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Level densities of 2⁺ states in ⁴⁰Ca have been extracted from the high energy-resolution (p,p′) experimental data by means of a fluctuation analysis. Two different methods of background determination have been considered, namely, Quasi-free calculations and Discrete Wavelet Transform (DWT) technique. The results are then compared to theoretical models based on phenomenological and microscopic approaches.

Medium-energy hadronic scattering and reactions at zero degrees are very selective to excitations with low angular momentum transfer. Only a few facilities exist worldwide where high energy-resolution measurements of this nature can be performed. The K600 Zero-Degree Facility at iThemba LABS, South Africa, was recently successfully developed. Measurements were performed for inelastic proton scattering at an incident energy of 200 MeV for targets ranging from ²⁷Al to ²⁰⁸Pb. Excitation energy-resolution of 50 keV (FWHM) was achieved. A reasonable background subtraction procedure allows for the extraction of excitation energy spectra with low background. Measurements of the (p,t) reaction at 100 MeV benefit from a large difference in magnetic rigidity between the reaction products and primary particles, resulting in almost background-free spectra with excitation energy-resolution of 32 keV (FWHM).

Experiments investigating the fine structure of the IsoScalar Giant Monopole Resonance (ISGMR) of ⁴⁸Ca were carried out with a 200 MeV alpha inelastic-scattering reaction, using the high energy-resolution capability and the zero-degree setup at the K600 magnetic spectrometer of iThemba LABS, Cape Town, South Africa. Considerable fine structure is observed in the energy region of the ISGMR. Characteristic energy scales are extracted from the experimental data by means of a wavelet analysis and compared with the state-of-the-art theoretical calculations within a Skyrme-RPA (random phase approximation) approach using the finite-rank separable approximation with the inclusion of phonon-phonon coupling (PPC). Good agreement was observed between the experimental data and the theoretical predictions.

Experiments investigating the fine structure of the IsoScalar Giant Monopole Resonance (ISGMR) of ⁴⁸Ca were carried out with a 200 MeV alpha inelastic-scattering reaction, using the high energy-resolution capability and the zero-degree setup at the K600 magnetic spectrometer of iThemba LABS, Cape Town, South Africa. Considerable fine structure is observed in the energy region of the ISGMR. Characteristic energy scales are extracted from the experimental data by means of a wavelet analysis and compared with the state-of-the-art theoretical calculations within a Skyrme-RPA (random phase approximation) approach using the finite-rank separable approximation with the inclusion of phonon-phonon coupling (PPC). Good agreement was observed between the experimental data and the theoretical predictions.

Level densities of 2⁺ states in ⁴⁰Ca have been extracted from the high energy-resolution (p,p′) experimental data by means of a fluctuation analysis. Two different methods of background determination have been considered, namely, Quasi-free calculations and Discrete Wavelet Transform (DWT) technique. The results are then compared to theoretical models based on phenomenological and microscopic approaches.

Medium-energy hadronic scattering and reactions at zero degrees are very selective to excitations with low angular momentum transfer. Only a few facilities exist worldwide where high energy-resolution measurements of this nature can be performed. The K600 Zero-Degree Facility at iThemba LABS, South Africa, was recently successfully developed. Measurements were performed for inelastic proton scattering at an incident energy of 200 MeV for targets ranging from ²⁷Al to ²⁰⁸Pb. Excitation energy-resolution of 50 keV (FWHM) was achieved. A reasonable background subtraction procedure allows for the extraction of excitation energy spectra with low background. Measurements of the (p,t) reaction at 100 MeV benefit from a large difference in magnetic rigidity between the reaction products and primary particles, resulting in almost background-free spectra with excitation energy-resolution of 32 keV (FWHM).

Level densities of 2⁺ states in ⁴⁰Ca have been extracted from the high energy-resolution (p,p′) experimental data by means of a fluctuation analysis. Two different methods of background determination have been considered, namely, Quasi-free calculations and Discrete Wavelet Transform (DWT) technique. The results are then compared to theoretical models based on phenomenological and microscopic approaches.

Medium-energy hadronic scattering and reactions at zero degrees are very selective to excitations with low angular momentum transfer. Only a few facilities exist worldwide where high energy-resolution measurements of this nature can be performed. The K600 Zero-Degree Facility at iThemba LABS, South Africa, was recently successfully developed. Measurements were performed for inelastic proton scattering at an incident energy of 200 MeV for targets ranging from ²⁷Al to ²⁰⁸Pb. Excitation energy-resolution of 50 keV (FWHM) was achieved. A reasonable background subtraction procedure allows for the extraction of excitation energy spectra with low background. Measurements of the (p,t) reaction at 100 MeV benefit from a large difference in magnetic rigidity between the reaction products and primary particles, resulting in almost background-free spectra with excitation energy-resolution of 32 keV (FWHM).

Medium-energy hadronic scattering and reactions at zero degrees are very selective to excitations with low angular momentum transfer. Only a few facilities exist worldwide where high energy-resolution measurements of this nature can be performed. The K600 Zero-Degree Facility at iThemba LABS, South Africa, was recently successfully developed. Measurements were performed for inelastic proton scattering at an incident energy of 200 MeV for targets ranging from ²⁷Al to ²⁰⁸Pb. Excitation energy-resolution of 50 keV (FWHM) was achieved. A reasonable background subtraction procedure allows for the extraction of excitation energy spectra with low background. Measurements of the (p,t) reaction at 100 MeV benefit from a large difference in magnetic rigidity between the reaction products and primary particles, resulting in almost background-free spectra with excitation energy-resolution of 32 keV (FWHM).

