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ObjectiveDepression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.MethodPatients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.ResultsIn total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.ConclusionET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.

Planners and policymakers are increasingly calling for investment into walkable neighborhoods as a means for creating new social, economic, and cultural value in cities. Such calls are often for the kind of high density, mixed-use urbanism that existed prior to the automobile era. Notably, many older industrial cities once exhibited this style of urbanism, and were characterized as “walking cities”. More recently, these cities have battled persistent population loss, economic contraction, physical deterioration, and auto-oriented development. As such, their landscapes of walkability may now be fractured or uneven. Moreover, redevelopment efforts that champion “walkability” in such places are regularly targeted toward stable and gentrifying neighborhoods, rather than more distressed areas where resident mobility is comparatively limited. This paper engages with these and related themes for Buffalo, NY—a classic American “shrinking city”—to understand if/how walkability varies for different socioeconomic and demographic groups. We use WalkScore® data measured at the census block group-level to study the geographies of walkability relative to selected socioeconomic attributes. We find that walkable block groups are highly clustered in certain parts of the city, that housing values in walkable areas are increasing, and that individuals in poverty and members of certain minority groups live in block groups with disproportionately low WalkScore®. Crucially, the city features several clusters of limited mobility wherein walkability is poor and residents have insufficient access to automobiles. These results suggest that social justice must be a prominent element in urban redevelopment strategies that call for investments into “walkability”.

Author(s): Grumbach, Kevin; Vargas, Roberto A; Fleisher, Paula; Aragon, Tomas J; Chung, Lisa; Chawla, Colleen; Yant, Abbie; Garcia, Estela R; Santiago, Amor; Lang, Perry L; Jones, Paula; Liu, Wylie; Schmidt, Laura A | Abstract: BackgroundThe San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors.Community contextWe report on 3 SFHIP prevention initiatives: reducing consumption of sugar sweetened beverages (SSBs), regulating retail alcohol sales, and eliminating disparities in children's oral health.MethodsSFHIP is governed by a steering committee. Partnership working groups for each initiative collaborate to 1) develop and implement action plans emphasizing feasible, scalable, translational-science-informed interventions and 2) consider sustainability early in the planning process by including policy and structural interventions.OutcomeThrough SFHIP's efforts, San Francisco enacted ordinances regulating sale and advertising of SSBs and a ballot measure establishing a soda tax. Most San Francisco hospitals implemented or committed to implementing healthy-beverage policies that prohibited serving or selling SSBs. SFHIP helped prevent Starbucks and Taco Bell from receiving alcohol licenses in San Francisco and helped prevent state authorization of sale of powdered alcohol. SFHIP increased the number of primary care clinics providing fluoride varnish at routine well-child visits from 3 to 14 and acquired a state waiver to allow dental clinics to be paid for dental services delivered in schools.InterpretationThe SFHIP model of collective impact emphasizing community engagement and policy change accomplished many of its intermediate goals to create an environment promoting health and health equity.

This study examined the benefits of incorporating screening for distress as a routine part of care for patients with head and neck and neurologic cancers in a tertiary cancer center. Using a comparative 2-cohort pre-post implementation sequential design, consecutive outpatients with head and neck and neurologic cancers were recruited into 2 separate cohorts. Cohort 1 included patients attending clinics during April 2010, before the implementation of the screening program. The program was then implemented and patients completed the Screening for Distress Minimum Dataset (the Edmonton Symptom Assessment System [ESAS] and the Canadian Problem Checklist [CPC]) at each clinic visit. Cohort 2 included patients attending clinics during March 2011. Consenting patients completed screening and outcome measures (ESAS, CPC, and either the Functional Assessment of Cancer Therapy-Brain or the Functional Assessment of Cancer Therapy-Head and Neck). A total of 146 patients (78 head and neck and 68 neurologic) provided data for Cohort 1, and 143 (81 head and neck and 62 neurologic) provided data for Cohort 2. Compared with Cohort 1, patients with neurologic cancers in Cohort 2 reported significantly higher scores on the Functional Assessment of Cancer Therapy: General total and emotional quality of life subscale; fewer high scores (≥ 4) on the ESAS breathlessness item; and fewer problems with fears/worries, frustration/anger, finding meaning in life, and worry about friends/family. Head and neck patients in Cohort 2 reported significantly higher emotional quality of life and fewer problems with eating and weight than those in Cohort 1. Although no definitive causal attributions can be made, patients exposed to routine screening for distress reported better well-being and fewer emotional, physical, and practical problems than historical controls.

