Collaborative Project. Understanding the effects of tides and eddies on the ocean dynamics, sea ice cover and decadal/centennial climate prediction using the Regional Arctic Climate Model (RACM)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hutchings, Jennifer; Joseph, Renu

2013-09-14

The goal of this project is to develop an eddy resolving ocean model (POP) with tides coupled to a sea ice model (CICE) within the Regional Arctic System Model (RASM) to investigate the importance of ocean tides and mesoscale eddies in arctic climate simulations and quantify biases associated with these processes and how their relative contribution may improve decadal to centennial arctic climate predictions. Ocean, sea ice and coupled arctic climate response to these small scale processes will be evaluated with regard to their influence on mass, momentum and property exchange between oceans, shelf-basin, ice-ocean, and ocean-atmosphere. The project willmore » facilitate the future routine inclusion of polar tides and eddies in Earth System Models when computing power allows. As such, the proposed research addresses the science in support of the BER’s Climate and Environmental Sciences Division Long Term Measure as it will improve the ocean and sea ice model components as well as the fully coupled RASM and Community Earth System Model (CESM) and it will make them more accurate and computationally efficient.« less

Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory.

PubMed

Coupe, Nia; Anderson, Emma; Gask, Linda; Sykes, Paul; Richards, David A; Chew-Graham, Carolyn

2014-05-01

Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting. This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care. Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated. Primary care professionals in this study valued the potential for collaboration, but GPs' understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework. ISRCTN32829227 30/9/2008.

Decadal-scale variation in dune erosion and accretion rates: An investigation of the significance of changing storm tide frequency and magnitude on the Sefton coast, UK

NASA Astrophysics Data System (ADS)

Pye, K.; Blott, S. J.

2008-12-01

Monitoring of frontal dune erosion and accretion on the Sefton coast in northwest England over the past 50 years has revealed significant spatial and temporal variations. Previous work has shown that the spatial variations primarily reflect longshore differences in beach and nearshore morphology, energy regime and sediment budget, but the causes of temporal variations have not previously been studied in detail. This paper presents the results of work carried out to test the hypothesis that a major cause of temporal variation is changes in the frequency and magnitude of storms, surges and resulting high tides. Dune toe erosion/accretion records dating from 1958 have been compared with tide gauge records at Liverpool and Heysham. Relatively high dune erosion rates at Formby Point 1958-1968 were associated with a relatively large number of storm tides. Slower erosion at Formby, and relatively rapid accretion in areas to the north and south, occurred during the 1970's and 1980's when there were relatively few major storm tides. After 1990 rates of dune erosion at Formby increased again, and dunes to the north and south experienced slower accretion. During this period high storm tides have been more frequent, and the annual number of hours with water levels above the critical level for dune erosion has increased significantly. An increase in the rate of mean sea-level rise at both Liverpool and Heysham is evident since 1990, but we conclude that this factor is of less importance than the occurrence of extreme high tides and wave action associated with storms. The incidence of extreme high tides shows an identifiable relationship with the lunar nodal tidal cycle, but the evidence indicates that meteorological forcing has also had a significant effect. Storms and surges in the eastern Irish Sea are associated with Atlantic depressions whose direction and rate of movement have a strong influence on wind speeds, wave energy and the height of surge tides. However, preliminary analysis has indicated only a modest relationship between dune erosion/accretion rates and the North Atlantic Oscillation index.

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial

PubMed Central

Rojas, Graciela; Guajardo, Viviana; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-01-01

Background In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. Objective The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. Methods In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Results Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Conclusions Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Trial Registration Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ) PMID:29712627

Improving Depression Treatment for Women: Integrating a Collaborative Care Depression Intervention into OB-GYN Care

PubMed Central

LaRocco-Cockburn, Anna; Reed, Susan D.; Melville, Jennifer; Croicu, Carmen; Russo, Joan; Inspektor, Michal; Edmondson, Eddie; Katon, Wayne

2013-01-01

Background Women have higher rates of depression and often experience depression symptoms during critical reproductive periods, including adolescence, pregnancy, postpartum, and menopause. Collaborative care intervention models for mood disorders in patients receiving care in an OB-GYN clinic setting have not been evaluated. Study design and methodology for a randomized, controlled trial of collaborative care depression management versus usual care in OB-GYN clinics and the details of the adapted collaborative care intervention and model implementation are described in this paper. Methods Women over age 18 years with clinically significant symptoms of depression, as measured by a Patient Health Questionnaire-9 (PHQ-9) score ≥10 and a clinical diagnosis of major depression or dysthymia, were randomized to the study intervention or to usual care and were followed for 18 months. The primary outcome assessed was change over time in the SCL-20 depression scale between baseline and 12 months. Baseline Results 205 women were randomized: 57% white, 20% African American, 9% Asian or Pacific Islander, 7% Hispanic, and 6% Native American. Mean age was 39 years. 4.6% were pregnant and 7.5% were within 12 months postpartum. The majority were single, (52%), and 95% had at least the equivalent of a high school diploma. Almost all patients met DSM IV criteria for major depression (99%) and approximately 33% met criteria for dysthymia. Conclusions An OB-GYN collaborative care team including a social worker, psychiatrist and OB-GYN physician who met weekly and used an electronic tracking system for patients were essential elements of the proposed depression care treatment model described here. Further study of models that improve quality of depression care that are adapted to the unique OB-GYN setting are needed. PMID:23939510

COCONet enhancements to circum-Caribbean tsunami warning, tidal, and sea-level monitoring: update on tide gauge installations

NASA Astrophysics Data System (ADS)

Dausz, K.; Dittmann, S. T.; Feaux, K.; von Hillebrandt-Andrade, C.; Mattioli, G. S.; Normandeau, J.

2014-12-01

The Continually Operating Caribbean GPS Observational Network (COCONet) is a National Science Foundation (NSF) funded multi-hazard geodetic and meteorological network distributed throughout the Caribbean, which provides infrastructure and capacity building for a broad range of earth science questions. The network is a multi-national collaboration consisting of 46 newly constructed continuous Global Positioning Systems (cGPS) and 21 refurbished existing GPS stations, all co-located with meteorological sensors. One recommendation of the COCONet working group was to improve the vertical reference frame for long-term sea level monitoring. A COCONet supplement was awarded by the NSF to further address this particular objective through the co-location of GPS and tide gauges. This COCOnet infrastructure, along with the new tide gauges, will have broad scientific implications for hazards mitigation, solid earth, and atmospheric science research. UNAVCO engineers have meet with members of the Caribbean tide gauge community to establish target locations and design station layout. Allocated NSF funds allow for the construction of two complete new tide gauge systems each with two complimentary cGPS. Following the recommendations of NOAA and the sea level monitoring community, the two "new" locales will be Port Royal, Jamaica and Puerto Morelos, Mexico. Both locations had previously existing, but currently non-operational tide gauges. UNAVCO engineers will install a Sutron Radar Level Recorder and a backup pressure sensor tide gauge with GOES satellite telemetry. Tide data will be freely available by the Intergovernmental Oceanographic Commission (www.ioc-sealevelmonitoring.org). The NSF supplement also provided funds for adding cGPS to two additional locations where currently functioning tide gauge systems exist. Proposed locations for this additional infrastructure are Barahona, Dominican Republic and Bocas del Toro, Panama. All four locations will feature two standard COCONet cGPS systems consisting of a Trimble Choke Ring GNSS antenna, Trimble NetR9 GPS receiver, and a Vaisala meteorological sensor. All GPS data will be collected, processed and distributed via standard COCONet archiving and processing along with raw meteorological data at coconet.unavco.org.

Collaborative depression care among Latino patients in diabetes disease management, Los Angeles, 2011-2013.

PubMed

Wu, Brian; Jin, Haomiao; Vidyanti, Irene; Lee, Pey-Jiuan; Ell, Kathleen; Wu, Shinyi

2014-08-28

The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes-Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.

Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013

PubMed Central

Wu, Brian; Jin, Haomiao; Vidyanti, Irene; Lee, Pey-Jiuan; Ell, Kathleen

2014-01-01

Introduction The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. Methods A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Results Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Conclusion Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system. PMID:25167093

Social Support, a Mediator in Collaborative Depression Care for Cancer Patients

ERIC Educational Resources Information Center

Oh, Hyunsung; Ell, Kathleen

2015-01-01

Objective: This study assessed whether perceived social support (PSS) is a factor in improving physical and functional well-being observed among cancer patients receiving collaborative depression care. Methods: A secondary analysis was conducted of data collected in a randomized clinical trial testing the effectiveness of collaborative depression…

Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer.

PubMed

Li, Madeline; Kennedy, Erin B; Byrne, Nelson; Gérin-Lajoie, Caroline; Katz, Mark R; Keshavarz, Homa; Sellick, Scott; Green, Esther

2017-05-01

Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer. Copyright © 2016 John Wiley & Sons, Ltd.

Demonstration of a Real Time Capability to Produce Tidal Heights and Currents for Naval Operational Use: A Cast Study for the West Coast of Africa (Liberia)

NASA Technical Reports Server (NTRS)

Mehra, Avichal; Anantharaj, Valentine; Payne, Steve; Kantha, Lakshmi

1996-01-01

This report documents an existing capability to produce operationally relevant products on sea level and currents from a tides/storm surge model for any coastal region around the world within 48 hours from the time of the request. The model is ready for transition to the Naval Oceanographic Office (NAVOCEANO) for potential contingency use anywhere around the world. A recent application to naval operations offshore Liberia illustrates this. Mississippi State University, in collaboration with the University of Colorado and NAVOCEANO, successfully deployed the Colorado University Rapidly Relocatable Nestable Tides and Storm Surge (CURReNTSS) model that predicts sea surface height, tidal currents and storm surge, and provided operational products on tidal sea level and currents in the littoral region off south-western coast of Africa. This report summarizes the results of this collaborative effort in an actual contingency use of the relocatable model, summarizes the lessons learned, and provides recommendations for further evaluation and transition of this modeling capability to operational use.

Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

PubMed Central

2012-01-01

Background Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. Methods This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial. Discussion COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation. Trial Registration Number ISRCTN80309252 Trial Status Open PMID:22906179

A High School Depression and Suicide Prevention Program: A Collaboration between Health Education and Psychological Services.

ERIC Educational Resources Information Center

Moilanen, Donna L.; Bradbury, Susan

2002-01-01

Examined a collaboration between health education and psychological services in generating a high school depression and suicide prevention program. The five-component program raised awareness of teen depression and suicide, increased communication about these issues within the school and community, and provided information about available…

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

PubMed

Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-04-30

In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ). ©Graciela Rojas, Viviana Guajardo, Pablo Martínez, Ariel Castro, Rosemarie Fritsch, Markus Moessner, Stephanie Bauer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.04.2018.

The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation.

PubMed

Kearns, Ben; Rafia, R; Leaviss, J; Preston, L; Brazier, J E; Palmer, S; Ara, R

2017-01-24

Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both. A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches. Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY. Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.

Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

PubMed

Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

2017-04-01

Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (p<.001 for all). Intervention patients also had significantly improved quality-of-care indicators, including the proportion of patients receiving either psychotherapy or antidepressant medication (77% versus 21%, p<.001). Collaborative care for depression can greatly improve care and outcomes in public-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

Collaborative care for depression in European countries: a systematic review and meta-analysis.

PubMed

Sighinolfi, Cecilia; Nespeca, Claudia; Menchetti, Marco; Levantesi, Paolo; Belvederi Murri, Martino; Berardi, Domenico

2014-10-01

This is a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of collaborative care compared to Primary Care Physician's (PCP's) usual care in the treatment of depression, focusing on European countries. A systematic review of English and non-English articles, from inception to March 2014, was performed using database PubMed, British Nursing Index and Archive, Ovid Medline (R), PsychINFO, Books@Ovid, PsycARTICLES Full Text, EMBASE Classic+Embase, DARE (Database of Abstract of Reviews of Effectiveness) and the Cochrane Library electronic database. Search term included depression, collaborative care, physician family and allied health professional. RCTs comparing collaborative care to usual care for depression in primary care were included. Titles and abstracts were independently examined by two reviewers, who extracted from the included trials information on participants' characteristics, type of intervention, features of collaborative care and type of outcome measure. The 17 papers included, regarding 15 RCTs, involved 3240 participants. Primary analyses showed that collaborative care models were associated with greater improvement in depression outcomes in the short term, within 3 months (standardized mean difference (SMD) -0.19, 95% CI=-0.33; -0.05; p=0.006), medium term, between 4 and 11 months (SMD -0.24, 95% CI=-0.39; -0.09; p=0.001) and medium-long term, from 12 months and over (SMD -0.21, 95% CI=-0.37; -0.04; p=0.01), compared to usual care. The present review, specifically focusing on European countries, shows that collaborative care is more effective than treatment as usual in improving depression outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Late-life depression in the primary care setting: Challenges, collaborative care, and prevention

PubMed Central

Hall, Charles A.; Reynolds, Charles F.

