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  • Psychological Medicine 07/2013; 43(7):1558-60. DOI:10.1017/S0033291713000913
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    ABSTRACT: Antipsychotic medications, while effective, often leave patients with ongoing positive and negative symptoms of schizophrenia. Guidelines recommend using cognitive behavior therapy (CBT) with this group. Clearly, mental health professionals require training and supervision to deliver CBT-based interventions. This study tested which antipsychotic-resistant patients were most likely to respond to brief CBT delivered by psychiatric nurses. Staff were trained over 10 consecutive days with ongoing weekly supervision. Training for carers in the basic principles of CBT was also provided. This article represents the secondary analyses of completer data from a previously published randomized controlled trial (Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180:523-527) (n = 354) to determine whether a number of a priori variables were predictive of a good outcome with CBT and treatment as usual. Logistic regression was employed to determine whether any of these variables were able to predict a 25% or greater improvement in overall symptoms and insight. In the CBT group only, female gender was found to strongly predict a reduction in overall symptoms (P = .004, odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33, 4.30) and increase in insight (P = .04, OR = 1.84, 95% CI = 1.03, 3.29). In addition, for individuals with delusions, a lower level of conviction in these beliefs was associated with a good response to brief CBT (P = .02, OR = 0.70, 95% CI = 0.51, 0.95). Women with schizophrenia and patients with a low level of conviction in their delusions are most likely to respond to brief CBT and should be offered this routinely alongside antipsychotic medications and other psychosocial interventions.
    Schizophrenia Bulletin 08/2009; 35(5):859-64. DOI:10.1093/schbul/sbp065
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    ABSTRACT: Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches.Method An audit of symptom outcome and satisfaction was conducted in depression case-management clinics run by practice nurses. Results were then benchmarked against appropriate randomised trial data. The cost of practice nurse time devoted to the delivery of the service was estimated by multiplying time by unit cost.Results A mean change of 9.07 (standard deviation (SD) 6.67, 95% confidence interval (CI) 7.93-10.22, P < 0.001) points on the Patient Health Questionnaire (PHQ9) score was observed in those who were using/had used the service. Clinical change demonstrated a shift from moderate-to-severe to mild depression. The results reflect the changes seen in randomised controlled trial data from similar interventions in similar samples, and are superior to expected treatment as usual outcomes. Overall, respondents were 'very satisfied' with the service on offer. The mean cost of practice nurse time was estimated at £45 per patient.Discussion While acknowledging the limitations of audit data, practice nurses in general practice appear to be able to offer effective and acceptable case management to patients experiencing depression.
    Mental Health in Family Medicine 06/2008; 5(2):111-9.
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    ABSTRACT: The cumulative absorbed dose in fired-clay bricks collected from ten buildings in the populated contaminated settlement (137Cs, 1,470 kBq m(-2)) of Stary Vishkov, located 175 km downwind of the Chernobyl Nuclear Power Plant (NPP) in the Bryansk administrative region of Russia, was determined using luminescence techniques by five laboratories. At each location, the cumulative dose, after subtraction of the natural background dose, was translated to absorbed dose in air using conversion factors derived from Monte Carlo simulations. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. At four locations the cumulative dose at a reference location was calculated, enabling the luminescence determinations to be compared directly with values of cumulative absorbed dose in air obtained using deterministic models. A "local" conversion factor was also derived from the Monte Carlo simulations for locations where the disturbance of soil was significant. Values of the "local" cumulative dose in air calculated using this factor were compared with those predicted using the deterministic models at each sampled location, allowing location factors to be calculated. The methodology developed is generally applicable to populated areas contaminated by radioactive fallout in which brick buildings are found. The sensitivity of the luminescence techniques for bricks from this region of Russia was sufficient to evaluate cumulative absorbed dose in brick due to fallout of less than 20 mGy.
    Health Physics 10/2005; 89(3):233-46. DOI:10.1097/01.HP.0000164654.66585.20
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    ABSTRACT: Luminescence retrospective dosimetry techniques have been applied with ceramic bricks to determine the cumulative external gamma dose due to fallout, primarily from the 1949 test, in populated regions lying NE of the Semipalatinsk Nuclear Test Site in Altai, Russia, and the Semipalatinsk region, Kazakhstan. As part of a pilot study, nine settlements were examined, three within the regions of highest predicted dose (Dolon in Kazakshstan; Laptev Log and Leshoz Topolinskiy in Russia) and the remainder of lower predicted dose (Akkol, Bolshaya Vladimrovka, Kanonerka, and Izvestka in Kazakshstan; Rubtsovsk and Kuria in Russia) within the lateral regions of the fallout trace due to the 1949 test. The settlement of Kainar, mainly affected by the 24 September 1951 nuclear test, was also examined. The bricks from this region were found to be generally suitable for use with the luminescence method. Estimates of cumulative absorbed dose in air due to fallout for Dolon and Kanonerka in Kazakshstan and Leshoz Topolinskiy were 475 +/- 110 mGy, 240 +/- 60 mGy, and 230 +/- 70 mGy, respectively. The result obtained in Dolon village is in agreement with published calculated estimates of dose normalized to Cs concentration in soil. At all the other locations (except Kainar) the experimental values of cumulative absorbed dose obtained indicated no significant dose due to fallout that could be detected within a margin of about 25 mGy. The results demonstrate the potential suitability of the luminescence method to map variations in cumulative dose within the relatively narrow corridor of fallout distribution from the 1949 test. Such work is needed to provide the basis for accurate dose reconstruction in settlements since the predominance of short-lived radionuclides in the fallout and a high degree of heterogeneity in the distribution of fallout are problematic for the application of conventional dosimetry techniques.