This paper explores the perceptions of academics and students towards embedding Education for Sustainable Development (ESD) into undergraduate degree programmes in the School for Earth, Ocean and Environmental Science (SEOES) at the University of Plymouth. The main purpose of the research was to identify current ESD related teaching and learning in a science-based undergraduate programme and the opportunities for, and barriers to, further extensions of ESD. The results indicate that there is general support for the embedding of ESD in the curriculum, but there is considerable uncertainty expressed by lecturers concerning how this can best be done. There is a general concern that additional embedding into the degree programme might lead to reductions in the amount of core subject matter being taught. The programme and ESD agendas are to an extent seen by lecturers as conflicting. ESD is viewed mainly in terms of curriculum content as opposed to the pedagogy employed.

The failure to consider access to food resources in an integrated way may lead to inequalities in nutritional opportunities among populations. Working with community groups and other public agencies, the San Francisco Department of Public Health has led interagency food system planning in San Francisco, California, since 2002. We report on one of the interventions within that initiative—a partnership between a public health agency, a local nonprofit organization, and the local food stamp program to institutionalize improved access to farmers' markets for federal food assistance beneficiaries. We further report on monitoring data collected at farmers' markets that documents significant and sustained increases of utilization by food stamp recipients since the initial intervention.

The Pacific Island countries face many similar problems in the provision of adequate and appropriate school library services. Education in these countries is still developing, and school libraries are not viewed as integral components of learning. Funding is insufficient, if at all, and there is it general lack of support library services. This article updates Joe Hallein's 1991 report on Cook Islands, Fiji, Samoa, Solomon Islands, Tonga, and Vanuatu. Niue Is included for the first time.

This chapter examines effective methods for using video and web conferencing tools to support online learning. The authors discuss the concept of presence, how web conferencing can be used to support presence in online courses, and why it is important to do so. Because of the impact web conferencing can have in learning, this chapter explores a variety of teaching roles that best leverage these conferencing tools. The chapter includes information on various web conferencing software programs (paid and open source). Best practices for using web conferencing tools in online learning are also explored.

The present study examined pre- to posttreatment changes on several outcome variables following a group treatment for sexually abused adolescent females living in a group home setting. The treatment, called SAY Group, is a 20-week, closed-enrollment group that employs a cognitive-behavioral, PTSD-informed approach. Pre- and posttest assessments were completed by 43 SAY Group participants and by their group-home caregivers. Significant improvements were found on adolescent self-report measures of internalizing and externalizing problems, PTSD symptoms, and self-worth. No significant improvement was noted for depression. Caregivers reported significant improvement on internalizing behavior problems and PTSD symptoms, but not on externalizing problems. Preliminary findings indicate that SAY Group is effective in reducing symptoms commonly associated with sexual abuse.

This paper reports on case study research into six higher education institutions (three in the UK and three in the USA) that give prominence to their sustainability credentials in their paper form and/or electronic promotional and recruitment materials. The purpose of the research was to draw important lessons and identify significant issues concerning the sustainability branding and marketing of higher education institutions. Key findings include, first, the importance of calibrating sustainability marketing according to actual sustainability performance while also embracing a sustainability vision, second, the importance of combining internal with external marketing, third, the importance of institutional clarity in determining marketing parameters, fourth, the advantages of marrying broad-based ‘subtle’ marketing with intensive niche and segment marketing. It was found, too, that higher education institutions with a sustainability brand are not collecting systematic data to assess marketing impact on student recruitment, or utilizing the sustainability/employability interface to good marketing effect, or employing a multi-dimensional conception of sustainability in their marketing. There is clear evidence of the stirrings of movement away from paper-form towards electronic marketing across the cases considered. An overarching insight of the study is that rigorous institutional engagement with marketing sustainability credentials can have a significant impact on the quality and depth of sustainability performance by helping spread, enrich and diversify the institutional sustainability culture.

Effective teaching begins with effective planning of instruction. Planned instruction with technology integrated appeals to students and accommodates students’ needs. Students expect technology to be utilized to support the learning process because of their acquaintance with a variety of technologies at a very early age. Educators must be aware of the needs and expectations of students and then design courses that integrate technology based on these identified needs and expectations. A critical element required to integrate technology into the learning environment successfully is the instructional design process. The instructional design process provides a framework for systematically planning, developing, and adapting instruction based on learner needs and content requirements. With the instructional design process, educators evaluate student needs, plan the lesson objectives, design the instructional content, and create assessments. Evaluation and revision of each of the instructional components is continually modified to meet the changing needs of the learners and the advancement of technology.