2014-01-01

Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy. PMID:24996484

Toward Equity and Diversity in Literacy Research, Policy, and Practice: A Critical, Global Approach

ERIC Educational Resources Information Center

Morrell, Ernest

2017-01-01

Can growing inequities between rich and poor and massive manifestations of hatred and intolerance amid rising tides of global populism inspire a focus on equity and diversity in literacy research, policy, and practice? Can such calls for change be collaborative rather than competitive? Can we envision self-love, wellness, and intercultural…

A Rising Tide of Digitization--The Ohio Memory Project

ERIC Educational Resources Information Center

Kupfer, Shannon

2010-01-01

In 2009, after a year of planning and preparation, the second generation of Ohio Memory was launched. A collaborative effort of the Ohio Historical Society (OHS) and the State Library of Ohio, Ohio Memory is a repository for more than 75,000 digital items, including photographs, journals, and other manuscript materials, as well as print documents…

"Google Reigns Triumphant"?: Stemming the Tide of Googlitis via Collaborative, Situated Information Literacy Instruction

ERIC Educational Resources Information Center

Leibiger, Carol A.

2011-01-01

Googlitis, the overreliance on search engines for research and the resulting development of poor searching skills, is a recognized problem among today's students. Google is not an effective research tool because, in addition to encouraging keyword searching at the expense of more powerful subject searching, it only accesses the Surface Web and is…

What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review.

PubMed

Wood, Emily; Ohlsen, Sally; Ricketts, Thomas

2017-05-01

Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care. A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care. The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities. Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators. Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Cost Effectiveness of On-site versus Off-site Depression Collaborative Care in Rural Federally Qualified Health Centers

PubMed Central

Pyne, Jeffrey M.; Fortney, John C.; Mouden, Sip; Lu, Liya; Hudson, Teresa J; Mittal, Dinesh

2018-01-01

Objective Collaborative care for depression is effective and cost-effective in primary care settings. However, there is minimal evidence to inform the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in Federally Qualified Health Centers (FQHCs). Methods Multi-site randomized pragmatic comparative cost-effectiveness trial. 19,285 patients were screened for depression, 14.8% (n=2,863) screened positive (PHQ9 ≥10) and 364 were enrolled. Telephone interview data were collected at baseline, 6-, 12-, and 18-months. Base case analysis used Arkansas FQHC healthcare costs and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, Medical Outcomes Study SF-12, and Quality of Well Being scale (QWB). Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. Results Mean base case FQHC incremental cost-effectiveness ratio (ICER) using depression-free days was $10.78/depression-free day. Mean base case ICERs using QALYs ranged from $14,754/QALY (depression-free day QALY) to $37,261/QALY (QWB QALY). Mean secondary national ICER using depression-free days was $8.43/depression-free day and using QALYs ranged from $11,532/QALY (depression-free day QALY) to $29,234/QALY (QWB QALY). Conclusions These results support the cost-effectiveness of the TBCC intervention in medically underserved primary care settings. Results can inform the decision about whether to insource (make) or outsource (buy) depression care management in the FQHC setting within the current context of Patient-Centered Medical Home, value-based purchasing, and potential bundled payments for depression care. The www.clinicaltrials.gov # for this study is NCT00439452. PMID:25686811

The Depression Inventory Development Workgroup: A Collaborative, Empirically Driven Initiative to Develop a New Assessment Tool for Major Depressive Disorder.

PubMed

Vaccarino, Anthony L; Evans, Kenneth R; Kalali, Amir H; Kennedy, Sidney H; Engelhardt, Nina; Frey, Benicio N; Greist, John H; Kobak, Kenneth A; Lam, Raymond W; MacQueen, Glenda; Milev, Roumen; Placenza, Franca M; Ravindran, Arun V; Sheehan, David V; Sills, Terrence; Williams, Janet B W

2016-01-01

The Depression Inventory Development project is an initiative of the International Society for CNS Drug Development whose goal is to develop a comprehensive and psychometrically sound measurement tool to be utilized as a primary endpoint in clinical trials for major depressive disorder. Using an iterative process between field testing and psychometric analysis and drawing upon expertise of international researchers in depression, the Depression Inventory Development team has established an empirically driven and collaborative protocol for the creation of items to assess symptoms in major depressive disorder. Depression-relevant symptom clusters were identified based on expert clinical and patient input. In addition, as an aid for symptom identification and item construction, the psychometric properties of existing clinical scales (assessing depression and related indications) were evaluated using blinded datasets from pharmaceutical antidepressant drug trials. A series of field tests in patients with major depressive disorder provided the team with data to inform the iterative process of scale development. We report here an overview of the Depression Inventory Development initiative, including results of the third iteration of items assessing symptoms related to anhedonia, cognition, fatigue, general malaise, motivation, anxiety, negative thinking, pain and appetite. The strategies adopted from the Depression Inventory Development program, as an empirically driven and collaborative process for scale development, have provided the foundation to develop and validate measurement tools in other therapeutic areas as well.

The "Tears of the Virgin" at Lakes Entrance, southeast Australia were made by the intertidal barnacle Chthamalus antennatus (Cirripedia: Thoracica) and cyanobacteria.

PubMed

Buckeridge, John S; Newman, William A

2017-05-01

Curious eroded depressions, most resembling an eye shedding an elongate tear, are found in gently sloping, intertidal, carbonate-rich arenite outcropping on the sea coast near Lakes Entrance, Victoria, southeast Australia. The depressions, known locally as "Tears of the Virgin," are evidently formed by multiple generations of a barnacle, Chthamalus antennatus Darwin, 1854 in association with cyanobacteria. While the round part of a depression offers the barnacle a modicum of protection from impacts during high tides, it is also partially inhabited by cyanobacteria, which extend into and tend to fill the elongate tear. As such, this appears to be the first case of mutualism between a higher invertebrate and cyanobacteria, with the cyanobacteria reducing the barnacle's risk of desiccation while receiving metabolic wastes from it during low tides. It is also the first record of a balanomorph barnacle eroding calcareous arenite beneath its shell, the net effect of which would be expected to reduce its adhesion to the substrate. However, the siliceous residue, resulting from the barnacle's dissolution of the more than 80% of the calcite-rich sedimentary rock, is sequestered in delicate folds on the inside of the shell wall as it grows. A brief review of cirripedes capable of excavation includes the first photographic documentation of excavation of a mollusc shell by a verrucomorph. © 2016 International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

From Crisis to Opportunity: French and Foreign Language Studies in the Twenty-First Century.

ERIC Educational Resources Information Center

Spencer, Samia I.

2003-01-01

In response to falling enrollments in French and a diminishing pool of high school teachers, faculty at Auburn University tried to turn the tide through a series of curricular and advocacy initiatives. They introduced new French majors in education and in international trade and a collaborative major with the Consumer Affairs Department in French…

An update to depression case management by practice nurses in primary care: a service evaluation.

PubMed

Murphy, R; Ekers, D; Webster, L

2014-01-01

There is a recognized need to enhance non-pharmaceutical interventions in a way that is more accessible to the primary care population. Collaborative care has been shown to have a positive impact upon depression symptoms and a core element of the collaborative care approach is the case manager. This paper is a service evaluation of a collaborative care intervention that uses primary care nurses as the depression case manager and is a follow-up to the service audit carried out by Ekers and Wilson. The results support the notion that primary care nurses are ideally placed for delivering care to depressed patients; especially in cases were a patient also has a comorbid long-term medical condition. There is a recognized need to enhance non-pharmaceutical interventions for depression in the primary care. This service evaluation of collaborative care for depression by primary care practice nurses is an update of Ekers and Wilson (2008), reporting outcomes 5 years following initial training. From an initial 13 trained practice nurses, three provided anonymized data. Mean post-treatment Patient Health Questionnaire-9 (PHQ9) score was 8 [standard deviation (SD) 6.53, n = 185], indicating a mean positive change in depression symptom level of 8.9 [SD 7.01, 95% confidence interval (CI) 7.89-9.93, P < 0.001]. Subgroup analysis for patients identified with a comorbid long-term conditions (LTC) mean post-treatment PHQ9 score was 9 (SD 7.72, n = 33), indicating a mean positive change in depression symptom level of 8.1 (SD 5.79, 95% CI 6.04-10.41, P < 0.001). Nurses provided feedback on the intervention showing potential areas that would benefit from further detailed qualitative review. It was concluded that primary care practice nurses would be ideally placed to deliver collaborative care to depression patients with comorbid LTCs. © 2014 John Wiley & Sons Ltd.

Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design.

PubMed

Wu, Shinyi; Ell, Kathleen; Gross-Schulman, Sandra G; Sklaroff, Laura Myerchin; Katon, Wayne J; Nezu, Art M; Lee, Pey-Jiuan; Vidyanti, Irene; Chou, Chih-Ping; Guterman, Jeffrey J

2014-03-01

Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities. Copyright © 2013 Elsevier Inc. All rights reserved.

Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs.

PubMed

Pyne, Jeffrey M; Fortney, John C; Mouden, Sip; Lu, Liya; Hudson, Teresa J; Mittal, Dinesh

2015-05-01

Collaborative care for depression in primary care settings is effective and cost-effective. However, there is minimal evidence to support the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in federally qualified health centers (FQHCs). In a multisite, randomized, pragmatic comparative cost-effectiveness trial, 19,285 patients were screened for depression, 2,863 (14.8%) screened positive, and 364 were enrolled. Telephone interview data were collected at baseline and at six, 12, and 18 months. Base case analysis used Arkansas FQHC health care costs, and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, the 12-Item Short-Form Survey, and the Quality of Well-Being (QWB) Scale. Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. The TBCC intervention resulted in more depression-free days and QALYs but at a greater cost than the PBCC intervention. The disease-specific (depression-free day) and generic (QALY) incremental cost-effectiveness ratios (ICERs) were below their respective ICER thresholds for implementation, suggesting that the TBCC intervention was more cost effective than the PBCC intervention. These results support the cost-effectiveness of TBCC in medically underserved primary care settings. Information about whether to insource (make) or outsource (buy) depression care management is important, given the current interest in patient-centered medical homes, value-based purchasing, and bundled payments for depression care.

Implementing collaborative primary care for depression and posttraumatic stress disorder: design and sample for a randomized trial in the U.S. military health system.

PubMed

Engel, Charles C; Bray, Robert M; Jaycox, Lisa H; Freed, Michael C; Zatzick, Doug; Lane, Marian E; Brambilla, Donald; Rae Olmsted, Kristine; Vandermaas-Peeler, Russ; Litz, Brett; Tanielian, Terri; Belsher, Bradley E; Evatt, Daniel P; Novak, Laura A; Unützer, Jürgen; Katon, Wayne J

2014-11-01

War-related trauma, posttraumatic stress disorder (PTSD), depression and suicide are common in US military members. Often, those affected do not seek treatment due to stigma and barriers to care. When care is sought, it often fails to meet quality standards. A randomized trial is assessing whether collaborative primary care improves quality and outcomes of PTSD and depression care in the US military health system. The aim of this study is to describe the design and sample for a randomized effectiveness trial of collaborative care for PTSD and depression in military members attending primary care. The STEPS-UP Trial (STepped Enhancement of PTSD Services Using Primary Care) is a 6 installation (18 clinic) randomized effectiveness trial in the US military health system. Study rationale, design, enrollment and sample characteristics are summarized. Military members attending primary care with suspected PTSD, depression or both were referred to care management and recruited for the trial (2592), and 1041 gave permission to contact for research participation. Of those, 666 (64%) met eligibility criteria, completed baseline assessments, and were randomized to 12 months of usual collaborative primary care versus STEPS-UP collaborative care. Implementation was locally managed for usual collaborative care and centrally managed for STEPS-UP. Research reassessments occurred at 3-, 6-, and 12-months. Baseline characteristics were similar across the two intervention groups. STEPS-UP will be the first large scale randomized effectiveness trial completed in the US military health system, assessing how an implementation model affects collaborative care impact on mental health outcomes. It promises lessons for health system change. Copyright © 2014 Elsevier Inc. All rights reserved.

Economics of collaborative care for management of depressive disorders: a community guide systematic review.