    Health Physics 01/2005; 87(6):625-41. DOI:10.1097/01.HP.0000137178.36835.79
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    ABSTRACT: The suitability of calcium silicate bricks (CSBs) for the retrospective measurement of gamma dose using luminescence techniques has been investigated. Bricks of this type are distinguished from fired clay bricks by containing negligible clay and requiring comparatively low temperature treatment during manufacture. They have been used widely in the construction of buildings in the Former Soviet Union since the 1970s but hitherto have not been used for retrospective dosimetry measurements. A procedure based on the use of the 210°C thermoluminescence (TL) peak of quartz was tested with granular quartz extracted from three types of CSB, one of which had been taken from a settlement downwind of Chernobyl. The degree to which the residual geological TL signal within the temperature range of the 210°C TL peak had been reduced during manufacture varied with brick type; the levels of residual TL corresponded, in the samples tested, to absorbed doses in the range –). The TL sensitivity of the quartz was generally sufficient to measure absorbed doses of and above. An estimate of the cumulative fallout dose obtained with the CSB from the contaminated settlement was in good agreement with that obtained in a previous study based on measurements with a fired clay brick from the same building.
    Radiation Measurements 02/2004; DOI:10.1016/j.radmeas.2003.07.004
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    ABSTRACT: The cumulative absorbed dose in bricks collected from six buildings in two heavily contaminated settlements (137Cs > 2,000 kBq m(-2)) located downwind of the Chernobyl Nuclear Power Plant was determined using luminescence techniques by six laboratories. The settlements, Vesnianoje in Ukraine and Zaborie in Russia, are located in, respectively, proximal and distal locations relative to the Chernobyl Nuclear Power Plant. The luminescence determinations of cumulative dose in brick, after subtraction of the natural background dose, were translated to absorbed dose in air at a Reference Location using conversion factors derived from Monte Carlo simulations of photon transport. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. This translation enables the luminescence determinations to be compared directly with values of cumulative absorbed dose obtained by computational modeling and also other dose reconstruction methods. For each sampled location the cumulative dose was calculated using three deterministic models, two of which are based on the attenuation of dose-rate with migration of radionuclides in soil and the third on historic instrumental gamma dose-rate data. The results of the comparison of the two methods indicate overall agreement within margins of +/-25%. The methodology developed is generally applicable and adaptable to areas contaminated by much lower levels of radioactive fallout in which brick buildings are found.
    Health Physics 01/2004; 86(1):25-41. DOI:10.1097/00004032-200401000-00006
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    ABSTRACT: The potential of cementitious building materials for use in retrospective dosimetry has been investigated by examination of three types of Portland cement, fine grain polymineral samples extracted from concrete and quartz inclusions extracted from ‘ready-mix’ mortar and samples of mortar applied to the external walls of buildings. The results of X-ray and optically stimulated luminescence measurements with samples of hydrated cement suggest that the emission associated with its presence in mortar, render and concrete is likely to be too weak for absorbed dose determinations of less than a few Gy. Measurements of the TL signal from quartz grains extracted from mortars indicate that a TL peak located at ∼170°C and measured with coarse grains of diameter provide the most promising approach for dose assessments above 100 mGy.
    Radiation Measurements 08/2003; DOI:10.1016/S1350-4487(03)00005-2
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    ABSTRACT: Spatially-resolved measurements of optically stimulated luminescence (OSL) were performed using a two-dimensional scanning system designed for use with planar samples. The scanning system employs a focused laser beam to stimulate a selected area of the sample, which is moved under the beam by a motorised stage. Exposure of the sample is controlled by an electronic shutter. Mapping of the distribution of OSL using a continuous wave laser source was obtained with sub-millimeter resolution for samples of sliced brick, synthetic single crystal quartz, concrete and dental ceramic. These revealed sporadic emission in the case of brick or concrete and significant spatial variation of emission for quartz and dental ceramic slices. Determinations of absorbed dose were performed for quartz grains within a slice of modern brick. Reconfiguration of the scanner with a pulsed laser source enabled quartz and feldspathic minerals within a ceramic sample to be differentiated using a single stimulation wavelength by measuring the time-resolved luminescence spectrum.
    Radiation Measurements 04/2003; 37(2-37):151-159. DOI:10.1016/S1350-4487(02)00187-7
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    ABSTRACT: This paper reviews recent progress that has been made in the application of luminescence techniques with ceramic materials to the problem of dose reconstruction at: Hiroshima and Nagasaki; areas downwind of the Nevada Test Site; regions of Belarus, the Russian Federation and the Ukraine contaminated by fallout from Chernobyl; settlements along the Techa River affected by releases from the Mayak facility at Chelyabinsk; Kiisa, Estonia where a stolen 137Cs irradiator source was discovered. Luminescence has an increasingly important role in radiological health studies at such sites because of the ability of the method to measure dose retrospectively in areas where radiation monitoring was lacking or sporadic following the incident. Commonly produced ceramics such as brick, tile and porcelain fittings and artefacts have been used to determine the integrated external gamma radiation dose (the transient dose). Evaluation of the reliability and accuracy with which the transient dose can be estimated when it approaches and drops below the level of the integrated natural background dose (<50 mGy for ceramic samples of age 20–30 y) is the subject of current research. In addition to various improvements in the performance of the experimental techniques and understanding of the luminescence properties of the minerals, other developments include improved integration with the requirements of dose reconstruction by the combined use of luminescence and computational modelling.
    Radiation Measurements 12/1997; DOI:10.1016/S1350-4487(97)00217-5
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