Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment

BACKGROUND: Little is known about predictors of recovery from bipolar depression. AIMS: We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression. METHOD: A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n = 141) or a brief psychoeducational intervention (n = 111). All analyses were by intention-to-treat. RESULTS: Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression. CONCLUSIONS: Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.

The effectiveness of a brief intervention using a pedometer and step-recording diary in promoting physical activity in people diagnosed with type 2 diabetes or impaired glucose tolerance

Issue addressed: To evaluate the effectiveness of a brief intervention using a pedometer and step-recording diary on promoting physical activity in people with type 2 diabetes or impaired glucose tolerance (IGT). Methods: People with type 2 diabetes or IGT who attended the Illawarra Diabetes Service were invited to participate. Participants in the intervention group received a pedometer and a diary to record their daily steps for a two-week period. Both the intervention and comparison group received advice on physical activity. Physical activity levels were measured using the Active Australia Survey at baseline, and at two and 20 weeks. Results: A total of 226 participants were recruited. At two-week follow-up the mean self-reported minutes of walking was significantly higher in the intervention group than the comparison group (223 minutes versus 164 minutes; p=0.01), as was the percentage of intervention participants achieving recommended levels of moderate-intensity physical activity (63.5% versus 41.8%, p=0.02) and the percentage of intervention participants achieving adequate levels of total physical activity (68.9% versus 48.0%, p=0.04). There were no differences between study groups for any physical activity measure at 20-week follow-up. Conclusions: A pedometer and a step-recording diary were useful tools to promote short-term increase in physical activity in people diagnosed with type 2 diabetes or IGT. Future studies need to examine whether a longer intervention, individualised physical activity counselling and support for achieving step goals could result in increasing physical activity over the long term.

Daily step-count and change in waist circumference during a workplace pedometer program

Background: The health benefit associated with a daily step-count target within pedometer pro- grams is unclear. The aim of this study was to determine if the daily step-count attained during a four month pedometer-based workplace health program was associated with change in waist circumference (WC).

Methods: 762 Australian adults enrolled in a workplace pedometer pro- gram were recruited from ten workplaces in 2008. At the end of the program (four months), 436 participants were eligible for the current analysis. Data included demographics, perceived physical activity change during the program, measured WC at baseline and follow-up, and reported daily pedometer step-counts throughout the program. The association between daily step count and change in WC was examined using linear re- gression.

Results: WC improved by an average of –1.61cm (95% CI: –2.13, –1.09) by the end of the program. There was no relationship between daily step-count and the degree of change in WC. However, among participants reporting an in- crease in physical activity during the program a relationship between daily step count and change in WC was observed, such that those who un-dertook on average 10,000 steps or more per day improved their WC by –1.38cm (95%CI: –2.14, –0.63) more than those who did not achieve an average of 10,000 steps per day. Similarly, among individuals not meeting WC guidelines at baseline a greater daily step count was associ-ated with a greater decrease in WC.

Conclusions: Within a workplace pedometer program, reported daily step count was not associated with greater reductions in WC. However, it was a useful in-dicator of potential health benefits in those who increased their level of physical activity during the program. Pedometer programs need to com- municate clearly the importance of both a step goal and improvement in step count to manage participant expectations about improvements in health markers.

The next step in energy rating: the international ETTV method vs. BCA Section-J glazing calculator

The most important prevention in minimizing energy transfer in commercial buildings is the treatment of glazing in the building facade. In a commercial building, while the impacts of roof, walls and floors on the overall heating and cooling loads of the building have low effects, glazing is likely to be the most important factor. This paper investigates the BCA Section-J glazing calculator and the ETTV (Envelope Thermal Transfer Value) methods and tries to look for differences as well as similarities in calculation of building envelopes energy performance. For this investigation, a hypothetical high-rise commercial building in Melbourne, Australia is considered when evaluating the energy performance of the envelope through these two methods. Both methods consider the U-Value of glass and wall materials as well as Solar Heat Gain Coefficient (SHGC) and Shading Coefficient (SC) of the glass. Findings in this research project indicate differences and significant discrepancies between the BCA Section-J and ETTV methods in evaluating the energy performance of commercial building façades. Issues of calculation weaknesses are identified with the lack of air leakage and infiltration of a particular façade design or window to wall ratio (WWR). Suggestions have been made where improvement to the overall energy calculation through facades of a commercial building is needed.