Level densities of 2⁺ states in ⁴⁰Ca have been extracted from the high energy-resolution (p,p′) experimental data by means of a fluctuation analysis. Two different methods of background determination have been considered, namely, Quasi-free calculations and Discrete Wavelet Transform (DWT) technique. The results are then compared to theoretical models based on phenomenological and microscopic approaches.

BACKGROUND: Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined.METHODS: This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment).DISCUSSION: The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions

Contains fulltext : 307395.pdf (Publisher’s version ) (Open Access), PURPOSE: The aim of this study was to investigate the biodistribution of (super-)selective trans-arterial radioembolization (TARE) with holmium-166 microspheres ((166)Ho-MS), when administered as adjuvant therapy after RFA of HCC 2-5 cm. The objective was to establish a treatment volume absorbed dose that results in an absorbed dose of ≥ 120 Gy on the hyperemic zone around the ablation necrosis (i.e., target volume). METHODS: In this multicenter, prospective dose-escalation study in BCLC early stage HCC patients with lesions 2-5 cm, RFA was followed by (super-)selective infusion of (166)Ho-MS on day 5-10 after RFA. Dose distribution within the treatment volume was based on SPECT-CT. Cohorts of up to 10 patients were treated with an incremental dose (60 Gy, 90 Gy, 120 Gy) of (166)Ho-MS to the treatment volume. The primary endpoint was to obtain a target volume dose of ≥ 120 Gy in 9/10 patients within a cohort. RESULTS: Twelve patients were treated (male 10; median age, 66.5 years (IQR, [64.3-71.7])) with a median tumor diameter of 2.7 cm (IQR, [2.1-4.0]). At a treatment volume absorbed dose of 90 Gy, the primary endpoint was met with a median absorbed target volume dose of 138 Gy (IQR, [127-145]). No local recurrences were found within 1-year follow-up. CONCLUSION: Adjuvant (super-)selective infusion of (166)Ho-MS after RFA for the treatment of HCC can be administered safely at a dose of 90 Gy to the treatment volume while reaching a dose of ≥ 120 Gy to the target volume and may be a favorable adjuvant therapy for HCC lesions 2-5 cm. TRIAL REGISTRATION: Clinicaltrials.gov NCT03437382 . (registered: 19-02-2018)., 01 juni 2024

Item does not contain fulltext, Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD). Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD. Method: A net–benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net–benefit analysis was used to relate costs to QALYs and to draw acceptability curves. Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively. Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.

Item does not contain fulltext, Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD). Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD. Method: A net–benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net–benefit analysis was used to relate costs to QALYs and to draw acceptability curves. Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively. Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.

Contains fulltext : 298919.pdf (Publisher’s version ) (Open Access), 1 p.

Contains fulltext : 246545.pdf (Publisher’s version ) (Open Access), Major depressive disorder (MDD) is one of the most common psychiatric disorders, however, current treatment options are insufficiently effective for about 35% of patients, resulting in treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is effective in treating TRD. Not much is known about the comparative efficacy of rTMS and other treatments and their timing within the treatment algorithm, making it difficult for the treating physician to establish when rTMS is best offered as a treatment option. This study aims to investigate the (cost-)effectiveness of rTMS (in combination with cognitive behavioral therapy (CBT) and continued antidepressant medication), compared to the next step in the treatment algorithm. This will be done in a sample of patients with treatment resistant non-psychotic unipolar depression.

Contains fulltext : 242378.pdf (Publisher’s version ) (Open Access), Background: Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective. Methods: We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted. Results: Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes. Limitations: Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution. Conclusions: School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.

Item does not contain fulltext, Background: Self-management is considered relevant and effective for people living with chronic diseases, with studies showing that individuals with persistent anxiety and depressive disorders apply a wide range of cognitive and behavioural strategies to cope with their symptoms. But what is the patient perspective of such interventions? Methods: In a mixed-methods design, we used two patient focus groups and concept mapping to elicit and cluster self-management strategies in chronic anxiety. Based on these and earlier outcomes on chronic depression, we developed the Assessment of Self-management in Anxiety and Depression (ASAD). Adults with chronic, treatment-resistant anxiety and depression under the care of 12 Dutch outpatients mental health care settings were subsequently invited to complete the questionnaire to assess which strategies they used and which of these they perceived as most and least helpful. Results: The focus groups generated 91 strategies, which they sorted and prioritised. Analysis of the rank-ordered data yielded 45 unique strategies, which were included in the ASAD. Of the 141 patients invited, 71.6% (n = 101) completed the questionnaire. Although subgroup strategies varied somewhat, the top three were comparable for the anxiety, depression, and comorbid group. Limitations: Our subgroup comparison needs to be interpreted with caution given the limited number of participants. Conclusion: Respondents perceived a diverse set of self-management strategies as helpful in coping with chronic anxiety and depression, with patient groups employing similar techniques across different stages of the disorder. We recommend discussing those self-management strategies that were deemed most helpful with patients as part of their treatment.