PubMed

Jacob, Verughese; Chattopadhyay, Sajal K; Sipe, Theresa Ann; Thota, Anilkrishna B; Byard, Guthrie J; Chapman, Daniel P

2012-05-01

Major depressive disorders are frequently underdiagnosed and undertreated. Collaborative Care models developed from the Chronic Care Model during the past 20 years have improved the quality of depression management in the community, raising intervention cost incrementally above usual care. This paper assesses the economic efficiency of collaborative care for management of depressive disorders by comparing its economic costs and economic benefits to usual care, as informed by a systematic review of the literature. The economic review of collaborative care for management of depressive disorders was conducted in tandem with a review of effectiveness, under the guidance of the Community Preventive Services Task Force, a nonfederal, independent group of public health leaders and experts. Economic review methods developed by the Guide to Community Preventive Services were used by two economists to screen, abstract, adjust, and summarize the economic evidence of collaborative care from societal and other perspectives. An earlier economic review that included eight RCTs was included as part of the evidence. The present economic review expanded the evidence with results from studies published from 1980 to 2009 and included both RCTs and other study designs. In addition to the eight RCTs included in the earlier review, 22 more studies of collaborative care that provided estimates for economic outcomes were identified, 20 of which were evaluations of actual interventions and two of which were based on models. Of seven studies that measured only economic benefits of collaborative care in terms of averted healthcare or productivity loss, four found positive economic benefits due to intervention and three found minimal or no incremental benefit. Of five studies that measured both benefits and costs, three found lower collaborative care cost because of reduced healthcare utilization or enhanced productivity, and one found the same for a subpopulation of the intervention group. One study found that willingness to pay for collaborative care exceeded program costs. Among six cost-utility studies, five found collaborative care was cost effective. In two modeled studies, one showed cost effectiveness based on comparison of $/disability-adjusted life-year to annual per capita income; the other demonstrated cost effectiveness based on the standard threshold of $50,000/quality-adjusted life year, unadjusted for inflation. Finally, six of eight studies in the earlier review reported that interventions were cost effective on the basis of the standard threshold. The evidence indicates that collaborative care for management of depressive disorders provides good economic value. Published by Elsevier Inc.

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.

PubMed

Richards, David A; Bower, Peter; Chew-Graham, Carolyn; Gask, Linda; Lovell, Karina; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Barkham, Michael; Bland, J Martin; Gilbody, Simon; Green, Colin; Lewis, Glyn; Manning, Chris; Kontopantelis, Evangelos; Hill, Jacqueline J; Hughes-Morley, Adwoa; Russell, Abigail

2016-02-01

Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. To determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. UK primary care practices (n = 51) in three UK primary care districts. A total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. In total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI -0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI -£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator. Collaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se. Current Controlled Trials ISRCTN32829227. This project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.

Observing Storm Surges from Space: A New Opportunity

NASA Astrophysics Data System (ADS)

Han, Guoqi; Ma, Zhimin; Chen, Dake; de Young, Brad; Chen, Nancy

2013-04-01

Coastal tide gauges can be used to monitor variations of a storm surge along the coast, but not in the cross-shelf direction. As a result, the cross-shelf structure of a storm surge has rarely been observed. In this study we focus on Hurricane Igor-induced storm surge off Newfoundland, Canada. Altimetric observations at about 2:30, September 22, 2010 UTC (hours after the passage of Hurricane Igor) reveal prominent cross-shelf variation of sea surface height during the storm passage, including a large nearshore slope and a mid-shelf depression. A significant coastal surge of 1 m derived from satellite altimetry is found to be consistent with tide-gauge measurements at nearby St. John's station. The post-storm sea level variations at St. John's and Argentia are argued to be associated with free equatorward-propagating continental shelf waves (with phase speeds of 11-13 m/s), generated along the northeast Newfoundland coast hours after the storm moved away from St. John's. The cross-shelf e-folding scale of the shelf wave was estimated to be ~100 km. We further show approximate agreement of altimetric and tide-gauge observations in the Gulf of Mexico during Hurricane Katrina (2005) and Isaac (2012). The study for the first time in the literature shows the robustness of satellite altimetry to observe storm surges, complementing tide-gauge observations for the analysis of storm surge characteristics and for the validation and improvement of storm surge models.

Evaluation of a depression screening and treatment program in primary care for patients with diabetes mellitus: insights and future directions.

PubMed

Palmer, Carrie; Vorderstrasse, Allison; Weil, Amy; Colford, Cristin; Dolan-Soto, Diane

2015-03-01

To evaluate a collaborative depression care program by assessing adherence to the program by internal medicine clinic (IMC) staff, and the program's effectiveness in treating depression in patients with diabetes mellitus. We also describe the rate of depression among patients with diabetes in the IMC. Data for this program were obtained from a de-identified disease registry and included 1312 outpatient IMC visits in adult patients with diabetes between March 2011 and September 2011. Collaborative depression care results in high rates of screening for and identification of depression, high rates of antidepressant utilization, and improved depression scores; however, more focused interventions are needed to improve diabetes outcomes in patients with depression and diabetes. The results indicate that the multidisciplinary IMC staff can work together with patients to identify and monitor depression within primary care. This study provides valuable information about models of depression care that can be implemented and evaluated in a clinical setting. ©2014 American Association of Nurse Practitioners.

Depositional evolution of the Lower Khuzestan plain (SW Iran) since the end of the Late Pleistocene

NASA Astrophysics Data System (ADS)

Bogemans, Frieda; Janssens, Rindert; Baeteman, Cecile

2017-09-01

A detailed sedimentological investigation of sixty-six cores supported by radiocarbon age determination enabled the reconstruction of the depositional environmental evolution since the end of the Late Pleistocene in the Iranian part of the Mesopotamian plain. Both fluvial and estuarine environments have been identified on the basis of the sediment characteristics and their between-core stratigraphic correlations. At the end of the Late Pleistocene the fluvial behaviour allowed only the deposition of sand. Prior to 12400-12040 yr cal BP the palaeohydraulics changed by which heterolithic fluvial facies were deposited. Shortly after 12400 - 12040 yr cal BP an erosional phase caused the incision of depressions most probably because of a climate change to further arid conditions. In the early Holocene, mud-dominated river systems filled the depressions; a situation that lasted at least until 7900 - 7700 yr cal BP. After this period tides invaded via the active channels in the downstream part of the area, which turned into an estuarine environment for a period of about 2000-2500 years. Tidal influence diminished and stopped around 5000 yr cal BP because of progradation. Fluvial processes dominated again the sedimentary environment in the study area, except at the southern margin of it where tides controlled, although very locally, the environment.

Comparative Studies of Collaborative Team Depression Care Adoption in Safety Net Clinics

ERIC Educational Resources Information Center

Ell, Kathleen; Wu, Shinyi; Guterman, Jeffrey; Schulman, Sandra-Gross; Sklaroff, Laura; Lee, Pey-Jiuan

2018-01-01

Purpose: To evaluate three approaches adopting collaborative depression care model in Los Angeles County safety net clinics with predominantly Latino type 2 diabetes patients. Methods: Pre-post differences in treatment rates and symptom reductions were compared between baseline, 6-month, and 12-month follow-ups for each approach: (a) Multifaceted…

Effectiveness and cost-effectiveness of transmural collaborative care with consultation letter (TCCCL) and duloxetine for major depressive disorder (MDD) and (sub)chronic pain in collaboration with primary care: design of a randomized placebo-controlled multi-Centre trial: TCC:PAINDIP.

PubMed

de Heer, Eric W; Dekker, Jack; van Eck van der Sluijs, Jonna F; Beekman, Aartjan Tf; van Marwijk, Harm Wj; Holwerda, Tjalling J; Bet, Pierre M; Roth, Joost; Hakkaart-Van Roijen, Leona; Ringoir, Lianne; Kat, Fiona; van der Feltz-Cornelis, Christina M

2013-05-24

The comorbidity of pain and depression is associated with high disease burden for patients in terms of disability, wellbeing, and use of medical care. Patients with major and minor depression often present themselves with pain to a general practitioner and recognition of depression in such cases is low, but evolving. Also, physical symptoms, including pain, in major depressive disorder, predict a poorer response to treatment. A multi-faceted, patient-tailored treatment programme, like collaborative care, is promising. However, treatment of chronic pain conditions in depressive patients has, so far, received limited attention in research. Cost effectiveness of an integrated approach of pain in depressed patients has not been studied. This study is a placebo controlled double blind, three armed randomized multi centre trial. Patients with (sub)chronic pain and a depressive disorder are randomized to either a) collaborative care with duloxetine, b) collaborative care with placebo or c) duloxetine alone. 189 completers are needed to attain sufficient power to show a clinically significant effect of 0.6 SD on the primary outcome measures (PHQ-9 score). Data on depression, anxiety, mental and physical health, medication adherence, medication tolerability, quality of life, patient-doctor relationship, coping, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. This study enables us to show the value of a closely monitored integrated treatment model above usual pharmacological treatment. Furthermore, a comparison with a placebo arm enables us to evaluate effectiveness of duloxetine in this population in a real life setting. Also, this study will provide evidence-based treatments and tools for their implementation in practice. This will facilitate generalization and implementation of results of this study. Moreover, patients included in this study are screened for pain symptoms, differentiating between nociceptive and neuropathic pain. Therefore, pain relief can be thoroughly evaluated. NTR1089.

Sustainability of depression care improvements: success of a practice change improvement collaborative.

PubMed

Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

2010-01-01

Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

Improving the quality of depression and pain care in multiple sclerosis using collaborative care: The MS-care trial protocol.

PubMed

Ehde, Dawn M; Alschuler, Kevin N; Sullivan, Mark D; Molton, Ivan P; Ciol, Marcia A; Bombardier, Charles H; Curran, Mary C; Gertz, Kevin J; Wundes, Annette; Fann, Jesse R

2018-01-01

Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044. Copyright © 2017 Elsevier Inc. All rights reserved.

Effectiveness in Regular Practice of Collaborative Care for Depression Among Adolescents: A Retrospective Cohort Study.

PubMed

Shippee, Nathan D; Mattson, Angela; Brennan, RoxAnne; Huxsahl, John; Billings, Marcie L; Williams, Mark D

2018-05-01

Depression is common among adolescents, but many lack ready access to mental health services. Integrated models of care for depression are needed, along with evidence to support their use in regular practice. The authors examined the effectiveness of an ongoing collaborative care program for depressed adolescents embedded in a busy primary care practice. This retrospective cohort study assessed EMERALD (Early Management and Evidence-based Recognition of Adolescents Living with Depression), a collaborative care program. All patients ages 12-17 and age 18 and still in high school with a score of ≥10 on the nine-item Patient Health Questionnaire for Adolescents (PHQ-9A) and without a diagnosis of bipolar disorder were eligible. The sample included 162 EMERALD participants and 499 similarly eligible non-EMERALD patients. Outcomes were six-month remission of depression (score <5) and six-month treatment response (>50% reduction from baseline) as measured by the PHQ-9A. Analyses included logistic regression and propensity score matching to adjust for differences in demographic factors and number of contacts-observations. After propensity score matching, EMERALD patients had better adjusted rates of depression remission (11 percentage points higher, p=.035) and treatment response (14 percentage points higher, p<.001) than comparison patients. Results from primary analyses were as conservative as or more conservative than results from all sensitivity analyses tested. Collaborative care for adolescents in regular practice led to better remission and treatment response than usual care. Future studies could examine which groups might benefit most and flexible payment models to support these services.

Cost-effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics

PubMed Central

Fortney, John C; Gifford, Allen L; Rimland, David; Monson, Thomas; Rodriguez-Barradas, Maria C.; Pyne, Jeffrey M

2015-01-01

Objective To examine the cost-effectiveness of the HITIDES intervention. Design Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care. Setting Three Veterans Health Administration (VHA) HIV clinics in the Southern US. Subjects 249 HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care. Intervention HITIDES consisted of an off-site HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines. Main outcome measure(s) Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost effectiveness ratios (ICERs) and net health benefit (NHB). ICER distributions were generated using nonparametric bootstrap with replacement sampling. Results The HITIDES intervention was more effective and cost-saving compared to usual care in 78% of bootstrapped samples. The intervention NHB was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY. Conclusions In HIV clinic settings this intervention was more effective and cost-saving compared to usual care. Implementation of off-site depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients, but also maximizes the efficient use of limited healthcare resources. PMID:26102447

The Costs and Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care Settings: A Randomized Clinical Trial.