Specific mood symptoms confer risk for subsequent suicidal ideation in bipolar disorder with and without suicide attempt history: multi-wave data from STEP-BD

BACKGROUND: Little is known about specific mood symptoms that may confer risk for suicidal ideation (SI) among patients with bipolar disorder (BD). We evaluated prospectively whether particular symptoms of depression and mania precede the onset or worsening of SI, among adults with or without a history of a suicide attempt. METHODS: We examined prospective data from a large (N = 2,741) cohort of patients participating in the Systematic Treatment Enhancement Program for BD (STEP-BD). We evaluated history of suicide attempts at baseline, and symptoms of depression and mania at baseline and follow-up visits. Hierarchical linear modeling tested whether specific mood symptoms predicted subsequent levels of SI, and whether the strength of the associations differed based on suicide attempt history, after accounting for the influence of other mood symptoms and current SI. RESULTS: Beyond overall current depression and mania symptom severity, baseline SI, and illness characteristics, several mood symptoms, including guilt, reduced self-esteem, psychomotor retardation and agitation, increases in appetite, and distractibility predicted more severe levels of subsequent SI. Problems with concentration, distraction, sleep loss and decreased need for sleep predicted subsequent SI more strongly among individuals with a suicide attempt history. CONCLUSIONS: Several specific mood symptoms may confer risk for the onset or worsening of SI among treatment-seeking patients with BD. Individuals with a previous suicide attempt may be at greater risk in part due to greater reactivity to certain mood symptoms in the form of SI. However, overall, effect sizes were small, suggesting the need to identify additional proximal predictors of SI.

Associations between step duration variability and inertial measurement unit derived gait characteristics

Inertial measurement units (IMU) provide a convenient tool for gait stability assessment. However, it is unclear how various gait characteristics relate to each other and whether gait characteristics can be obtained from resultant acceleration. Therefore, step duration variability was measured in treadmill walking from 39 young ambulant volunteers (age 24.2 [± 2.5] y; height 1.79 [± 0.09] m; mass 71.6 [± 12.0] kg) using motion capture. Accelerations and gyrations were simultaneously recorded with an IMU. Harmonic ratio, maximum Lyapunov exponents, and multiscale sample entropy (MSE) were calculated. Step duration variability was positively associated with MSE with coarseness levels = 3-6 (r = -.33 to -.42, P ≤ .045). Harmonic ratio and MSE with all coarseness levels were negatively associated (r = -.45 to -.57, P ≤ .004). The MSE with coarseness level = 2 was negatively associated with short-term maximum Lyapunov exponents (r = -.32, P = .047). The agreement between resultant and vertical acceleration derived gait characteristics was excellent (ICC = 0.97-0.99). In conclusion, MSE with varying coarseness levels was associated with the other gait characteristics evaluated in the study. Resultant and vertical acceleration derived results had excellent agreement, which suggests that resultant acceleration is a viable alternative to considering the acceleration dimensions independently.

Implementation of China's new policies on organ procurement: An important but challenging step forward

In the last decade, health authorities in China have made a series of policy announcements concerning organ procurement programs and changes in practice have been intermittently reported (1). The international community of transplant professionals has followed these reports closely, preoccupied with one fundamental issue: the procurement of organs from executed prisoners, a practice that for many years has provided the majority of organs transplanted in China. Sharif et al. describe this practice as “ethically indefensible” (2), an evaluation that reflects the position embraced by the international community for more than two decades (3-5). Sharif et al. express concern that whilst some transplant programs in China have ceased using organs from executed prisoners, others continue to do so, and that all organs procured from the deceased may be allocated through a collective pool as part of the new China Organ Transplant Response System, effectively “laundering” organs obtained from prisoners. They also note that one of the new strategies to encourage deceased donation of organs among the Chinese public has involved financial incentives for donor families, another practice that has been strongly critiqued by the international professional community and global health authorities (6,7).

In China and in the United States, proponents of organ procurement from executed prisoners have argued that prisoners should not be denied the option to donate organs after their death if they so choose, as this may provide them or their families solace and an opportunity for moral, spiritual or social redemption (8,9). However, the predominant argument in favour of the practice appears to be essentially pragmatic: prisoners condemned to death represent an additional pool of potential “donors” with organs that will otherwise “go to waste” (10). In contrast, international professional societies and the World Health Organization among others have argued that the practice not only violates the core principles of medical ethics but also thereby undermines efforts to establish a sufficient supply of deceased donor organs. In this commentary, we reaffirm the ethics policy of The Transplantation Society (TTS) concerning organ procurement from executed prisoners (4), and briefly discuss the implications of this policy for international professional engagement with China at this time of significant evolution of Chinese organ procurement programs.

One-step amino-functionalization of milled carbon fibre for enhancement of thermo-physical properties of epoxy composites

Development of new chemical approaches for preparation of engineered carbon-based fillers is critical for high-performance applications. Herein, an efficient method for covalent functionalization of polyacrylonitrile-based carbon fibre through azo radical addition under mild condition is demonstrated. In this way, isobutyronitrile radicals in situ produced from thermal decomposition of 2,2′-azobisisobutyronitrile (AIBN), were covalently grafted on milled carbon fibre (MCF) surface, assisted by microwave irradiation, as evidenced by FTIR, Raman, and TGA analysis. The grafted isobutyronitriles on MCF surface (n-MCF) were applied for further MCF amino-functionalization (a-MCF) via nucleophilic reaction of an amine-rich compound. Then, both pure MCF and a-MCF were incorporated into epoxy matrix; and its curing process and thermo-physical properties were investigated using DSC, rheometry, DMA, TGA, and flexural analysis. The Tg and flexural strength of epoxy/a-MCF composites, compared to epoxy/MCF, increased by ∼3.5% and ∼10.2%, resulting from good adhesion between a-MCF and epoxy matrix which confirmed by SEM observations.