Item does not contain fulltext, PURPOSE: To investigate the biodistribution of holmium-166 microspheres ((166)Ho-MS) when administered after radiofrequency ablation (RFA) of early-stage hepatocellular carcinoma (HCC). The aim is to establish a perfused liver administration dose that results in a tumoricidal dose of holmium-166 on the hyperaemic zone around the ablation necrosis (i.e. target volume). MATERIALS AND METHODS: This is a multicentre, prospective, dose-escalation study in HCC patients with a solitary lesion 2-5 cm, or a maximum of 3 lesions of /= 120 Gy has been reached on the target volume in 9/10 patients of a cohort. Secondary endpoints include toxicity, local recurrence, disease-free and overall survival. DISCUSSION: This study aims to find the optimal administration dose of adjuvant radioembolization with (166)Ho-MS after RFA. Ultimately, the goal is to bring the efficacy of thermal ablation up to par with surgical resection for early-stage HCC patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03437382.

Contains fulltext : 246545.pdf (Publisher’s version ) (Open Access), Major depressive disorder (MDD) is one of the most common psychiatric disorders, however, current treatment options are insufficiently effective for about 35% of patients, resulting in treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is effective in treating TRD. Not much is known about the comparative efficacy of rTMS and other treatments and their timing within the treatment algorithm, making it difficult for the treating physician to establish when rTMS is best offered as a treatment option. This study aims to investigate the (cost-)effectiveness of rTMS (in combination with cognitive behavioral therapy (CBT) and continued antidepressant medication), compared to the next step in the treatment algorithm. This will be done in a sample of patients with treatment resistant non-psychotic unipolar depression.

Contains fulltext : 253508.pdf (Publisher’s version ) (Open Access), Background: Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is increasingly used to treat major depressive disorder (MDD). However, treatment with rTMS could be optimized by identifying optimal treatment parameters or characteristics of patients that are most likely to benefit. This meta-analysis and meta-regression aims to identify sample and treatment characteristics that are associated with change in depressive symptom level, treatment response and remission. Methods: The databases PubMed, Embase, Web of Science and Cochrane library were searched for randomized controlled trials (RCTs) reporting on the therapeutic efficacy of high-frequent, low-frequent, or bilateral rTMS for MDD compared to sham. Study and sample characteristics as well as rTMS parameters and outcome variables were extracted. Effect sizes were calculated for change in depression score and risk ratios for response and remission. Results: Sixty-five RCTs with a total of 2982 subjects were included in this meta-analysis. Active rTMS resulted in a larger depressive symptom reduction than sham protocol (Hedges' g = -0.791 95% CI -0.977; -0.605). Risk ratios for response and remission were 2.378 (95% CI 1.882; 3.005) and 2.450 (95% CI 1.779; 3.375), respectively. We found no significant association between sample and treatment parameters and rTMS efficacy. Conclusions: rTMS is an efficacious treatment for MDD. No associations between sample or treatment characteristics and efficacy were found, for which we caution that publication bias, heterogeneity and lack of consistency in the definition of remission might bias these latter null findings. Our results are clinically relevant and support the use of rTMS as a non-invasive and effective treatment option for depression.

Contains fulltext : 242378.pdf (Publisher’s version ) (Open Access), Background: Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective. Methods: We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted. Results: Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes. Limitations: Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution. Conclusions: School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.

Contains fulltext : 246545.pdf (Publisher’s version ) (Open Access), Major depressive disorder (MDD) is one of the most common psychiatric disorders, however, current treatment options are insufficiently effective for about 35% of patients, resulting in treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is effective in treating TRD. Not much is known about the comparative efficacy of rTMS and other treatments and their timing within the treatment algorithm, making it difficult for the treating physician to establish when rTMS is best offered as a treatment option. This study aims to investigate the (cost-)effectiveness of rTMS (in combination with cognitive behavioral therapy (CBT) and continued antidepressant medication), compared to the next step in the treatment algorithm. This will be done in a sample of patients with treatment resistant non-psychotic unipolar depression.

Contains fulltext : 253508.pdf (Publisher’s version ) (Open Access), Background: Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is increasingly used to treat major depressive disorder (MDD). However, treatment with rTMS could be optimized by identifying optimal treatment parameters or characteristics of patients that are most likely to benefit. This meta-analysis and meta-regression aims to identify sample and treatment characteristics that are associated with change in depressive symptom level, treatment response and remission. Methods: The databases PubMed, Embase, Web of Science and Cochrane library were searched for randomized controlled trials (RCTs) reporting on the therapeutic efficacy of high-frequent, low-frequent, or bilateral rTMS for MDD compared to sham. Study and sample characteristics as well as rTMS parameters and outcome variables were extracted. Effect sizes were calculated for change in depression score and risk ratios for response and remission. Results: Sixty-five RCTs with a total of 2982 subjects were included in this meta-analysis. Active rTMS resulted in a larger depressive symptom reduction than sham protocol (Hedges' g = -0.791 95% CI -0.977; -0.605). Risk ratios for response and remission were 2.378 (95% CI 1.882; 3.005) and 2.450 (95% CI 1.779; 3.375), respectively. We found no significant association between sample and treatment parameters and rTMS efficacy. Conclusions: rTMS is an efficacious treatment for MDD. No associations between sample or treatment characteristics and efficacy were found, for which we caution that publication bias, heterogeneity and lack of consistency in the definition of remission might bias these latter null findings. Our results are clinically relevant and support the use of rTMS as a non-invasive and effective treatment option for depression.