PubMed

Wright, Davene R; Haaland, Wren L; Ludman, Evette; McCauley, Elizabeth; Lindenbaum, Jeffrey; Richardson, Laura P

2016-11-01

Depression is one of the most common adolescent chronic health conditions and can lead to increased health care use. Collaborative care models have been shown to be effective in improving adolescent depressive symptoms, but there are few data on the effect of such a model on costs. To evaluate the costs and cost-effectiveness of a collaborative care model for treatment of adolescent major depressive disorder in primary care settings. This randomized clinical trial was conducted between April 1, 2010, and April 30, 2013, at 9 primary care clinics in the Group Health system in Washington State. Participants were adolescents (age range, 13-17 years) with depression who participated in the Reaching Out to Adolescents in Distress (ROAD) collaborative care intervention trial. A 12-month collaborative care intervention included an initial in-person engagement session, delivery of evidence-based treatments, and regular follow-up by master's level clinicians. Youth in the usual care control condition received depression screening results and could access mental health services and obtain medications through Group Health. Cost outcomes included intervention costs and per capita health plan costs, calculated from the payer perspective using administrative records. The primary effectiveness outcome was the difference in quality-adjusted life-years (QALYs) between groups from baseline to 12 months. The QALYs were calculated using Child Depression Rating Scale-Revised scores measured during the clinical trial. Cost and QALYs were used to calculate an incremental cost-effectiveness ratio. Of those screened, 105 youths met criteria for entry into the study, and 101 were randomized to the intervention (n = 50) and usual care (n = 51) groups. Overall health plan costs were not significantly different between the intervention ($5161; 95% CI, $3564-$7070) and usual care ($5752; 95% CI, $3814-$7952) groups. Intervention delivery cost an additional $1475 (95% CI, $1230-$1695) per person. The intervention group had a mean daily utility value of 0.78 (95% CI, 0.75-0.80) vs 0.73 (95% CI, 0.71-0.76) for the usual care group. The net mean difference in effectiveness was 0.04 (95% CI, 0.02-0.09) QALY at $883 above usual care. The mean incremental cost-effectiveness ratio was $18 239 (95% CI, dominant to $24 408) per QALY gained, with dominant indicating that the intervention resulted in both a net cost savings and a net increase in QALYs. Collaborative care for adolescent depression appears to be cost-effective, with 95% CIs far below the strictest willingness-to-pay thresholds. These findings support the use of collaborative care interventions to treat depression among adolescent youth. clinicaltrials.gov Identifier: NCT01140464.

CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial.

PubMed

Overend, Karen; Lewis, Helen; Bailey, Della; Bosanquet, Kate; Chew-Graham, Carolyn; Ekers, David; Gascoyne, Samantha; Hems, Deborah; Holmes, John; Keding, Ada; McMillan, Dean; Meer, Shaista; Meredith, Jodi; Mitchell, Natasha; Nutbrown, Sarah; Parrott, Steve; Richards, David; Traviss, Gemma; Trépel, Dominic; Woodhouse, Rebecca; Gilbody, Simon

2014-11-19

Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. ISRCTN45842879 (24 July 2012).

Ice-Shelf Tidal Flexure and Subglacial Pressure Variations

NASA Technical Reports Server (NTRS)

Walker, Ryan T.; Parizek, Byron R.; Alley, Richard B.; Anandakrishnan, Sridhar; Riverman, Kiya L.; Christianson, Knut

2013-01-01

We develop a model of an ice shelf-ice stream system as a viscoelastic beam partially supported by an elastic foundation. When bed rock near the grounding line acts as a fulcrum, leverage from the ice shelf dropping at low tide can cause significant (approx 1 cm) uplift in the first few kilometers of grounded ice.This uplift and the corresponding depression at high tide lead to basal pressure variations of sufficient magnitude to influence subglacial hydrology.Tidal flexure may thus affect basal lubrication, sediment flow, and till strength, all of which are significant factors in ice-stream dynamics and grounding-line stability. Under certain circumstances, our results suggest the possibility of seawater being drawn into the subglacial water system. The presence of sea water beneath grounded ice would significantly change the radar reflectivity of the grounding zone and complicate the interpretation of grounded versus floating ice based on ice-penetrating radar observations.

The complete spectrum of the equatorial electrojet related to solar tides: CHAMP observations

NASA Astrophysics Data System (ADS)

Lühr, H.; Manoj, C.

2013-08-01

Based on 10 yr of magnetic field measurements by the CHAMP satellite we draw a detailed picture of the equatorial electrojet (EEJ) tidal variations. For the first time the complete EEJ spectrum related to average solar tides has been compiled. A large fraction of the resulting spectrum is related to the switch on/off of the EEJ between day and night. This effect has carefully been considered when interpreting the results. As expected, largest amplitudes are caused by the migrating tides representing the mean diurnal variation. Higher harmonics of the daily variations show a 1/f fall-off in amplitude. Such a spectrum is required to represent the vanishing of the EEJ current at night. The migrating tidal signal exhibits a distinct annual variation with large amplitudes during December solstice and equinox seasons but a depression by a factor of 1.7 around June-July. A rich spectrum of non-migrating tidal effects is deduced. Most prominent is the four-peaked longitudinal pattern around August. Almost 90% of the structure can be attributed to the diurnal eastward-propagating tide DE3. In addition the westward-propagating DW5 is contributing to wave-4. The second-largest non-migrating tide is the semi-diurnal SW4 around December solstice. It causes a wave-2 feature in satellite observations. The three-peaked longitudinal pattern, often quoted as typical for the December season, is significantly weaker. During the months around May-June a prominent wave-1 feature appears. To first order it represents a stationary planetary wave SPW1 which causes an intensification of the EEJ at western longitudes beyond 60° W and a weakening over Africa/India. In addition, a prominent ter-diurnal non-migrating tide TW4 causes the EEJ to peak later, at hours past 14:00 local time in the western sector. A particularly interesting non-migrating tide is the semi-diurnal SW3. It causes largest EEJ amplitudes from October through December. This tidal component shows a strong dependence on solar flux level with increasing amplitudes towards solar maximum. We are not aware of any previous studies mentioning this behaviour of SW3. The main focus of this study is to present the observed EEJ spectrum and its relation to tidal driving. For several of the identified spectral components we cannot offer convincing explanations for the generation mechanisms.

Moving beyond Depression: A Collaborative Approach to Treating Depressed Mothers in Home Visiting Programs

ERIC Educational Resources Information Center

Ammerman, Robert T.; Putnam, Frank W.; Teeters, Angelique R.; Van Ginkel, Judith B.

2014-01-01

Research indicates that up to half of mothers in home visiting experience clinically significant levels of depression during their participation in services. Depression alters maternal life course, negatively impacts child development, and contributes to poorer home visiting outcomes. This article describes the Moving Beyond Depression (MBD)…

Documentation and hydrologic analysis of Hurricane Sandy in New Jersey, October 29–30, 2012

USGS Publications Warehouse

Suro, Thomas P.; Deetz, Anna; Hearn, Paul

2016-11-17

In 2012, a late season tropical depression developed into a tropical storm and later a hurricane. The hurricane, named “Hurricane Sandy,” gained strength to a Category 3 storm on October 25, 2012, and underwent several transitions on its approach to the mid-Atlantic region of the eastern coast of the United States. By October 28, 2012, Hurricane Sandy had strengthened into the largest hurricane ever recorded in the North Atlantic and was tracking parallel to the east coast of United States, heading toward New Jersey. On October 29, 2012, the storm turned west-northwest and made landfall near Atlantic City, N.J. The high winds and wind-driven storm surge caused massive damage along the entire coastline of New Jersey. Millions of people were left without power or communication networks. Many homes were completely destroyed. Sand dunes were eroded, and the barrier island at Mantoloking was breached, connecting the ocean with Barnegat Bay.Several days before the storm made landfall in New Jersey, the U.S. Geological Survey (USGS) made a decision to deploy a temporary network of storm-tide sensors and barometric pressure sensors from Virginia to Maine to supplement the existing USGS and National Oceanic and Atmospheric Administration (NOAA) networks of permanent tide monitoring stations. After the storm made landfall, the USGS conducted a sensor data recovery and high-water-mark collection campaign in cooperation with the Federal Emergency Management Agency (FEMA).Peak storm-tide elevations documented at USGS tide gages, tidal crest-stage gages, temporary storm sensor locations, and high-water-mark sites indicate the area from southern Monmouth County, N.J., north through Raritan Bay, N.J., had the highest peak storm-tide elevations during this storm. The USGS tide gages at Raritan River at South Amboy and Raritan Bay at Keansburg, part of the New Jersey Tide Telemetry System, each recorded peak storm-tide elevations of greater than 13 feet (ft)—more than 5 ft higher than the previously recorded period-of-record maximum. A comparison of peak storm-tide elevations to preliminary FEMA Coastal Flood Insurance Study flood elevations indicated that these areas experienced the highest recurrence intervals along the coast of New Jersey. Analysis showed peak storm-tide elevations exceeded the 100-year FEMA flood elevations in many parts of Middlesex, Union, Essex, Hudson, and Bergen Counties, and peak storm-tide elevations at many locations in Monmouth County exceeded the 500-year recurrence interval.A level 1 HAZUS (HAZards United States) analysis was done for the counties in New Jersey affected by flooding to estimate total building stock losses. The aggregated total building stock losses estimated by HAZUS for New Jersey, on the basis of the final inundation verified by USGS high-water marks, was almost $19 billion. A comparison of Hurricane Sandy with historic coastal storms showed that peak storm-tide elevations associated with Hurricane Sandy exceeded most of the previously documented elevations associated with the storms of December 1992, March 1962, September 1960, and September 1944 at many coastal communities in New Jersey. This scientific investigation report was prepared in cooperation with FEMA to document flood processes and flood damages resulting from this storm and to assist in future flood mitigation actions in New Jersey.

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems.

PubMed

Knowles, Sarah E; Chew-Graham, Carolyn; Coupe, Nia; Adeyemi, Isabel; Keyworth, Chris; Thampy, Harish; Coventry, Peter A

2013-09-20

Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems

PubMed Central

2013-01-01

Background Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. Methods A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Results Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Conclusions Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice. PMID:24053257

Internal tides affect benthic community structure in an energetic submarine canyon off SW Taiwan

NASA Astrophysics Data System (ADS)

Liao, Jian-Xiang; Chen, Guan-Ming; Chiou, Ming-Da; Jan, Sen; Wei, Chih-Lin

2017-07-01

Submarine canyons are major conduits of terrestrial and shelf organic matter, potentially benefiting the seafloor communities in the food-deprived deep sea; however, strong bottom currents driven by internal tides and the potentially frequent turbidity currents triggered by storm surges, river flooding, and earthquakes may negatively impact the benthos. In this study, we investigated the upper Gaoping Submarine Canyon (GPSC), a high-sediment-yield canyon connected to a small mountain river (SMR) off southwest (SW) Taiwan. By contrasting the benthic meiofaunal and macrofaunal communities within and outside the GPSC, we examined how food supplies and disturbance influenced the benthic community assemblages. The benthic communities in the upper GPSC were mainly a nested subset of the adjacent slope assemblages. Several meiofaunal (e.g. ostracods) and macrofaunal taxa (e.g. peracarid crustaceans and mollusks) that typically occurred on the slope were lost from the canyon. The polychaete families switched from diverse feeding guilds on the slope to motile subsurface deposit feeders dominant in the canyon. The diminishing of epibenthic peracarids and proliferation of deep burrowing polychaetes in the GPSC resulted in macrofauna occurring largely within deeper sediment horizons in the canyon than on the slope. The densities and numbers of taxa were depressed with distinct and more variable composition in the canyon than on the adjacent slope. Both the densities and numbers of taxa were negatively influenced by internal tide flushing and positively influenced by food availability; however, the internal tides also negatively influenced the food supplies. While the meiofauna and macrofauna densities were both depressed by the extreme physical conditions in the GPSC, only the macrofaunal densities increased with depth in the canyon, presumably related to increased frequency and intensity of disturbance toward the canyon head. The population densities of meiofauna, on the other hand, rebounded more rapidly due to their fast growth rate and short generation time and thus did not display bathymetric pattern in the canyon. To our knowledge, this is the first benthic ecological study in a submarine canyon connected to a high-sediment-yield SMR. The biological responses to extreme physical conditions in the GPSC could have broad implications on understanding the anthropogenic and climate change impacts in the deep-sea ecosystems.

Facies transition and depositional architecture of the Late Eocene tide-dominated delta in northern coast of Birket Qarun, Fayum, Egypt

NASA Astrophysics Data System (ADS)

Abdel-Fattah, Zaki A.