Numerical simulation of a Savonius turbine above an infinite-width forward facing step

The Savonius turbine, although simple in construction, typically has a maximum power coefficient (cP) of about 0.2. This is significantly lower than the cP of the axial flow propeller-type turbine which typically can be as high as 0.5. However, a simple means to improve the cP of a Savonius turbine is to install it above a forward facing step, for example, a cliff or a building. In this work, prior experimental results of the tow testing of a Savonius turbine installed above a finite-width bluff body were used to validate computational fluid dynamics simulation of the same experimental conditions. The validated simulation settings were then used to obtain the maximum cP of a similar turbine of finite width but installed above an infinite-width forward facing step over a range of installation positions above and behind the step.

A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: results from STEP-BD

Background We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. Methods We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. Results The cluster analysis yielded a two-cluster solution: 1) "less-recurrent/severe" and 2) "chronic/recurrent." Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p=.040, OR=4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p=.034, OR=2.62). Limitations Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. Conclusions A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.

The abolition of defensive homicide : a step towards populist punitivism at the expense of mentally impaired offenders

The offence of defensive homicide was abolished in Victoria in November 2014, following a widely held perception that it was being abused by violent men. While primarily associated with battered women who killed in response to prolonged family violence — but who were unable to establish their offending as self-defence — a less publicised rationale underpinning the introduction of defensive homicide was to provide an alternative offence for offenders with cognitive impairments not covered by the mental impairment (formerly the insanity) defence. Cognitive impairments are complex and varied in their nature and symptomatology. Offenders presenting with cognitive impairments therefore require an appropriate range of legal responses to capture the nuances and appropriate moral culpability of their conduct. Drawing from an analysis of the cases of defensive homicide heard over its 10–year lifespan, this article contends that the abolition of defensive homicide did not adequately take into consideration the potential impacts on individuals whose mental conditions are not typically covered by the restrictive mental impairment defence. We further argue that the decision to abolish defensive homicide was driven by dominant, populist voices, without sufficient attention given to the offence’s potential to achieve the aims underpinning its enactment, including providing an alternative offence for women who kill in response to prolonged family violence.

Criminalising controlling and coercive behaviour: the next step in the prosecution of family violence?

A new offence of controlling or coercive behaviour in intimate or family relationships has recently come into force in England. The parliament of Scotland is contemplating introducing a related offence. The offence is distinctive because it criminalises conduct – controlling and coercive behaviour – which has specified negative behavioural and psychological consequences without necessarily requiring that a victim sustain physical injury or fear death or serious harm. This significant extension of the criminal law supplements anti-stalking legislation and has been justified on the basis that it addresses a core feature of abusive relationships, is essential to protect the human rights of victims of domestic abuse, and has community support. In the context of the ongoing debate about how best to tackle the problem of domestic abuse in Australia, this development provides an innovative – albeit still untested – model and should be closely examined.

Semantic Web for the legal domain: the next step

Ontology-driven systems with reasoning capabilities in the legal field are now better understood. Legal concepts are not discrete, but make up a dynamic continuum between common sense terms, specific technical use, and professional knowledge, in an evolving institutional reality. Thus, the tension between a plural understanding of regulations and a more general understanding of law is bringing into view a new landscape in which general legal frameworks – grounded in well-known legal theories stemming from 20th-century c. legal positivism or sociological jurisprudence – are made compatible with specific forms of rights management on the Web. In this sense, Semantic Web tools are not only being designed for information retrieval, classification, clustering, and knowledge management. They can also be understood as regulatory tools, i.e. as components of the contemporary legal architecture, to be used by multiple stakeholders – front-line practitioners, policymakers, legal drafters, companies, market agents, and citizens. That is the issue broadly addressed in this Special Issue on the Semantic Web for the Legal Domain, overviewing the work carried out over the last fifteen years, and seeking to foster new research in this field, beyond the state of the art.

One-step synthesis of graphene quantum dots from defective CVD graphene and their application in IGZO UV thin film phototransistor

Chemical vapor deposition (CVD) has recently been considered as the most reliable method to prepare high-quality monolayer graphene films, yet the as-grown graphene usually contains wrinkles and cracks or suffers from discontinuity. These defects can easily result in the shredding of large-sized graphene into small pieces even under a gentle disturbance. Herein, this work presents a cost-effective new method to produce high-quality GQDs by vigorous sonication of defective CVD graphene. The prepared GQDs can be easily and stably dispersed in organic solvents. Morphology and optical properties of the GQDs are investigated using a number of techniques. And we observed the as-prepared GQDs are highly homogeneous, mostly consisted of single-layered graphene, roughly round shapes less than 8 nm in a diameter, and exhibited a strong blue luminescence. Impressively, it is also confirmed that the as-obtained GQDs can act as a promising light absorption material for phototransistor with a hybrid film of GQDs and indium gallium zinc oxide (IGZO) as the channel layer. The GQD/IGZO phototransistor exhibited an appreciated photocurrent, which is 10 times larger than that of the IGZO one when exposed to 270 nm light.