Background To assess the literature for the impact of iron overload and infusion Iron Chelation Therapy (ICT) on patients' quality of life (QoL), and the availability of QoL instruments for patients undergoing infusion ICT. Also, to obtain patients' experiences of having iron overload and receiving infusion ICT, and experts' clinical opinions about the impact of treatment on patients' lives. Methods A search of studies published between 1966 and 2004 was conducted using Medline and the Health Economic Evaluation Database (HEED). Qualitative results from patient and expert interviews were analysed. Hand searching of relevant conference abstracts completed the search. Results Few studies measuring the impact of ICT with deferoxamine (DFO) on patients QoL were located (n = 15). QoL domains affected included: depression; fatigue; dyspnoea; physical functioning; psychological distress; decrease in QoL during hospitalization. One theme in all articles was that oral ICT should improve QoL. No iron overload or ICT-specific QoL instruments were located in the articles. Interviews revealed that the impact of ICT on patients with thalassemia, sickle cell disease, and myelodysplastic syndromes is high. Conclusion A limited number of studies assessed the impact of ICT or iron overload on QoL. All literature suggested a need for easily administered, efficacious and well tolerated oral iron overload treatments, given the impact of current ICT on adherence. Poor adherence to ICT was documented to negatively impact survival. Further research is warranted to continue the qualitative and quantitative study of QoL using validated instruments in patients receiving ICT to further understanding the issues and improve patients QoL.

Infections affecting the central nervous system caused by Blastomyces dermatitidis are rare but curable. We describe a case of a 24-year-old man who presented to the emergency department with progressive bilateral lower extremity weakness over 1 month. On the day of admission, he had minimal muscle strength and was hyperreflexic in the lower extremities. Sensation, however, was intact. Skin examination revealed annular, raised, crusted lesions on his face and legs. A magnetic resonance imaging (MRI) scan showed marrow replacement of the T7 and T8 vertebral bodies and an epidural mass with cord compression. A chest radiograph showed an infiltrate, and a subsequent needle biopsy revealed yeast resembling B. dermatitidis. A skin biopsy was then obtained, and the culture grew out B. dermatitidis. He received 4 weeks of amphotericin B lipid complex (total of 6 grams), followed by oral itraconazole. After 1 week on antifungals, he was able to walk with a walker and the skin lesions virtually resolved. At 5 months he was ambulatory and riding a bicycle daily. Blastomycosis should be included in the differential diagnosis of epidural masses.

Glial-neuronal interchange of amino acids was studied by13C nuclear magnetic resonance spectroscopy of brain extracts from fluoroacetate-treated mice that received [1,2-13C]acetate and [1-13C]glucose simultaneously. [13C]Acetate was found to be a specific marker for glial metabolism even with the large doses necessary for nuclear magnetic resonance spectroscopy. Fluoroacetate, 100 mg/kg, blocked the glial, but not the neuronal tricarboxylic acid cycles as seen from the13C labeling of glutamine, glutamate, and γ-aminobutyric acid. Glutamine, but not citrate, was the only glial metabolite that could account for the transfer of13C from glia to neurons. Massive glial uptake of transmitter glutamate was indicated by the labeling of glutamine from [1-13C]glucose in fluoroacetate-treated mice. The C-3/C-4 enrichment ratio, which indicates the degree of cycling of label, was higher in glutamine than in glutamate in the presence of fluoroacetate, suggesting that transmitter glutamate (which was converted to glutamine after release) is associated with a tricarboxylic acid cycle that turns more rapidly than the overall cerebral tricarboxylic acid cycle.

Introduction: Blood transfusions are required as supportive care in thalassaemia and sickle cell patients. Regular blood transfusions may result in iron overload (IO) and, left untreated, in morbidity and earlier morality. Current infusion chelation therapy (ICT) requires 8–12 hour infusions, 5–7 days per week, potentially limiting quality of life (QoL) and inhibiting adherence in patients already limited by thalassaemia and sickle cell disease. Methods: To assess the impact of ICT on the QoL of patients with thalassemia and sickle cell disease and adherence, a literature review in Medline (539 abstracts; 130 articles), analysis of IO patient transcripts (4 thalassaemia, 1 sickle cell disease) and five IO clinical expert interviews were conducted. Results: Few published studies (11) used validated QoL instruments and even fewer assessed IO in thalassaemia (4) and sickle cell patients (7). No IO-specific QoL instruments were found. ICT in sickle cell patients may cause additional needle-site pain/discomfort, and may impact on evening social life and sleep, recreational activities, as well as emotional and physical well-being, occupational capacity and feelings of independence. ICT in thalassaemia patients may impact on emotional wellbeing such as self-esteem and worry about the future, family relationships and development of intimate relationships. Published articles and patient and clinician input suggested that QoL impact inhibited prescription of and adherence to ICT and therefore there is a need for easier, efficacious and safe oral chelation therapy (OCT). Discussion: Limited empirical studies assessed ICT’s impact on QoL in patients with thalassaemia or sickle cell disease, though results indicated that ICT’s QoL impact is significant and prescription and adherence rates would likely improve with OCT. We recommend further qualitative and empirical studies to assess the impact of ICT and OCT in IO patients with thalassaemia and sickle cell patients, using validated instruments.