Item does not contain fulltext, Background: Self-management is considered relevant and effective for people living with chronic diseases, with studies showing that individuals with persistent anxiety and depressive disorders apply a wide range of cognitive and behavioural strategies to cope with their symptoms. But what is the patient perspective of such interventions? Methods: In a mixed-methods design, we used two patient focus groups and concept mapping to elicit and cluster self-management strategies in chronic anxiety. Based on these and earlier outcomes on chronic depression, we developed the Assessment of Self-management in Anxiety and Depression (ASAD). Adults with chronic, treatment-resistant anxiety and depression under the care of 12 Dutch outpatients mental health care settings were subsequently invited to complete the questionnaire to assess which strategies they used and which of these they perceived as most and least helpful. Results: The focus groups generated 91 strategies, which they sorted and prioritised. Analysis of the rank-ordered data yielded 45 unique strategies, which were included in the ASAD. Of the 141 patients invited, 71.6% (n = 101) completed the questionnaire. Although subgroup strategies varied somewhat, the top three were comparable for the anxiety, depression, and comorbid group. Limitations: Our subgroup comparison needs to be interpreted with caution given the limited number of participants. Conclusion: Respondents perceived a diverse set of self-management strategies as helpful in coping with chronic anxiety and depression, with patient groups employing similar techniques across different stages of the disorder. We recommend discussing those self-management strategies that were deemed most helpful with patients as part of their treatment.

Contains fulltext : 283310.pdf (Publisher’s version ) (Open Access), PURPOSE: To investigate the biodistribution of holmium-166 microspheres ((166)Ho-MS) when administered after radiofrequency ablation (RFA) of early-stage hepatocellular carcinoma (HCC). The aim is to establish a perfused liver administration dose that results in a tumoricidal dose of holmium-166 on the hyperaemic zone around the ablation necrosis (i.e. target volume). MATERIALS AND METHODS: This is a multicentre, prospective, dose-escalation study in HCC patients with a solitary lesion 2-5 cm, or a maximum of 3 lesions of /= 120 Gy has been reached on the target volume in 9/10 patients of a cohort. Secondary endpoints include toxicity, local recurrence, disease-free and overall survival. DISCUSSION: This study aims to find the optimal administration dose of adjuvant radioembolization with (166)Ho-MS after RFA. Ultimately, the goal is to bring the efficacy of thermal ablation up to par with surgical resection for early-stage HCC patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03437382.

Background: Two recent studies of the evolution of the isoscalar giant monopole resonance (ISGMR) within the calcium isotope chain report conflicting results. One study suggests that the monopole resonance energy, and thus the incompressibility of the nucleus, K-A, increase with mass, which implies that K-tau, the asymmetry term in the nuclear incompressibility, has a positive value. The other study reports a weak decreasing trend of the energy moments, resulting in a generally accepted negative value for K-tau. Differences in the observed trends have been attributed to the use of different techniques to account for instrumental background and the physical continuum. Purpose: An independent measurement of the ISGMR in the Ca isotope chain is provided to gain a better understanding of the origin of possible systematic trends. Methods: Inelastically scattering of 196 MeV alpha particles were observed at small scattering angles, including 0 degrees, for a range of calcium targets (Ca-40,Ca-42,Ca-44,Ca-48). The scattered alpha particles were momentum analyzed in the K600 magnetic spectrometer at iThemba LABS, South Africa. Monopole strengths spanning an excitation-energy range between 9.5 and 25.5 MeV were obtained using the difference-of-spectra (DoS) technique, adjusted to allow corrections for the variation of the angular shape of the sum of the L > 0 multipoles as a function of excitation energy, and compared with previous results that employed the multipole-decomposition analysis (MDA) techniques. Results: The structure of the E0 strength distributions of Ca-40,Ca-42,Ca-44 agrees well with the results from the previous measurement that support a weak decreasing trend of the energy moments, while no two datasets agree in the case of Ca-48. Despite the variation in the structural character of E0 strength distribution from different studies, we find for all datasets that the moment ratios, calculated from the ISGMR strength in the excitation-energy range that covers t

This study proposes a unique workflow to unravel complex burial diagenetic histories of overpressured basins based on the integration of seismic and well log data, biostratigraphy, petrography, clumped isotope analyses and basin modelling. This approach is demonstrated with an example from the Chalk Group in the Danish Central Graben, where a seismic-scale palaeo-lithification front has been observed and studied in detail to elucidate the timing of the establishment of overpressured conditions and its relation to changing diagenetic activity. The palaeo-lithification front separates high-porosity chalks above, that dominantly underwent mechanical compaction and contact cementation, from low-porosity chalk below, that dominantly underwent severe pressure dissolution and pore-filling cementation. Analysis of chalk buried under hydrostatic conditions shows a strikingly similar lithification front between 1000 and 1200 m burial, much shallower than the lithification front in the Danish Central Graben at a current depth between 2100 and 2400 m below seafloor. The discrepancy of 1200 m is due to the establishment of overpressured conditions that limited the increase in effective stress as burial continued, finally halting burial compaction when formation fluids started to carry the lithostatic weight. Basin modelling data indicate that this occurred at the end of the Oligocene for large parts of the Danish Central Graben, which is much earlier than the Middle Miocene timing that is currently assumed. The results imply a regional occurrence of a relict lithification front in the North Sea Basin, its position guided by stratigraphy, but mainly dependent on the maximum effective stress experienced during its burial history. The study shows that the porosity bipartition is a remnant of the past and not from ongoing compaction as has previously been suggested. Since it was established before the thermal maturity of the main source rocks, chalk below the lithification front

