Assessment for vagus nerve stimulation in patients with difficult-to-treat depression: a model from the Newcastle Regional Affective Disorders Service (RADS).

BACKGROUND: Vagus nerve stimulation (VNS) has been shown to improve long-term outcomes for some patients with difficult-to-treat depression (DTD). OBJECTIVES: Set out criteria to support the identification of patients for whom VNS is a suitable treatment option. METHODS: Published clinical evidence, coupled with clinical experience garnered at the Regional Affective Disorders Service (RADS; Newcastle, UK) to inform VNS criteria. RESULTS: Patients with major depressive disorder or bipolar disorder (predominantly depressive) and a history of failed trials of multiple treatment modalities including pharmacotherapy, psychotherapy and/or electroconvulsive therapy (ECT) may be suitable candidates for VNS, if no contraindications are present. In the RADS such patients are offered VNS if they are able to provide informed consent and two specialists agree it is appropriate. CONCLUSIONS: VNS provides a valuable treatment option for DTD when used under appropriate circumstances; these assessment criteria facilitate the identification of patients with greatest potential to benefit.

Differences in quality of life among college student electronic cigarette users.

PURPOSE: The purpose of this study was to explore an association between e-cigarette use and Quality of Life (QOL) among college students. METHODS: During February 2016, 1,132 students completed an online survey that included measures of tobacco use and the WHOQOL-BREF instrument. Differences were tested using Chi-square, Fisher's exact test, and ANOVA, and regression was used to assess possible relationships. RESULTS: E-cigarettes were used by 6.97% of the participants, either solo or along with traditional cigarettes. Bivariate analyses suggest that male college students are more likely than females to use e-cigarettes, either solo or in combination with traditional cigarettes (χ2 =19.4, P < .01). Lesbian, gay, and bisexual students are more likely than heterosexual students to use traditional cigarettes, either solo or in combination with e-cigarettes (χ2 = 32.9, P < .01). Multivariate models suggest that for every 10-unit increase in overall QOL, psychological well-being, social relations or environmental health the adjusted odds of being a sole cigarette user were significantly lower (all, P < .01), respectively. For every 10-unit increase in psychological well-being the adjusted odds of being a dual user was significantly lower (OR = .83, P = .026). CONCLUSIONS: Findings indicate that lower quality of life appears to be connected to tobacco use.

Predictors of well-being among college students.

OBJECTIVES: Identification of health-related risk behaviors associated with well-being in college students is essential to guide the development of health promotion strategies for this population. The purposes were to evaluate well-being among undergraduate students and to identify health-related risk behaviors that predict well-being in this population. METHODS: A cross-sectional Web-based survey of undergraduate students was conducted at a metropolitan university in the Southeast United States. A total of 568 students responded (response rate 14.2%). Data were collected on health-related risk behaviors using the National College Health Assessment II. RESULTS: Controlling demographic characteristics, the best predictive model included physical activity, current tobacco user, depression, ever received mental health services, and sleep quality, which was the strongest predictor (ß = .45, p < .001). This model explained 35% of the variance in well-being. CONCLUSIONS: Interventions that promote sleep quality among college students may be most beneficial in improving well-being.

Bacterial community profiles from sediments of the Anacostia River using metabolic and molecular analyses.

UNLABELLED: BACKGROUND AIM AND SCOPE: Though the tidal Anacostia River, a highly polluted riverine system, has been well characterized with regard to contaminants, its overall resident bacterial populations have remained largely unknown. Improving the health of this system will rely upon enhanced understanding of the diversity and functions of these communities. Bacterial DNA was extracted from archived (AR, year 2000) and fresh sediments (RE, year 2006) collected from various locations within the Anacostia River. Using a combination of metabolic and molecular techniques, community snapshots of sediment bacterial diversity and activity were produced. RESULTS: Employing Biolog EcoPlates, metabolic analysis of RE sediments from July revealed similar utilization of amines, amino acids, carbohydrates, carboxylic acids, and polymers at all sites. Normalized optical density measurements demonstrated that for most compounds, utilizations were similar though when differences did occur, the downstream site was enhanced compared to one or both of the upstream sites. Using denaturing gradient gel electrophoresis, bacterial diversity fingerprints of operational taxonomic units (OTUs) were obtained. Dendograms of the banding patterns revealed qualitative relationships as well as differences between replicate samples from similar sites. Replicates from the AR sites shared several common OTUs, while RE sites were more varied. Species richness and Shannon diversity indices generally increased with increasingly downstream locations, and were significant for the AR sediments (analysis of variance, P < 0.0001). Carbon and nitrogen content and concentration of fine grain sediment (<63 µm) were positively correlated with OTU richness (r (2) = 0.37, P = 0.0008; r (2) = 0.45, P < 0.0001; r (2) = 0.48, P = 0.001, respectively). CONCLUSIONS: This study demonstrated that the bacterial communities from all regions sampled were not only metabolically active with the capacity to utilize several different compounds as energy sources but also were genetically diverse. This study is the first to focus on the overall bacterial community, providing insight into this vital component of stream ecosystems. Understanding the bacterial components of aquatic systems such as the Anacostia River will increase our knowledge of the overall structure and function of the ecological communities in polluted systems, subsequently enhancing our ability to improve the health of this important tidal river.

Nutrients, oxygen dynamics, stable isotopes and fatty acid concentrations of a freshwater tidal system, Washington, D.C.

