommends establishing a national standard for cardiovascular screening as well as a certification process for non-physicians who perform screening exams. Well designed studies are needed in the U.S. to demonstrate the effectiveness of the ECG for identifying underlying cardiovascular abnormalities in young athletes.