Psychological problems like procrastination, perfectionism, low self-esteem, test anxietyand stress are common among college students. There are evidence-based interventions available for these problems that not only have direct effects on these problems, but also indirect effects on mental disorders such as depression and anxiety disorders. Targeting these psychological problems may offer new opportunities to prevent and treat mental disorders in a way that is less stigmatizing to students. In this study we examined the association of five psychological problems with five common mental disorders (panic, generalized anxiety, bipolar, major depressive, and substance use disorder) in a sample of 2,449 students from two Dutch universities. Psychological problems were measured with one item for each problem and mental disorders were measured with the Composite International Diagnostic Interview Screening Scales. Associations were examined with Poisson regression models as relative risks (RR) of the disorders as a function of the psychological problems. The population attributable fraction (PAF) indicates by what percentage the prevalence of the mental disorder would be reduced if the psychological problem was addressed successfully by an intervention. Especially generalized anxiety disorder was strongly associated with psychological problems (strong associations with stress and low self-esteem and moderately with test anxiety). The group with three or more psychological problems had a strongly increased risk for generalized anxiety (RR = 11.25; 95% CI: 7.51–16.85), and a moderately increase risk for major depression (RR = 3.22; 95% CI: 2.63–3.95), panic disorder (RR = 3.19; 95% CI: 1.96–5.20) and bipolar disorder (RR = 3.66; 95% CI: 2.40–5.58). The PAFs for having any of the psychological problems (one or more) were considerable, especially for generalized anxiety (60.8%), but also for panic disorder (35.1%), bipolar disorder (30.6%) and major depression (34.0%)

Contains fulltext : 240640.pdf (Publisher’s version ) (Open Access), Background: Already a major health concern, late-life depression (LLD) is expected to form an increasing problem in the aging population. Moreover, despite current treatments, LLD is associated with a poor long-term prognosis and high rate of chronicity. Treatment provision and treatment accordingly warrant improvement, where add-on treatments might contribute to the efficacy of conventional therapies. Although it is known that impaired cognitive control contributes to LDD, it is not targeted sufficiently by current interventions. Research on cognitive control training (CCT) shows promising results on depressive symptoms, cognitive performance, and overall functioning. However, further research is needed to determine the long-term effects of CCT on LLD, its cost-effectiveness, and mechanisms of change. Methods: In the current multicenter randomized controlled trial (RCT) with a between-subjects design participants aged 60 years and over with a current LLD receiving treatment as usual (TAU) are randomized to add-on CCT or placebo training. Randomization is stratified by depression severity. Participants will receive eight online CCT or placebo sessions spread across four consecutive weeks. They will complete a post-training assessment after 1 month and three follow-up assessments scheduled three, six and 12 months after completing the training. We expect CCT and TAU to be more (cost-)effective in reducing depressive symptoms than placebo training and TAU. Additionally, we will be looking at secondary clinical, cognitive and global functioning outcomes and likely mechanisms of change (e.g., improved cognitive functioning, reduced rumination, and improved inhibition of negative stimuli). Discussion: The proposed RCT aims to contribute to the clinical and scientific knowledge on the long-term effects of CCT as an add-on treatment for LLD. Cost-effectiveness is particularly relevant considering the expected volume of the target demographic. The study will be a pragmatic

Contains fulltext : 240307.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 229008.pdf (publisher's version ) (Closed access), Primary closure of fetal skin in spina bifida protects the spinal cord and improves clinical outcome, but is also associated with postnatal growth malformations and spinal cord tethering. In this study, we evaluated the postnatal effects of prenatally closed full-thickness skin defects in sheep applying collagen scaffolds with and without heparin/vascular endothelial growth factor/fibroblast growth factor 2, focusing on skin regeneration and growth. At 6 months, collagen scaffold functionalized with heparin, VEGF, and FGF2 (COL-HEP/GF) resulted in a 6.9-fold increase of the surface area of the regenerated skin opposed to 1.7 × for collagen only. Epidermal thickness increased 5.7-fold at 1 month, in line with high gene expression of S100 proteins, and decreased to 2.1 at 6 months. Increased adipose tissue and reduced scaffold degradation and number of myofibroblasts were observed for COL-HEP/GF. Gene ontology terms related to extracellular matrix (ECM) organization were enriched for both scaffold treatments. In COL-HEP/GF, ECM gene expression resembled native skin. Expression of hair follicle-related genes in COL-HEP/GF was comparable to native skin, and de novo hair follicle generation was indicated. In conclusion, in utero closure of skin defects using functionalized collagen scaffolds resulted in long-term skin regeneration and growth. Functionalized collagen scaffolds that grow with the child may be useful for prenatal treatment of closure defects like spina bifida. Impact statement Prenatal closure of fetal skin in case of spina bifida prevents damage to the spinal cord. Closure of the defect is challenging and may result in postnatal growth malformations. In this study, the postnatal effects of a prenatally applied collagen scaffold functionalized with heparin and vascular endothelial growth factor (VEGF)/fibroblast growth factor (FGF) were investigated. An increase of the surface area of regenerated skin ("growing with the child") and generation of hair follic