2016-07-01

Late Eocene successions in the Fayum Depression display notable facies transition from open-marine to brackish-marine realms. Stratigraphic and sedimentologic characteristics of the depositional facies are integrated with ichnological data for the recognition of four facies associations (FA1 to FA4). The transition from open-marine sandstones (FA1) to the brackish-marine deposits (FA2) heralds a transgressive - regressive dislocation. The shallowing- and coarsening-upward progradation from the basal prodelta mudstone-dominated facies (FA2a) to deltafront heterolithics (FA2b) and sandstone facies (FA2c) are overlain by finning-upward delta plain deposits which are expressed by the delta plain mudstone (FA2d) and erosive-based distributary channel fills (FA4). Prodelta/deltfront deposits of FA2 are arranged in thinning- and coarsening-upward parasequences which are stacked in a shallowing-upward progressive cycle. Shallow-marine fossiliferous sandstones (FA3) mark the basal part of each parasequence. Stratigraphic and depositional architectures reflect a tide-dominated delta rather than an estuarine and incised valley (IV) model. This can be evinced by the progressive facies architecture, absence of basal regional incision or a subaerial unconformity and the stratigraphic position above a maximum flooding surface (MFS), in addition to the presence of multiple tidally-influenced distributary channels. Stratigraphic and depositional characteristics of the suggested model resemble those of modern tide-dominated deltaic systems. Accordingly, this model contributes to our understanding of the depositional models for analogous brackish-marine environments, particularly tide-dominated deltas in the rock record.

Collaborative care for depression and anxiety problems.

PubMed

Archer, Janine; Bower, Peter; Gilbody, Simon; Lovell, Karina; Richards, David; Gask, Linda; Dickens, Chris; Coventry, Peter

2012-10-17

Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. To assess the effectiveness of collaborative care for patients with depression or anxiety. We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.

Cost-Effectiveness of Collaborative Care for Depression in UK Primary Care: Economic Evaluation of a Randomised Controlled Trial (CADET)

PubMed Central

Green, Colin; Richards, David A.; Hill, Jacqueline J.; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J. Martin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

2014-01-01

Background Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking. Aims To assess the cost-effectiveness of collaborative care in a UK primary care setting. Methods An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane. Results The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: –0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: –202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual. Conclusion Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting. PMID:25121991

Cost effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes

PubMed Central

Hay, Joel W.; Katon, Wayne J.; Ell, Kathleen; Lee, Pey-Jiuan; Guterman, Jeffrey J.

2011-01-01

OBJECTIVE To evaluate cost effectiveness of a socio-culturally adapted collaborative depression care program among low-income Hispanics with diabetes. RESEARCH DESIGN AND METHODS A randomized controlled trial of 387 diabetes patients (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program (MDDP) aimed at increasing patient exposure to evidenced-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Dept. of Health Services claims records. Patient reported outcomes included SF-12 and PHQ-9-calculated depression-free days (DFDs). RESULTS Intervention patients had significantly greater SF-12 utility improvement from baseline compared to controls over the 18 month evaluation period (4.8%; P<.001) and a corresponding significant improvement in DFDs (43.0; P<.001). Medical cost differences were not statistically significant in OLS and log-transformed cost regressions. The average costs of the MDDP study intervention were $515 per patient. The program cost effectiveness averaged $4,053/QALY per MDDP recipient and was more than 90% likely to fall below $12,000/QALY. CONCLUSIONS Socio-culturally adapted collaborative depression care improved utility and quality of life in predominantly low income Hispanic diabetes patients and was highly cost effective. PMID:22433755

[Collaborative and stepped care for depression: Development of a model project within the Hamburg Network for Mental Health (psychenet.de)].

PubMed

Härter, Martin; Heddaeus, Daniela; Steinmann, Maya; Schreiber, Robert; Brettschneider, Christian; König, Hans-Helmut; Watzke, Birgit

2015-04-01

Depression is one of the most widespread mental disorders in Germany and causes a great suffering and involves high costs. Guidelines recommend stepped and interdisciplinary collaborative care models for the treatment of depression. Stepped and collaborative care models are described regarding their efficacy and cost-effectiveness. A current model project within the Hamburg Network for Mental Health exemplifies how guideline-based stepped diagnostics and treatment incorporating innovative low-intensity interventions are implemented by a large network of health care professionals and clinics. An accompanying evaluation using a cluster randomized controlled design assesses depressive symptom reduction and cost-effectiveness for patients treated within "Health Network Depression" ("Gesundheitsnetz Depression", a subproject of psychenet.de) compared with patients treated in routine care. Over 90 partners from inpatient and outpatient treatment have been successfully involved in recruiting over 600 patients within the stepped care model. Communication in the network was greatly facilitated by the use of an innovative online tool for the supply and reservation of treatment capacities. The participating professionals profit from the improved infrastructure and the implementation of advanced training and quality circle work. New treatment models can greatly improve the treatment of depression owing to their explicit reference to guidelines, the establishment of algorithms for diagnostics and treatment, the integration of practices and clinics, in addition to the implementation of low-intensity treatment alternatives. These models could promote the development of a disease management program for depression.

Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression.

PubMed

Barr, Paul J; Forcino, Rachel C; Mishra, Manish; Blitzer, Rachel; Elwyn, Glyn

2016-01-08

To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 'important features' in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. Online cross-sectional surveys fielded in September to December 2014. We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was 'Will the treatment work?' Clinicians were aware of consumers' priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing misalignment in information priorities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes.

PubMed

Hay, Joel W; Katon, Wayne J; Ell, Kathleen; Lee, Pey-Jiuan; Guterman, Jeffrey J

2012-01-01

To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes. A randomized controlled trial of 387 patients with diabetes (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program aimed at increasing patient exposure to evidence-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Department of Health Services claims records. Patient-reported outcomes included Short-Form Health Survey-12 and Patient Health Questionnaire-9-calculated depression-free days. Intervention patients had significantly greater Short-Form Health Survey-12 utility improvement from baseline compared with controls over the 18-month evaluation period (4.8%; P < 0.001) and a corresponding significant improvement in depression-free days (43.0; P < 0.001). Medical cost differences were not statistically significant in ordinary least squares and log-transformed cost regressions. The average costs of the Multifaceted Diabetes and Depression Program study intervention were $515 per patient. The program's cost-effectiveness averaged $4053 per quality-adjusted life-year per MDDP recipient and was more than 90% likely to fall below $12,000 per quality-adjusted life-year. Socioculturally adapted collaborative depression care improved utility and quality of life in predominantly low-income Hispanic patients with diabetes and was highly cost-effective. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges.

PubMed

Lipschitz, Jessica M; Benzer, Justin K; Miller, Christopher; Easley, Siena R; Leyson, Jenniffer; Post, Edward P; Burgess, James F

2017-10-10

The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes. Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders' agendas amidst competing priorities and logistics (staffing and space). Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable.

Insertion, Validation, and Application of Barotropic and Baroclinic Tides in 1/12 and 1/25 Degree Global HYCOM

DTIC Science & Technology

2012-09-30

Alterman, graduate student in the Applied Physics Program, University of Michigan: Alterman will collaborate with Arbic, NRL researchers , and...relationship that the lead PI of this proposal, Brian Arbic, has established since 2006 with the Naval Research Laboratory (NRL) and Florida State...NAVOCEANO), Stennis Space Center, MS. This project builds upon work begun with Naval Research Laboratory contract N000173-06-2-C003, and reported on in

Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial

PubMed Central

Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

2016-01-01

Objectives To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). Setting 36 primary care general practices in North West England. Participants 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Intervention Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. Outcome measures As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). Results The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI −30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI −0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Conclusions Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. Trial registration number ISRCTN80309252; Post-results. PMID:27855101

Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: the design of the MOMCare study.

PubMed

Grote, Nancy K; Katon, Wayne J; Lohr, Mary Jane; Carson, Kathy; Curran, Mary; Galvin, Erin; Russo, Joan E; Gregory, Marilyn

2014-09-01

Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services (MSS). Pregnant, public health patients, >18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9 (PHQ-9) or the Mini-International Neuropsychiatric Interview (MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline (one-year postpartum). 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making <$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% unplanned pregnancy. A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study. Copyright © 2014 Elsevier Inc. All rights reserved.

Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: The design of the MOMCare study*

PubMed Central

Grote, Nancy K.; Katon, Wayne J.; Lohr, Mary Jane; Carson, Kathy; Curran, Mary; Galvin, Erin; Russo, Joan E.; Gregory, Marilyn

2014-01-01

Background Depression during pregnancy has been demonstrated to be predictive of low birthweight, prematurity, and postpartum depression. These adverse outcomes potentially have lasting effects on maternal and child well-being. Socio-economically disadvantaged women are twice as likely as middle-class women to meet diagnostic criteria for antenatal major depression (MDD), but have proven difficult to engage and retain in treatment. Collaborative care treatment models for depression have not been evaluated for racially/ethnically diverse, pregnant women on Medicaid receiving care in a public health system. This paper describes the design, methodology, culturally relevant enhancements, and implementation of a randomized controlled trial of depression care management compared to public health Maternity Support Services(MSS). Methods Pregnant, public health patients, ≥18 years with a likely diagnosis of MDD or dysthymia, measured respectively by the Patient Health Questionnaire-9(PHQ-9) or the Mini-International Neuropsychiatric Interview(MINI), were randomized to the intervention or to public health MSS. The primary outcome was reduction in depression severity from baseline during pregnancy to 18-months post-baseline(one-year postpartum). Baseline Results 168 women with likely MDD (96.4%) and/or dysthymia (24.4%) were randomized. Average age was 27.6 years and gestational age was 22.4 weeks; 58.3% racial/ethnic minority; 71.4% unmarried; 22% no high school degree/GED; 65.3% unemployed; 42.1% making ≤$10,000 annually; 80.4% having recurrent depression; 64.6% PTSD, and 72% an unplanned pregnancy. Conclusions A collaborative care team, including a psychiatrist, psychologist, project manager, and 3 social workers, met weekly, collaborated with the patients' obstetrics providers, and monitored depression severity using an electronic tracking system. Potential sustainability of the intervention within a public health system requires further study. PMID:25016216

Stepped care for depression is easy to recommend, but harder to implement: results of an explorative study within primary care in the Netherlands.

PubMed

Hermens, Marleen L M; Muntingh, Anna; Franx, Gerdien; van Splunteren, Peter T; Nuyen, Jasper

2014-01-09

Depression is a common mental disorder with a high burden of disease which is mainly treated in primary care. It is unclear to what extent stepped care principles are applied in routine primary care. The first aim of this explorative study was to examine the gap between routine primary depression care and optimal care, as formulated in the depression guidelines. The second aim was to explore the facilitators and barriers that affect the provision of optimal care. Optimal care was operationalised by indicators covering the entire continuum of depression care: from prevention to chronic depression. Routine care was investigated by interviewing general practitioners (GPs) individually and together with other mental health care providers about the depression care they delivered collaboratively. Qualitative analysis of transcripts was performed using thematic coding. Additionally, the GPs completed a self-report questionnaire. Six GPs and 22 other (mostly primary) mental health care providers participated. The GPs and their primary care colleagues embraced a general stepped care approach. They offered psycho-education and counselling to mildly depressed patients. When the treatment effects were not satisfactory or patients were more severely depressed, the GPs offered, or referred to, psychotherapy or pharmacotherapy. Patients with a complex and severe depressive disorder were directly referred to specialised mental health care. However, GPs relied on their clinical judgment and rarely used instruments to assess and monitor the severity of depressive symptoms. Structured, evidence based interventions such as self-management and e-health were rarely offered to patients with depressive symptoms. Specific psychological interventions for relapse prevention or for chronically depressed patients were not available. A wide range of influencing factors for the provision of optimal depression care were put forward. Close collaboration with other mental health care professionals was considered an important factor for improvement by nearly all GPs. The management of depression in primary care seems in line with stepped care principles, although it can be improved by applying more elements of a stepped care approach. Collaboration between GPs and mental health care providers in primary care and secondary care should be enhanced.

The Miocene Sommières basin, SE France: Bioclastic carbonates in a tide-dominated depositional system

NASA Astrophysics Data System (ADS)

Reynaud, Jean-Yves; James, Noël P.

2012-12-01

The Miocene Sommières Basin in SE France is a semi-enclosed depression that was connected to the Mediterranean Sea by a flooded paleo-incised valley and then filled by a suite of sediments comprising carbonate grains coming from temperate factories that were largely deposited in tidal-dominated paleoenvironments. The strata are partitioned into two sequences that reflect repeated flooding of the incised valley system, one of several similar situations in this region of France. The carbonate grains are mostly bioclasts, namely from barnacles, bryozoans, coralline algae (encrusting, branching, and rhodoliths), echinoids, and benthic foraminifers (large and small) with ostracods, sponge spicules and planktic foraminifers prominent in muddy facies. Particles were produced by shallow water carbonate factories on hard substrates (valley walls in particular), associated with subaqueous dunes, and in deeper water basinal settings. Each depositional sequence is underlain by an eroded and bored hard surface that is progressively overlain by TST subaqueous tidal dunes or storm deposits that grade up, in one case, into HST marls (the HST of the upper sequence has been removed by erosion). The lower sequence is ebb tide dominated whereas the upper sequence is flood tide dominated. The succession is interpreted to represent a TST whose tidal currents were focused by the narrow valley and a HST that reflected flooding of the overbanks. This stratigraphic and depositional motif is comparable to that in other spatially separated Neogene paleovalleys that are filled with tide-dominated clastic carbonates in the region. Together with other recently documented similar systems, these limestones constitute an important new group of carbonate sand bodies in the carbonate depositional realm.

Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial)

PubMed Central

Bruce, Martha L.; Pearson, Jane L.

1999-01-01

Suicide is a major public health problem with greatest risk in the very old. This paper describes an approach to reducing the risk of suicide by intervening on depression in elderly primary care patients. Depression is an appropriate target for an intervention as it is highly prevalent in primary care, is a strong risk factor for suicide, and is more often than not inadequately treated. PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) is a National institute of Mental Health (NIMH)-funded collaborative study that is testing this approach to suicide risk prevention in 18 primary care practices in the United States. PROSPECT'S intervention of “guideline management” introduces a health specialist into the primary care setting to help physicians provide “on-time, on-target” treatment and long-term management of late-life depression following structured clinical guidelines. The effectiveness of the intervention in reducing suicidal risk and depression is evaluated by following a representative sample of older patients identified using a 2-stage design. PMID:22033641

FY08 DRMRP Clinical Trial: Strengthening Pathways to PTSD Recovery Using Systems-Level Intervention

DTIC Science & Technology

2016-05-01

consent forms and store them centrally at RTI for the required six year time period rather than storing the hard copies at their respective posts was...care. In progress. Lavelle T, et al. The cost-effectiveness of a collaborative care approach to treating depression and post -traumatic stress...effectiveness of a collaborative care approach to treating depression and post -traumatic stress disorder in military personnel. AcademyHealth

Bipolar mood cycles and lunar tidal cycles.

PubMed

Wehr, T A

2018-04-01

In 17 patients with rapid cycling bipolar disorder, time-series analyses detected synchronies between mood cycles and three lunar cycles that modulate the amplitude of the moon's semi-diurnal gravimetric tides: the 14.8-day spring-neap cycle, the 13.7-day declination cycle and the 206-day cycle of perigee-syzygies ('supermoons'). The analyses also revealed shifts among 1:2, 1:3, 2:3 and other modes of coupling of mood cycles to the two bi-weekly lunar cycles. These shifts appear to be responses to the conflicting demands of the mood cycles' being entrained simultaneously to two different bi-weekly lunar cycles with slightly different periods. Measurements of circadian rhythms in body temperature suggest a biological mechanism through which transits of one of the moon's semi-diurnal gravimetric tides might have driven the patients' bipolar cycles, by periodically entraining the circadian pacemaker to its 24.84-h rhythm and altering the pacemaker's phase-relationship to sleep in a manner that is known to cause switches from depression to mania.

Tide-related variability of TAG hydrothermal activity observed by deep-sea monitoring system and OBSH

NASA Astrophysics Data System (ADS)

Fujioka, Kantaro; Kobayashi, Kazuo; Kato, Kazuhiro; Aoki, Misumi; Mitsuzawa, Kyohiko; Kinoshita, Masataka; Nishizawa, Azusa

1997-12-01

Hydrothermal activities were monitored by an ocean bottom seismometer with hydrophone (OBSH) and a composite measuring system (Manatee) including CTD, current meter, transmission meter and cameras at a small depression on the TAG hydrothermal mound in the Mid-Atlantic Ridge. Low-frequency pressure pulses detected by the hydrophone with semi-diurnal periodicity seem to correspond to cycles of hydrothermal upflow from a small and short-lived smoker vent close to the observing site. The peaks of pressure pulses are synchronous with the maximum gradient of areal strain decrease due to tidal load release. Microearthquakes with very near epicenters occur sporadically and do not appear to be directly correlatable to hydrothermal venting. Temporal variations in bottom water temperature also have semi-diurnal periodicity but are more complicated than the pressure events. Temperatures may be affected both by upwelling of hot water and by lateral flow of the bottom current changing its directions with ocean tide.

Improving Care for Depression in Obstetrics and Gynecology: A Randomized Controlled Trial

PubMed Central

Melville, Jennifer L.; Reed, Susan D.; Russo, Joan; Croicu, Carmen A.; Ludman, Evette; LaRocco-Cockburn, Anna; Katon, Wayne

2014-01-01

OBJECTIVE To evaluate an evidence-based collaborative depression care intervention adapted to obstetrics and gynecology clinics compared with usual care. METHODS Two-site randomized controlled trial included screen-positive women (Patient Health Questionnaire-9 of at least 10) who then met criteria for major depression, dysthymia or both (Mini-International Neuropsychiatric Interview). Women were randomized to 12-months of collaborative depression management or usual care; 6, 12 and 18-month outcomes were compared. The primary outcomes were change from baseline to 12-months on depression symptoms and functional status. Secondary outcomes included at least 50% decrease and remission in depressive symptoms, global improvement, treatment satisfaction, and quality of care. RESULTS Participants were on average 39 years old, 44% were non-white and 56% had posttraumatic stress disorder. Intervention (n= 102) compared to usual care (n=103) patients had greater improvement in depressive symptoms at 12 months (P< .001) and 18 months (P=.004). The intervention group compared with usual care had improved functioning over 18 months (P< .05), were more likely to have an at least 50% decrease in depressive symptoms at 12 months (relative risk [RR]=1.74, 95% confidence interval [CI] 1.11–2.73), greater likelihood of at least 4 specialty mental health visits (6 month RR=2.70, 95% CI1.73–4.20; 12 month RR=2.53, 95% CI 1.63–3.94), adequate dose of antidepressant (6-month RR=1.64, 95% CI 1.03–2.60; 12-month RR=1.71, 95%CI 1.08 2.73), and greater satisfaction with care (6-month RR=1.70, 95% CI 1.19–2.44; 12-month RR=2.26, 95% CI 1.52–3.36). CONCLUSION Collaborative depression care adapted to women’s health settings improved depressive and functional outcomes and quality of depression care. PMID:24807320

The DEBOT Model, a New Global Barotropic Ocean Tidal Model: Test Computations and an Application in Related Geophysical Disciplines

NASA Astrophysics Data System (ADS)

Einspigel, D.; Sachl, L.; Martinec, Z.

2014-12-01

We present the DEBOT model, which is a new global barotropic ocean model. The DEBOT model is primarily designed for modelling of ocean flow generated by the tidal attraction of the Moon and the Sun, however it can be used for other ocean applications where the barotropic model is sufficient, for instance, a tsunami wave propagation. The model has been thoroughly tested by several different methods: 1) synthetic example which involves a tsunami-like wave propagation of an initial Gaussian depression and testing of the conservation of integral invariants, 2) a benchmark study with another barotropic model, the LSGbt model, has been performed and 3) results of realistic simulations have been compared with data from tide gauge measurements around the world. The test computations prove the validity of the numerical code and demonstrate the ability of the DEBOT model to simulate the realistic ocean tides. The DEBOT model will be principaly applied in related geophysical disciplines, for instance, in an investigation of an influence of the ocean tides on the geomagnetic field or the Earth's rotation. A module for modelling of the secondary poloidal magnetic field generated by an ocean flow is already implemented in the DEBOT model and preliminary results will be presented. The future aim is to assimilate magnetic data provided by the Swarm satellite mission into the ocean flow model.

The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression.

PubMed

Rollman, Bruce L; Belnap, Bea Herbeck; LeMenager, Michelle S; Mazumdar, Sati; Schulberg, Herbert C; Reynolds, Charles F

2009-02-01

To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery. BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) >or=10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians' "usual care." The primary hypothesis will test whether the intervention can produce an effect size of >or=0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs. Not applicable. This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.

Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review.

PubMed

Overbeck, Gritt; Davidsen, Annette Sofie; Kousgaard, Marius Brostrøm

2016-12-28

Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression. We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT). We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers. The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in settings outside the USA and the UK.

Managing Depression Among Homeless Mothers: Pilot Testing an Adapted Collaborative Care Intervention.

PubMed

Weinreb, Linda; Upshur, Carole C; Fletcher-Blake, Debbian; Reed, George; Frisard, Christine

2016-01-01

Although depression is common among homeless mothers, little progress has been made in testing treatment strategies for this group. We describe pilot test results of an adapted collaborative care model for homeless mothers with depression. We conducted a pilot intervention study of mothers screening positive for depression in 2 randomly selected shelter-based primary care clinics in New York over 18 months in 2010-2012. Study participants completed a psychosocial, health, and mental health assessment at baseline, 3 months, and 6 months. One-third of women screened positive for depression (123 of 328 women). Sixty-seven women (63.2% of the eligible sample) enrolled in the intervention. At 6 months, compared to usual-care women, intervention group women were more likely to be receiving depression treatment (40.0% vs 5.9%, P = .01) and antidepressant medication (73.3% vs 5.9%, P = .001, respectively) and had more primary care physician and care manager visits at both 3 months (74.3% vs 53.3%, P = .009 and 91.4% vs 26.7%, P < .001, respectively) and 6 months (46.7% vs 23.5%, P = .003 and 70% vs 17.7%, P = .001, respectively). More women in the intervention group compared to usual-care women reported ≥ 50% improvement in depression symptoms at 6 months (30% vs 5.9%, P = .07). This pilot study found that implementing an adapted collaborative care intervention was feasible in a shelter-based primary care clinic and had promising results that require further testing. ClinicalTrials.gov identifier: NCT02723058.

Reducing suicidal ideation in depressed older primary care patients.

PubMed

Unützer, Jürgen; Tang, Lingqi; Oishi, Sabine; Katon, Wayne; Williams, John W; Hunkeler, Enid; Hendrie, Hugh; Lin, Elizabeth H B; Levine, Stuart; Grypma, Lydia; Steffens, David C; Fields, Julie; Langston, Christopher

2006-10-01

To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults. Randomized, controlled trial. Eighteen diverse primary care clinics. One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. Primary care-based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients.

An Innovative Model of Depression Care Delivery: Peer Mentors in Collaboration with a Mental Health Professional to Relieve Depression in Older Adults

PubMed Central

Joo, Jin Hui; Hwang, Seungyoung; Abu, Hawa; Gallo, Joseph J.

2016-01-01

Objectives Traditional mental health services are not used by a majority of older adults with depression, suggesting a need for new methods of health service delivery. We conducted a pilot study using peer mentors to deliver depression care to older adults in collaboration with a mental health professional. We evaluated the acceptability of peer mentors to older adults and examined patient experiences of the intervention. Methods Six peer mentors met 30 patients for 1 hour weekly for 8 weeks. A mental health professional provided an initial clinical evaluation as well as supervision and guidance to peer mentors concurrent with patient meetings. We measured depressive symptoms at baseline and after study completion, and depressive symptoms and working alliance at weekly peer-patient meetings. We also interviewed participants and peer mentors to assess their experiences of the intervention. Results Ninety-six percent of patients attended all eight meetings with the peer mentor and PHQ-9 scores decreased for 85% of patients. Patients formed strong, trusting relationships with peer mentors. Patients emphasized the importance of trust, of developing a strong relationship, and of the credibility and communication skills of the peer mentor. Participants described benefits such as feeling hopeful, and reported changes in attitude, behavior, and insight. Conclusions Use of peer mentors working in collaboration with a mental health professional is promising as a model of depression care delivery for older adults. Testing of effectiveness is needed and processes of recruitment, role definition, and supervision should be further developed. PMID:27066731

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial.

PubMed

Llewellyn-Jones, R H; Baikie, K A; Smithers, H; Cohen, J; Snowdon, J; Tennant, C C

1999-09-11

To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Population of residential facility in Sydney living in self care units and hostels. 220 depressed residents aged >/=65 without severe cognitive impairment. The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Geriatric depression scale. Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

Cost-Effectiveness of Collaborative Care for the Treatment of Depressive Disorders in Primary Care: A Systematic Review

PubMed Central

Grochtdreis, Thomas; Brettschneider, Christian; Wegener, Annemarie; Watzke, Birgit; Riedel-Heller, Steffi; Härter, Martin; König, Hans-Helmut

2015-01-01

Background For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care. Purpose To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care. Methods A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration’s tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC) list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP). Results In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562. Conclusion Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year. PMID:25993034

Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

PubMed

Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

2016-10-07

To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. ISRCTN80309252; Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Assessing organizational readiness for depression care quality improvement: relative commitment and implementation capability.

