Self-guided online cognitive behavioural therapy for insomnia: A naturalistic evaluation in patients with potential psychiatric comorbidities.

BACKGROUND: Insomnia is the most prevalent sleep disorder worldwide, and regularly co-occurs with anxiety and depression. Cognitive behavioural therapy is the gold standard treatment for insomnia (CBT-I), however demand for treatment providers drastically exceeds supply. Internet-delivered programs for insomnia (iCBT-I) improve treatment access. However the effects of unguided iCBT-I for individuals with comorbidities within a naturalistic setting remains unexplored. We developed a novel unguided iCBT-I program and evaluated its impact on insomnia, psychological distress, and wellbeing when accessed by the public. METHODS: 317 participants experiencing insomnia for over 3 months enrolled in the program. The program consisted of 4 lessons delivered online with automated web support. Insomnia symptoms, psychological distress, and general wellbeing were assessed at lesson 1 and 4. Intention-to-treat linear mixed models were used to examine effects on insomnia, distress, and wellbeing. RESULTS: Participants experienced large (g = 1.11) and significant reductions in insomnia, moderate (g = 0.55) and significant reductions in distress, and small (g = 0.37) but significant improvements in wellbeing. 65% of participants who reported pre-treatment insomnia severity at clinical levels remitted following treatment. LIMITATIONS: To examine the program in a naturalistic setting, we did not employ a control group or follow participants beyond the completion of treatment. CONCLUSIONS: Unguided iCBT-I is effective for individuals in the community who experience insomnia and are likely experiencing comorbid mental health problems. These effects in the absence of guided contact strengthen the utility of unguided iCBT-I as a scalable and cost-effective method of disseminating treatments for this disorder.

Production of cryoprecipitate of intermediate purity in a closed system thaw-siphon process.

The thaw-siphon procedure for routine production of cryoprecipitate is described briefly, and also its extension to a reproducible procedure for production of cryoprecipitates of intermediate purity. For the latter, the average yield of factor VIII is 60% of that in the prefrozen plasma and approximately 30% is present in the supernatant plasma. The product contains 0.53 units of VIII: C per mg of total protein (of which about 70% is clottable). The mean value of the ratio VIII: C/VIII: RAG is about 0.7. The yield and purity of the product compare favourably with those reported for intermediate purity factor VIII concentrates produced by large-scale plasma fractionation laboratories. The procedure offers an alternative pathway to the production of factor VIII concentrate of intermediate purity and can be operated in any blood bank with a minimum of equipment.

Sensitivities of radioimmunoassay and enzyme-linked immunosorbent assay for detection of hepatitis B surface antigen.

Radioimmunoassay (RIA) using Austria II (Abbott) was found to be more sensitive for the detection of HBsAg than the Hepanostika Micro-Elisa system (Organon Teknika), by a factor of 5- to 20-fold for subtype 'ad' (with one exception), and 2- to 5-fold for subtype 'ay'. The sensitivities of RIA and the enzyme-linked immunosorbent assay (Elisa) have also been evaluated in the screening of 178 selected serum samples contributed by 7 different laboratories. Of these, 149 were found to be positive for HBsAg by RIA, 142 were positive by Elisa and 36 were positive by CEP.

Thaw-siphon technique for production of cryoprecipitate concentrate of factor VIII.

Plasma, which has been deep-frozen in plastic packs as flat slabs, is thawed in a 3-5 degrees C water-bath, and allowed to siphon continually into an attached satellite pack external to the bath. This thaw-siphon procedure is completed within 55-65 min and the cryoprecipitate, retained in the residual 25 ml of frozen plasma, contains 70-100% of the original plasma factor VIII. Clinical observations in haemophilic patients treated with these cryoprecipitates, have confirmed that the higher in-vitro content of factor VIII is associated with enhanced in-vivo effectiveness.