Contains fulltext : 231016.pdf (Publisher’s version ) (Open Access), Introduction: According to the network perspective, psychopathology is the result of interactions between symptoms. A previous study used network analysis to identify central symptoms of adolescent depression. The aim of the current study was replicate and extend this study by including suicide ideation as a symptom of depression and evaluating which depression symptoms are contributing factors to suicide ideation in adolescents. Method: A large community sample (N = 5,888) of adolescents aged 11-16 years completed the Children's Depression Inventory (CDI-2). Network analysis was used to identify the network structure of the CDI-2 and which symptoms were directly related to suicide ideation in the network. Additionally, the network structure of adolescents who did and did not experience suicide ideation were compared. Results: Results pertaining the depression network were highly similar to the study we aimed to replicate. The most central symptoms in the depression network were loneliness, sadness, self-hatred, fatigue, self-deprecation and crying. Loneliness explained most variance of suicide ideation. Adolescents who experience suicide ideation had a similar network structure as those who do not. Adolescents with suicide ideation scored higher on all depression symptoms. Limitations: The use of cross-sectional data indicates that only undirected networks and results based on between-subject data could be estimated. Conclusions: Loneliness was a central factor for depression networks and also the most contributing factor of suicide ideation. Preventative efforts should consider taking experiences of loneliness into account as these are especially prevalent in adolescents. Suicide ideation seems more representative of depression symptom severity in adolescents.

Contains fulltext : 243983.pdf (Publisher’s version ) (Open Access), Background: Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained. Methods: Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed. Results: Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers’ stories and shared their own experiences with depression. Conclusions: Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms. Trial registration The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).

Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41–0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = −0.15, 95%CI = -0.28–-0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33–0.82) and 18–48-months (RR = 0.60, 95%CI = 0.42–0.84), but not 6-months. Findings at 12-months and 18–48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. Study registration: Research Registry ID: reviewregistry907.

Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41–0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = −0.15, 95%CI = -0.28–-0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33–0.82) and 18–48-months (RR = 0.60, 95%CI = 0.42–0.84), but not 6-months. Findings at 12-months and 18–48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage.

Contains fulltext : 225612.pdf (Publisher’s version ) (Open Access), Background/objective: To describe the design of 'DepMod', a health-economic Markov model for assessing cost-effectiveness and budget impact of user-defined preventive interventions and treatments in depressive disorders. Methods: DepMod has an epidemiological layer describing how a cohort of people can transition between health states (sub-threshold depression, first episode of mild, moderate or severe depression, (partial) remission, recurrence, death). Superimposed on the epidemiological layer, DepMod has an intervention layer consisting of a reference scenario and alternative scenario comparing the effectiveness and cost-effectiveness of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression. Results are presented in terms of quality-adjusted life years (QALYs) gained and healthcare expenditure. Costs and effects can be modelled over five years and are subjected to probabilistic sensitivity analysis. Results: DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression, which showed that there is an 82% probability that scaling up prevention is cost-effective given a willingness-to-pay threshold of €20,000 per QALY. Conclusion: DepMod is a Markov model that assesses the cost-utility and budget impact of different healthcare packages aimed at preventing and treating depression and is freely available for academic purposes upon request at the authors.

Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.

Contains fulltext : 229008.pdf (publisher's version ) (Closed access), Primary closure of fetal skin in spina bifida protects the spinal cord and improves clinical outcome, but is also associated with postnatal growth malformations and spinal cord tethering. In this study, we evaluated the postnatal effects of prenatally closed full-thickness skin defects in sheep applying collagen scaffolds with and without heparin/vascular endothelial growth factor/fibroblast growth factor 2, focusing on skin regeneration and growth. At 6 months, collagen scaffold functionalized with heparin, VEGF, and FGF2 (COL-HEP/GF) resulted in a 6.9-fold increase of the surface area of the regenerated skin opposed to 1.7 × for collagen only. Epidermal thickness increased 5.7-fold at 1 month, in line with high gene expression of S100 proteins, and decreased to 2.1 at 6 months. Increased adipose tissue and reduced scaffold degradation and number of myofibroblasts were observed for COL-HEP/GF. Gene ontology terms related to extracellular matrix (ECM) organization were enriched for both scaffold treatments. In COL-HEP/GF, ECM gene expression resembled native skin. Expression of hair follicle-related genes in COL-HEP/GF was comparable to native skin, and de novo hair follicle generation was indicated. In conclusion, in utero closure of skin defects using functionalized collagen scaffolds resulted in long-term skin regeneration and growth. Functionalized collagen scaffolds that grow with the child may be useful for prenatal treatment of closure defects like spina bifida. Impact statement Prenatal closure of fetal skin in case of spina bifida prevents damage to the spinal cord. Closure of the defect is challenging and may result in postnatal growth malformations. In this study, the postnatal effects of a prenatally applied collagen scaffold functionalized with heparin and vascular endothelial growth factor (VEGF)/fibroblast growth factor (FGF) were investigated. An increase of the surface area of regenerated skin ("growing with the child") and generation of hair follic