The Anacostia River in Washington, D.C., USA is an urban waterway contaminated with PAHs, PCBs, metals and sewage. Although several studies have examined the heavy metal geochemistry within the river, no studies have examined basic biogeochemical processes within the Anacostia river system. This study examines nutrients, bacterial biomarkers, organic material, and carbon, nitrogen and sulfur sources in the system. High biological oxygen demand and low nitrogen (0.33-0.56 mg L(-1)) and phosphorus (0.014-0.021 mg L(-1)) concentrations were observed in three areas of the river. Downstream sites had higher nutrient concentrations and dissolved organic matter (up to 13.7 mg L(-1)). Odd-chain length and branched fatty acids (FAs) in the sediments indicated bacterial sources, but long chain FAs indicative of terrestrial primary production were also abundant in some sediments. Sediment carbon stable isotope analyses showed a mix of autochthonous and allochthonous derived materials, but most carbon was derived from terrestrial sources (-23.3 to -31.7 per thousand). Sediment nitrogen stable isotopes ranged from -5.4 to 5.6 per thousand, showing nitrate uptake by plants and also recycling of nitrogen within the river. Sulfur sources were generally between 3 and -5 per thousand, reflecting local sulfate sources and anaerobic sulfate reduction.

Nitrifier and denitrifier molecular operational taxonomic unit compositions from sites of a freshwater estuary of Chesapeake Bay.

Temporal and spatial changes in the molecular operational taxonomic unit (OTU) compositions of bacteria harboring genes for nitrification and denitrification were assessed using denaturing gradient gel electrophoresis (DGGE), clone-based DNA sequencing of selected PCR products, and analyses of ammonium and organic matter concentrations. Sediment, overlying water, and pore-water samples were taken from different vegetated sites of Jug Bay National Estuarine Research Reserve, Maryland, during spring, summer, and fall 2006. OTU richness and the diversities of nitrifiers and denitrifiers were assessed by the presence of bands on DGGE gels, both ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) were seasonally dependent. AOB OTU richness was highest in the summer when NOB richness was decreased, whereas NOB richness was highest in the spring when AOB richness was decreased. The OTU diversities of nitrifiers did not correlate with ammonium concentrations, organic matter concentrations, or the presence of vegetation. The OTU diversities of denitrifiers possessing either the nirK or nosZ genes were not seasonally dependent but were positively correlated with organic matter content (p = 0.0015, r2 = 0.27; p < 0.0001, r2 = 0.39, respectively). Additionally, the presence of vegetation significantly enhanced nosZ species richness (Wilcoxon/Kruskal-Wallis test, p < 0.008), but this trend was not seen for nirK OTU richness. Banding patterns for nirK OTUs were more similar within sites for each season compared with any of the other genes. Over all seasons, nirK OTU richness was highest and AOB and nosZ OTU richness were lowest (Wilcoxon/Kruskal-Wallis test, p < 0.0001). High levels of sequence divergence among cloned nirK PCR products indicate a broad diversity of nirK homologs in this freshwater estuary.

Interprofessional ambulatory primary care practice-based educational program.

Although interprofessional teamwork and collaboration are considered key elements for improving patient outcomes, there are few reports of controlled studies involving interprofessional training of health care learners in the ambulatory primary care setting. We describe an educational program for teams of nurse practitioners, family medicine residents and social work students to work together at clinical sites in the delivery of longitudinal care in primary care ambulatory clinics. Year 1 was a planning year. Program evaluation completed at the end of the second curriculum (Year 3) indicated that the changes the team made at the end of the first curriculum (Year 2) resulted in increased appreciation of the training program, greater perception of value of care delivered by interprofessional teams among team learners as compared to non-team learners, and team learner self assessment of improved team skills including working with other professionals, resolving conflict, and integrating prevention and health promotion into health care. Team learners demonstrated an increased awareness of the limits of their own profession's approach to team care. We conclude that interprofessional ambulatory clinical training in primary care where learners work together providing care to patients can contribute to fostering both positive learner attitudes toward interprofessional work and development of team skills.

The effects of small dam removal on the distribution of sedimentary contaminants.

With increasing concern over degradation of aquatic resources, issues of liability, and maintenance costs, removal of small dams has become increasing popular. Although the benefits of removal seem to outweigh the drawbacks, there is a relative paucity of studies documenting the extent and magnitude of biological and chemical changes associated with dam removal, especially those evaluating potential changes in contaminant inventories. In August and November of 2000, a run-of-the-river dam on Manatawny Creek (southeast Pennsylvania) was removed in a two-stage process. To assess the effects of dam removal on the contaminant redistribution within the creek, sedimentary concentrations of polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and trace metals (Cd, Cr, Cu, Ni, Pb, Zn) were evaluated prior to and several months after removal. Pre- and post-removal analyses revealed elevated and spatially variable concentrations of total PAHs (ranging from approximately 200 to 81,000 ng(g dry weight) and low to moderate concentrations of trace metals and PCBs. The concentrations of these sedimentary contaminants pre- versus post-removal were not significantly different. Additionally, though the impoundment received storm water run-off and associated contaminants from the adjacent city of Pottstown, the total inventory of fine-grain sediments in the impoundment prior to removal was very low. The removal of the low-level Manatawny Creek dam did not significantly redistribute contaminants downstream. However, each dam removal should be assessed on a case by case basis where the potential of sedimentary contaminant redistribution upon dam removal exists.

Supporting self-management in patients with chronic illness.

Support of patient self-management is a key component of effective chronic illness care and improved patient outcomes. Self-management support goes beyond traditional knowledge-based patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support application of knowledge in real-life situations that matter to patients. This approach also encompasses system-focused changes in the primary care environment. Family physicians can support patient self-management by structuring patient-physician interactions to identify problems from the patient perspective, making office environment changes that remove self-management barriers, and providing education individually and through available community self-management resources. The emerging evidence supports the implementation of practice strategies that are conducive to patient self-management and improved patient outcomes among chronically ill patients.