PubMed

Rubenstein, Lisa V; Danz, Marjorie S; Crain, A Lauren; Glasgow, Russell E; Whitebird, Robin R; Solberg, Leif I

2014-12-02

Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice's commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. All five implementation capability measures independently predicted practice leaders' relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p <0.001), prior depression quality improvement activities (p <0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders' relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers.

Analogies between Cushing's disease and depression: a case report.

PubMed

Becker, L; Gold, P; Chrousos, G

1983-07-01

A case report is used to illustrate the difficult differential diagnostic dilemma between depression and Cushing's disease that has led to extensive scientific collaboration to test the hypothesis that both diagnoses may fall within a pathophysiological continuum. Unique to the collaborative study underway is the commitment of psychiatric clinical investigators to bring state of the art techniques for studying neurobiology in a disease traditionally viewed as medical, and of endocrinologists to address their expertise in a disease viewed primarily as psychiatric.

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series-Depression (CBS-D) Project

ERIC Educational Resources Information Center

Chung, Henry; Klein, Michael C.; Silverman, Daniel; Corson-Rikert, Janet; Davidson, Eleanor; Ellis, Patricia; Kasnakian, Caroline

2011-01-01

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to…

Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis.

PubMed

van der Feltz-Cornelis, Christina M; Nuyen, Jasper; Stoop, Corinne; Chan, Juliana; Jacobson, Alan M; Katon, Wayne; Snoek, Frank; Sartorius, Norman

2010-01-01

Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes. PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis. Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. amongst others, the number of RCTs is small. The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed. Copyright 2010 Elsevier Inc. All rights reserved.

Exploration of the Pathways to Delinquency for Female Adolescents with Depression: Implications for Cross-Systems Collaboration and Counseling

ERIC Educational Resources Information Center

Mellin, Elizabeth A.; Fang, Hong-Ning

2010-01-01

This study found that lack of involvement in prosocial institutions, affiliation with other troubled youth, and indifference regarding personal safety partially mediate the relationship between depression and delinquency among justice-involved female adolescents. The results suggest that depression may not be the primary conduit to delinquency.…

Collaborative care for depression symptoms in an outpatient cardiology setting: A randomized clinical trial.

PubMed

Carney, Robert M; Freedland, Kenneth E; Steinmeyer, Brian C; Rubin, Eugene H; Ewald, Gregory

2016-09-15

Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6months. There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p=.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p=0.34) after 6months, or in the number of hospitalizations after 12months (p=0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p=0.03). This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ketamine Metabolites for the Treatment of Depression and Pain | NCI Technology Transfer Center | TTC

Cancer.gov

The National Institute on Aging, Laboratory of Clinical Investigation, is seeking parties interested in collaborative research to co-develop ketamine metabolites for the treatment of different forms of depression and for alleviating pain.

The Impact of Posttraumatic Stress Disorder on the 6-Month Outcomes in Collaborative Care Management for Depression.

PubMed

Angstman, Kurt B; Marcelin, Alberto; Gonzalez, Cesar A; Kaufman, Tara K; Maxson, Julie A; Williams, Mark D

2016-07-01

Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms. © The Author(s) 2016.

Bipolar mood cycles and lunar tidal cycles

PubMed Central

Wehr, T A

2018-01-01

In 17 patients with rapid cycling bipolar disorder, time-series analyses detected synchronies between mood cycles and three lunar cycles that modulate the amplitude of the moon’s semi-diurnal gravimetric tides: the 14.8-day spring–neap cycle, the 13.7-day declination cycle and the 206-day cycle of perigee-syzygies (‘supermoons’). The analyses also revealed shifts among 1:2, 1:3, 2:3 and other modes of coupling of mood cycles to the two bi-weekly lunar cycles. These shifts appear to be responses to the conflicting demands of the mood cycles’ being entrained simultaneously to two different bi-weekly lunar cycles with slightly different periods. Measurements of circadian rhythms in body temperature suggest a biological mechanism through which transits of one of the moon’s semi-diurnal gravimetric tides might have driven the patients’ bipolar cycles, by periodically entraining the circadian pacemaker to its 24.84-h rhythm and altering the pacemaker’s phase-relationship to sleep in a manner that is known to cause switches from depression to mania. PMID:28115741

Identifying Depressed Older Adults in Primary Care: A Secondary Analysis of a Multisite Randomized Controlled Trial

PubMed Central

Voils, Corrine I.; Olsen, Maren K.; Williams, John W.; for the IMPACT Study Investigators

2008-01-01

Objective: To determine whether a subset of depressive symptoms could be identified to facilitate diagnosis of depression in older adults in primary care. Method: Secondary analysis was conducted on 898 participants aged 60 years or older with major depressive disorder and/or dysthymic disorder (according to DSM-IV criteria) who participated in the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) study, a multisite, randomized trial of collaborative care for depression (recruitment from July 1999 to August 2001). Linear regression was used to identify a core subset of depressive symptoms associated with decreased social, physical, and mental functioning. The sensitivity and specificity, adjusting for selection bias, were evaluated for these symptoms. The sensitivity and specificity of a second subset of 4 depressive symptoms previously validated in a midlife sample was also evaluated. Results: Psychomotor changes, fatigue, and suicidal ideation were associated with decreased functioning and served as the core set of symptoms. Adjusting for selection bias, the sensitivity of these 3 symptoms was 0.012 and specificity 0.994. The sensitivity of the 4 symptoms previously validated in a midlife sample was 0.019 and specificity was 0.997. Conclusion: We identified 3 depression symptoms that were highly specific for major depressive disorder in older adults. However, these symptoms and a previously identified subset were too insensitive for accurate diagnosis. Therefore, we recommend a full assessment of DSM-IV depression criteria for accurate diagnosis. PMID:18311416

Response of Water Levels in Devils Hole, Death Valley National Park, Nevada, to Atmospheric Loading, Earth Tides, and Earthquakes

NASA Astrophysics Data System (ADS)

Cutillo, P. A.; Ge, S.

2004-12-01

Devils Hole, home to the endangered Devils Hole pupfish (Cyprinodon diabolis) in Death Valley National Park, Nevada, is one of about 30 springs and the largest collapse depression in the Ash Meadows area. The small pool leads to an extensive subterranean cavern within the regional Paleozoic carbonate-rock aquifer. Previous work has established that the pool level fluctuates in response to changes in barometric pressure, Earth tides and earthquakes. Analyses of these fluctuations indicate that the formation is a sensitive indicator of crustal strain, and provide important information regarding the material properties of the surrounding aquifer. Over ten years of hourly water-level measurements were analyzed for the effects of atmospheric loading and Earth tides. The short-term water-level fluctuations caused by these effects were found to be on the order of millimeters to centimeters, indicating relatively low matrix compressibility. Accordingly, the Devils Hole water-level record shows strong responses to the June 28, 1992 Landers/Little Skull Mountain earthquake sequence and to the October 16, 1999 Hector Mine earthquake. A dislocation model was used to calculate volumetric strain for each earthquake. The sensitivity of Devils Hole to strain induced by the solid Earth tide was used to constrain the modeling. Water-level decreases observed following the 1992 and 1999 earthquakes were found to be consistent with areas of crustal expansion predicted by the dislocation model. The magnitude of the water-level changes was also found to be proportional to the predicted coseismic volumetric strain. Post-seismic pore-pressure diffusion, governed by the hydraulic diffusivity of the aquifer, was simulated with a numerical model using the coseismic change in pore pressure as an initial condition. Results of the numerical model indicate that factors such as fault-plane geometry and aquifer heterogeneity may play an important role in controlling pore pressure diffusion in the Devils Hole area.

The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

PubMed Central

Ngo, Victoria K.; Weiss, Bahr; Lam, Trung; Dang, Thanh; Nguyen, Tam; Nguyen, Mai Hien

2014-01-01

In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings. PMID:25568593

Depressive symptom deterioration among predominantly Hispanic diabetes patients in safety net care.

PubMed

Ell, Kathleen; Katon, Wayne; Lee, Pey-Jiuan; Kapetanovic, Suad; Guterman, Jeffrey; Xie, Bin; Chou, Chih-Ping

2012-01-01

This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetes patients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and who no longer met clinically significant depression criteria at 12 months post-trial baseline. A sub-cohort of 193 diabetes patients with major depression symptoms at baseline, who were randomized to a 12-month collaborative care intervention (INT) (problem-solving therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months. Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] = 2.66), 12-month PHQ-9 score (OR = 1.22), antidepressant treatment receipt during the initial 12-months (OR = 2.38), 12-month diabetes symptoms (OR = 2.27), and new ICD-9 medical diagnoses in the initial 12 months (OR = 1.11) (R2 = 27%; max-rescaled R2 = 37%; likelihood ratio test, χ2 = 59.79, df = 5, P < 0.0001). Among predominantly Hispanic diabetes patients in community safety net primary care clinics whose depression had improved over 1 year, more than one-third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration. Copyright © 2012 The Academy of Psychosomatic Medicine. All rights reserved.

The Clinical Research Center for Depression Study: Baseline Characteristics of a Korean Long-Term Hospital-Based Observational Collaborative Prospective Cohort Study

PubMed Central

Kim, Tae-Suk; Jeong, Seung Hee; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Yim, Hyeon-Woo

2011-01-01

Objective The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort. Methods Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant. Results One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode. Conclusion The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression. PMID:21519530

Depression and Its Correlates Among Older Adults Accessing Aging Services

PubMed Central

Richardson, Thomas M.; Friedman, Bruce; Podgorski, Carol; Knox, Kerry; Fisher, Susan; He, Hua; Conwell, Yeates

2011-01-01

Objectives To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers. Methods Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented. Results Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under $1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression. Conclusion Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults. PMID:22434017

Interdisciplinary Team Collaboration during Discharge of Depressed Older Persons: A Norwegian Qualitative Implementation Study

PubMed Central

Holm, Anne Lise; Severinsson, Elisabeth

2013-01-01

In order to deliver effective care, it is necessary to organise interdisciplinary activities for older persons who suffer from depressive disorders. This paper evaluated the interdisciplinary team members' perceptions of cooperation in the discharge planning of depressed older persons based on the Chronic Care Model (CCM). A qualitative implementation design was used, data were collected by means of multistage focus groups, and a thematic analysis was performed. Three themes emerged: lack of effective team leadership in the community, the need to change the delivery system, and enhancing self-management support for depressed older persons as well as the participation of their families. It was concluded that nurse managers must find ways of supporting the depressed older persons by better structuring the care, increasing cooperation with organisational leadership, and creating an environment characterised by trust and mutual respect. Distrust can have serious implications for discharge planning collaboration. The development of a common vision of transparency in the organization is important as is a policy of change among leadership and in clinical practice. PMID:23766896

[Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience].

PubMed

Calderón, Carlos; Balagué, Laura; Iruin, Álvaro; Retolaza, Ander; Belaunzaran, Jon; Basterrechea, Javier; Mosquera, Isabel

2016-01-01

To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness.

PubMed

Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen

2017-09-07

Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

Kingdom of the Tides.

ERIC Educational Resources Information Center

Carter, Samuel, III

Areas of discussion are the history of tides, the forces which exert an influence upon the earth's tides, the behavior of tides as modified by terrestrial features, "freak" behavior of tides, the marine life which inhabits tidal areas, the manner in which tides have helped to shape the course of history, how tides affect our lives on a…

Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support.

PubMed

Castillo, Enrico G; Shaner, Roderick; Tang, Lingqi; Chung, Bowen; Jones, Felica; Whittington, Yolanda; Miranda, Jeanne; Wells, Kenneth B

2018-02-01

Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.

What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model

PubMed Central

2010-01-01

Background There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. Methods Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. Results Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. Conclusions The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation. PMID:20181163

Collaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment Response.

PubMed

Bhat, Amritha; Grote, Nancy K; Russo, Joan; Lohr, Mary Jane; Jung, Hyunzee; Rouse, Caroline E; Howell, Elaine C; Melville, Jennifer L; Carson, Kathy; Katon, Wayne

2017-01-01

The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression. A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses. For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning. MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events.