Contains fulltext : 231016.pdf (Publisher’s version ) (Open Access), Introduction: According to the network perspective, psychopathology is the result of interactions between symptoms. A previous study used network analysis to identify central symptoms of adolescent depression. The aim of the current study was replicate and extend this study by including suicide ideation as a symptom of depression and evaluating which depression symptoms are contributing factors to suicide ideation in adolescents. Method: A large community sample (N = 5,888) of adolescents aged 11-16 years completed the Children's Depression Inventory (CDI-2). Network analysis was used to identify the network structure of the CDI-2 and which symptoms were directly related to suicide ideation in the network. Additionally, the network structure of adolescents who did and did not experience suicide ideation were compared. Results: Results pertaining the depression network were highly similar to the study we aimed to replicate. The most central symptoms in the depression network were loneliness, sadness, self-hatred, fatigue, self-deprecation and crying. Loneliness explained most variance of suicide ideation. Adolescents who experience suicide ideation had a similar network structure as those who do not. Adolescents with suicide ideation scored higher on all depression symptoms. Limitations: The use of cross-sectional data indicates that only undirected networks and results based on between-subject data could be estimated. Conclusions: Loneliness was a central factor for depression networks and also the most contributing factor of suicide ideation. Preventative efforts should consider taking experiences of loneliness into account as these are especially prevalent in adolescents. Suicide ideation seems more representative of depression symptom severity in adolescents.

Contains fulltext : 240640.pdf (Publisher’s version ) (Open Access), Background: Already a major health concern, late-life depression (LLD) is expected to form an increasing problem in the aging population. Moreover, despite current treatments, LLD is associated with a poor long-term prognosis and high rate of chronicity. Treatment provision and treatment accordingly warrant improvement, where add-on treatments might contribute to the efficacy of conventional therapies. Although it is known that impaired cognitive control contributes to LDD, it is not targeted sufficiently by current interventions. Research on cognitive control training (CCT) shows promising results on depressive symptoms, cognitive performance, and overall functioning. However, further research is needed to determine the long-term effects of CCT on LLD, its cost-effectiveness, and mechanisms of change. Methods: In the current multicenter randomized controlled trial (RCT) with a between-subjects design participants aged 60 years and over with a current LLD receiving treatment as usual (TAU) are randomized to add-on CCT or placebo training. Randomization is stratified by depression severity. Participants will receive eight online CCT or placebo sessions spread across four consecutive weeks. They will complete a post-training assessment after 1 month and three follow-up assessments scheduled three, six and 12 months after completing the training. We expect CCT and TAU to be more (cost-)effective in reducing depressive symptoms than placebo training and TAU. Additionally, we will be looking at secondary clinical, cognitive and global functioning outcomes and likely mechanisms of change (e.g., improved cognitive functioning, reduced rumination, and improved inhibition of negative stimuli). Discussion: The proposed RCT aims to contribute to the clinical and scientific knowledge on the long-term effects of CCT as an add-on treatment for LLD. Cost-effectiveness is particularly relevant considering the expected volume of the target demographic. The study will be a pragmatic

Contains fulltext : 240307.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 243983.pdf (Publisher’s version ) (Open Access), Background: Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained. Methods: Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed. Results: Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers’ stories and shared their own experiences with depression. Conclusions: Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms. Trial registration The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).

Contains fulltext : 225612.pdf (Publisher’s version ) (Open Access), Background/objective: To describe the design of 'DepMod', a health-economic Markov model for assessing cost-effectiveness and budget impact of user-defined preventive interventions and treatments in depressive disorders. Methods: DepMod has an epidemiological layer describing how a cohort of people can transition between health states (sub-threshold depression, first episode of mild, moderate or severe depression, (partial) remission, recurrence, death). Superimposed on the epidemiological layer, DepMod has an intervention layer consisting of a reference scenario and alternative scenario comparing the effectiveness and cost-effectiveness of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression. Results are presented in terms of quality-adjusted life years (QALYs) gained and healthcare expenditure. Costs and effects can be modelled over five years and are subjected to probabilistic sensitivity analysis. Results: DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression, which showed that there is an 82% probability that scaling up prevention is cost-effective given a willingness-to-pay threshold of €20,000 per QALY. Conclusion: DepMod is a Markov model that assesses the cost-utility and budget impact of different healthcare packages aimed at preventing and treating depression and is freely available for academic purposes upon request at the authors.

Introduction: Rheumatic heart disease (RHD) is still an important cause of acquired heart disease affecting children and young adults from poor socio-economic backgrounds. The most common presentation of RHD is mitral valve disease requiring surgical intervention. The study aim was firstly to describe peri-operative risk factors, procedures performed and surgical outcomes after mitral valve surgery for RHD in Central South Africa. Secondly, to compare these results in patients presenting with mitral regurgitation to those presenting with mitral stenosis and mixed mitral valve disease. Methods: Patients undergoing mitral valve surgery for RHD, with or without concomitant tricuspid valve repair between January 2009 and December 2019 were identified from the departmental database. The lesions were grouped into mitral stenosis (MS), mitral regurgitation (MR), and mixed mitral (MX) disease. Statistical analyses was performed using the IBM SPSS program, version 26.0. A p-value of 0.05 or less was considered statistically significant. Results: A total of 242 patients were included in the study of which 75.2% (n=182) were female. Black patients represented 74.4% (n=180), whites 13.6% (n=33) with Asian and mixed races at 12% (n=29). The mean age of the study population was 43.7 years. Distribution of patients according to the lesions was 25.6% (n=62) for MS, 45.0% (n=109) for MR and 29.3% (n=71) for MX disease. Patients presenting in NYHA status III and IV formed 44% of the MR group and 44% of the MS group and for 28% for the MX group. Calculated EuroSCORE > 5 was 29.4% (n=18) in the MS group, 29% (n=32) in the MR group, and 9.9% (n=7) in the MR group. For the MS group, 96.7% (n=60) had mitral valve replacement and only 2.8% (n=2) were repaired (valvotomy); whilst in the MR and MX groups the replacement vs repair rate was 90.3% (n=93) and 94% (n=63) vs 9.7% (n=10) and 5.6% (n=4) respectively. The MS group had the highest number of concomitant tricuspid valve repair at 58.0%

Introduction: Infective endocarditis (IE) remains an evolving disease with a persistently high mortality and morbidity. In Africa, it is predominantly a disease of the young in contrast to the developed world. South Africa represents a very high prevalence of HIV at 21.67% of global HIV infections. Other factors in South Africa include the high prevalence of rheumatic valvular heart disease, low socio-economic status and poverty makes the patient population completely different from the developed world. The primary aim was to determine the influence of HIV infection on infective endocarditis patients in central South Africa. The secondary aim was to compare the HIV positive patients and HIV negative patients in the context of this disease. Objectives: To determine the demographics, presentation, indication for surgery, microorganisms, and outcomes of HIV positive versus HIV negative patients presenting with Infective endocarditis. Methods: Retrospective, analytical cohort study that reviewed the records of adult patients who were tested for HIV and treated surgically for infective endocarditis between 2009 to 2019. Data was compared between the two groups using chi-square or Fisher exact tests for categorical variables. Median and interquartile ranges were used for continuous variables and frequencies and proportions for categorical variables. Significance was set as p < 0.05. Results: From the 141 IE patients who underwent surgery for IE, 105 patients were tested for HIV, 31% (n=33) tested positive. The mean age for both groups was comparable 38.87 versus 39.51 years. Eighty-eight percent (n=29) of positive patients were on HAART. In both groups, there was a male preponderance, 55% vs 46% and 56% vs 44% respectively. The majority of HIV positive (91%) and negative patients (71%) were of African descent, more than 50% of both groups presented with NYHA III&IV, both groups had a medium-high risk of developing IE (HIV (+) 72%; HIV (-) 62%). Prevention of embolization

Contains fulltext : 240307.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 243983.pdf (Publisher’s version ) (Open Access), Background: Stigma and limited mental health literacy impede adolescents getting the help they need for depressive symptoms. A serious game coupled with a classroom session led by lived experience workers (LEWs) might help to overcome these barriers. The school-based Strong Teens and Resilient Minds (STORM) preventive program employed this strategy and offered a serious game, Moving Stories. The current study was carried out to assess inhibiting and promoting factors for scaling up Moving Stories once its effectiveness has been ascertained. Methods: Moving Stories was offered in three steps: (1) introductory classroom session, (2) students playing the game for five days, (3) debriefing classroom session led by lived experience worker. Data was collected on the number of participating students, costs of offering Moving Stories, and was further based on the notes of the debriefing sessions to check if mental health first aid (MHFA) strategies were addressed. Results: Moving Stories was offered in seven high-schools. Coverage was moderate with 982 participating students out of 1880 (52%). Most participating students (83%) played the Moving Stories app three out of the five days. Qualitative data showed that the MHFAs were discussed in all debriefing sessions. Students showed great interest in lived experience workers’ stories and shared their own experiences with depression. Conclusions: Bringing Moving Stories to scale in the high-school setting appears feasible, but will remain logistically somewhat challenging. Future implementation and scale-up of Moving Stories could benefit from improved selection and training of LEWs that played such an important role in grabbing the full attention of students and were able to launch frank discussions about depressive disorder and stigma in classrooms. Trial registration The study is registered in the Dutch Trial Register: Trial NL6444 (NTR6622: https://www.trialregister.nl/trial/6444).

Contains fulltext : 231016.pdf (Publisher’s version ) (Open Access), Introduction: According to the network perspective, psychopathology is the result of interactions between symptoms. A previous study used network analysis to identify central symptoms of adolescent depression. The aim of the current study was replicate and extend this study by including suicide ideation as a symptom of depression and evaluating which depression symptoms are contributing factors to suicide ideation in adolescents. Method: A large community sample (N = 5,888) of adolescents aged 11-16 years completed the Children's Depression Inventory (CDI-2). Network analysis was used to identify the network structure of the CDI-2 and which symptoms were directly related to suicide ideation in the network. Additionally, the network structure of adolescents who did and did not experience suicide ideation were compared. Results: Results pertaining the depression network were highly similar to the study we aimed to replicate. The most central symptoms in the depression network were loneliness, sadness, self-hatred, fatigue, self-deprecation and crying. Loneliness explained most variance of suicide ideation. Adolescents who experience suicide ideation had a similar network structure as those who do not. Adolescents with suicide ideation scored higher on all depression symptoms. Limitations: The use of cross-sectional data indicates that only undirected networks and results based on between-subject data could be estimated. Conclusions: Loneliness was a central factor for depression networks and also the most contributing factor of suicide ideation. Preventative efforts should consider taking experiences of loneliness into account as these are especially prevalent in adolescents. Suicide ideation seems more representative of depression symptom severity in adolescents.