Nonlinear terms in storm surge predictions: Effect of tide and shelf geometry with case study from Hurricane Rita

NASA Astrophysics Data System (ADS)

Rego, JoãO. L.; Li, Chunyan

2010-06-01

This study applied the finite volume coastal ocean model (FVCOM) to the storm surge induced by Hurricane Rita along the Louisiana-Texas coast. The model was calibrated for tides and validated with observed water levels. Peak water levels were shown to be lower than expected for a landfall at high tide. For low- and high-tide landfalls, nonlinear effects due to tide-surge coupling were constructive and destructive to total storm tide, respectively, and their magnitude reached up to 70% of the tidal amplitude in the Rita application. Tide-surge interaction was further examined using a standard hurricane under idealized scenarios to evaluate the effects of various shelf geometries, tides, and landfall timings (relative to tide). Nonlinearity was important between landfall position and locations within 2.5 × radius of maximum winds. On an idealized wide continental shelf, nonlinear effects reached up to 80% of the tidal amplitude with an S2 tide and up to 47% with a K1 tide. Increasing average depths by 4 m reduced nonlinear effects to 41% of the tidal amplitude; increasing the slope by a factor of 3 produced nonlinearities of just 26% of tide (both with a K1 tide). The nonlinear effect was greatest for landfalls at low tide, followed by landfalls at high tide and then by landfalls at midebb or midflood.

Often Difficult--But Worth It. Collaboration among Professionals.

ERIC Educational Resources Information Center

Walker, Joyce A.

1988-01-01

A joint effort between the Minnesota Extension Service and University of Minnesota School of Medicine produced a community-based research and educational program on stress, depression, and suicide prevention. The Teens in Distress program represents a successful collaborative effort and illustrates the potential problems when Extension…

A target-driven collaborative care model for Major Depressive Disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative.

PubMed

Huijbregts, Klaas M L; de Jong, Fransina J; van Marwijk, Harm W J; Beekman, Aartjan T F; Adèr, Herman J; Hakkaart-van Roijen, Leona; Unützer, Jürgen; van der Feltz-Cornelis, Christina M

2013-04-25

Practice variation in the primary care treatment of depression may be considerable in the Netherlands, due to relatively small and unregulated practices. We adapted the collaborative care model for the treatment of Major Depressive Disorder (MDD) to accommodate existing practice variation and tested whether this had added value over Care as Usual (CAU). A cluster randomized controlled trial was conducted to compare an adapted target driven collaborative care model with Care as Usual (CAU). Randomization was at the level of 18 (sub)urban primary care centers. The care manager and GP were supported by a web-based tracking and decision aid system that advised targeted treatment actions to achieve rapid response and if possible remission, and that warned the consultant psychiatrist if such treatment advice was not followed up. Eligible patients had a score of 10 or higher on the PHQ9, and met diagnostic criteria for major depression at the subsequent MINI Neuropsychiatric interview. A total of 93 patients were identified by screening. They received either collaborative care (CC) or CAU. Another 56 patients received collaborative care after identification by the GP. The outcome measures were response to treatment (50% or greater reduction of the PHQ9-total score from baseline) at three, six, nine and twelve months, and remission (a score of 0-4 on the PHQ9 at follow-up). Treatment response and remission in CAU were low. Collaborative care was more effective on achieving treatment response than CAU at three months for the total group of patients who received collaborative care [OR 5.2 ((1.41-16.09), NNT 2] and at nine months [OR 5.6 ((1.40-22.58)), NNT 3]. The effect was not statistically significant at 6 and 12 months. A relatively high percentage of patients (36.5%) did not return one or more follow-up questionnaires. There was no evidence for selective non response. Our adapted target driven CC was considerably more effective than CAU for MDD in primary care in the Netherlands. The Numbers Needed To Treat (NNT) to achieve response in one additional patient were low (2-3), which suggest that introducing CC at a larger scale may be beneficial. The relatively large effects may be due to our focus on reducing practice variation through the introduction of easy to use web based tracking and decision aids. The findings are highly relevant for the application of the model in areas where practices tend to be small and for mixed healthcare systems such as in many countries in Europe. Dutch trial register ISRCTN15266438 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=820). Copyright © 2012 Elsevier B.V. All rights reserved.

Problem-Solving Therapy for Depression in Adults: A Systematic Review

ERIC Educational Resources Information Center

Gellis, Zvi D.; Kenaley, Bonnie

2008-01-01

Objectives: This article presents a systematic review of the evidence on problem-solving therapy (PST) for depressive disorders in noninstitutionalized adults. Method: Intervention studies using randomized controlled designs are included and methodological quality is assessed using a standard set of criteria from the Cochrane Collaborative Review…

Balancing "we" and "me".

PubMed

Congdon, Christine; Flynn, Donna; Redman, Melanie

2014-10-01

The open office is the dominant form of workspace design for good reason: It fosters collaboration, promotes learning, and nurtures strong culture. But what most companies fail to realize is that collaboration has a natural rhythm that requires both interaction and private contemplation. Companies have been trying for decades to find the balance between public and private workspace that best supports collaboration. In 1980 52% of U.S. employees lacked workspaces where they could concentrate without distraction. In response, high-walled cubicles took over the corporate landscape. By the late 1990s, the tide had turned, and only 23% of employees wanted more privacy, and 50% wanted more access to other people. Ever since, firms have been beefing up spaces that support collaboration and shrinking areas for individual work. But the pendulum seems to have swung too far: Once again, people feel a pressing need for privacy, not only to do heads-down work but to cope with the intensity of work today. To address these needs, according to the authors, we have to rethink our assumptions about privacy. Traditionally defined in physical terms, privacy is now about the individual's ability to control information and stimulation. In this article, the authors examine workspace design through the new lens of privacy and offer insights on how to foster teamwork and solitude.

Detecting the red tide based on remote sensing data in optically complex East China Sea

NASA Astrophysics Data System (ADS)

Xu, Xiaohui; Pan, Delu; Mao, Zhihua; Tao, Bangyi; Liu, Qiong

2012-09-01

Red tide not only destroys marine fishery production, deteriorates the marine environment, affects coastal tourist industry, but also causes human poison, even death by eating toxic seafood contaminated by red tide organisms. Remote sensing technology has the characteristics of large-scale, synchronized, rapid monitoring, so it is one of the most important and most effective means of red tide monitoring. This paper selects the high frequency red tides areas of the East China Sea as study area, MODIS/Aqua L2 data as the data source, analysis and compares the spectral differences in the red tide water bodies and non-red tide water bodies of many historical events. Based on the spectral differences, this paper develops the algorithm of Rrs555/Rrs488> 1.5 to extract the red tide information. Apply the algorithm on red tide event happened in the East China Sea on May 28, 2009 to extract the information of red tide, and found that the method can determine effectively the location of the occurrence of red tide; there is a good corresponding relationship between red tide extraction result and chlorophyll a concentration extracted by remote sensing, shows that these algorithm can determine effectively the location and extract the red tide information.

Extreme Attributions Predict the Course of Bipolar Depression: Results from the STEP-BD Randomized Controlled Trial of Psychosocial Treatment

PubMed Central

Stange, Jonathan P.; Sylvia, Louisa G.; da Silva Magalhães, Pedro Vieira; Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Berk, Michael; Nierenberg, Andrew A.; Deckersbach, Thilo

2013-01-01

Objective Little is known about predictors of recovery from bipolar depression or moderators of treatment response. In the present study we investigated attributional style (a cognitive pattern of explaining the causes of life events) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychotherapy for bipolar depression. Method 106 depressed outpatients with DSM-IV bipolar I or II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomized to intensive psychotherapy for depression (n=62), or collaborative care (n=44), a minimal psychoeducational intervention. The primary outcome was recovery status at each study visit as measured by the Clinical Monitoring Form. Attributional style was measured at baseline using the Attributional Style Questionnaire. Data were collected between 1998 and 2005. Results All analyses were by intention to treat. Extreme attributions predicted a lower likelihood of recovery (p=.01, OR=0.93, 95% CI=.88-.98) and longer time until recovery (p<.01, OR=0.96, 95% CI=.93-.99), independent of the effects of initial depression severity. Among individuals with more pessimistic attributional styles, initial depression severity predicted a lower likelihood of recovery (p=.01, OR=0.64, 95% CI=.45-.91) and longer time until recovery (p<.001, OR=0.76, 95% CI=.66-.88). There was no difference in recovery rates between intensive psychotherapy and collaborative care (OR=0.90, 95% CI=0.40-2.01) in the full sample. Conclusions These results suggest that extreme, rigid attributions may be associated with a more severe course of depression, and that evaluating attributional style may help clinicians to identify patients who are at risk for experiencing a more severe course of depression. PMID:23561230

Direct and Indirect Effects of Tides on Ecosystem-Scale CO2 Exchange in a Brackish Tidal Marsh in Northern California

NASA Astrophysics Data System (ADS)

Knox, S. H.; Windham-Myers, L.; Anderson, F.; Sturtevant, C.; Bergamaschi, B.

2018-03-01

We investigated the direct and indirect influence of tides on net ecosystem exchange (NEE) of carbon dioxide (CO2) in a temperate brackish tidal marsh. NEE displayed a tidally driven pattern with obvious characteristics at the multiday scale, with greater net CO2 uptake during spring tides than neap tides. Based on the relative mutual information between NEE and biophysical variables, this was driven by a combination of higher water table depth (WTD), cooler air temperature, and lower vapor pressure deficit (VPD) during spring tides relative to neap tides, as the fortnightly tidal cycle not only influenced water levels but also strongly modulated water and air temperature and VPD. Tides also influenced NEE at shorter timescales, with a reduction in nighttime fluxes during growing season spring tides when the higher of the two semidiurnal tides caused inundation at the site. WTD significantly influenced ecosystem respiration (Reco), with lower Reco during spring tides than neap tides. While WTD did not appear to affect ecosystem photosynthesis (gross ecosystem production, GPP) directly, the impact of tides on temperature and VPD influenced GPP, with higher daily light-use efficiency and photosynthetic activity during spring tides than neap tides when temperature and VPD were lower. The strong direct and indirect influence of tides on NEE across the diel and multiday timescales has important implications for modeling NEE in tidal wetlands and can help inform the timing and frequency of chamber measurements as annual or seasonal net CO2 uptake may be underestimated if measurements are only taken during nonflooded periods.

[Influences of tide on silicon and nitrogen contents in soil and porewater in the Minjiang Ri-ver estuary, Southeast China].

PubMed

Hou, Guan Yun; Zhai, Shui Jing; Le, Xiao Qing; Tong, Chuan

2017-01-01

Taking Shanyuntan wetland in the Minjiang River estuary as test object, the dissolved silicates (DSi) and inorganic nitrogen contents in porewater and the biogenic silica (BSi) and total nitrogen contents in surface soil of the Phragmites australis wetland, Cyperus malaccensis wetland and Spartina alterniflora wetland were measured in October 2014 (spring tide month) and April 2015 (neap tide month), respectively, to illuminate the influence of tide on silicon and nitrogen contents in soil and porewater of estuarine wetland. Results showed that the DSi content in porewater and the BSi content in surface soil in spring tide month were slightly higher than those in neap tide month, with the highest being observed on neap tide day and the lowest occurring on spring tide day. In contrast, the BSi content in surface soil on spring tide day showed an opposite trend with that on neap tide day. The contents of NH 4 + -N and NO 3 - -N in porewater of different wetland soils in spring tide month were higher than those in neap tide month, while the content of NH 4 + -N on spring tide day was significantly higher than that on neap tide day (P<0.05). The study found that hydrological conditions such as flooding duration and drying-wetting alternation caused by tide had great influences on silicon and nitrogen contents in porewater and surface soil, and vegetation types also showed great influences on their distributions in intertidal wetland of the Minjiang River estuary.

The relative importance of oceanic nutrient inputs for Bass Harbor Marsh Estuary at Acadia National Park, Maine

USGS Publications Warehouse

Huntington, Thomas G.; Culbertson, Charles W.; Fuller, Christopher; Glibert, Patricia; Sturtevant, Luke

2014-01-01

The U.S. Geological Survey and Acadia National Park (ANP) collaborated on a study of nutrient inputs into Bass Harbor Marsh Estuary on Mount Desert Island, Maine, to better understand ongoing eutrophication, oceanic nutrient inputs, and potential management solutions. This report includes the estimation of loads of nitrate, ammonia, total dissolved nitrogen, and total dissolved phosphorus to the estuary derived from runoff within the watershed and oceanic inputs during summers 2011 and 2012. Nutrient outputs from the estuary were also monitored, and nutrient inputs in direct precipitation to the estuary were calculated. Specific conductance, water temperature, and turbidity were monitored at the estuary outlet. This report presents a first-order analysis of the potential effects of projected sea-level rise on the inundated area and estuary volume. Historical aerial photographs were used to investigate the possibility of widening of the estuary channel over time. The scope of this report also includes analysis of sediment cores collected from the estuary and fringing marsh surfaces to assess the sediment mass accumulation rate. Median concentrations of nitrate, ammonium, and total dissolved phosphorus on the flood tide were approximately 25 percent higher than on the ebb tide during the 2011 and 2012 summer seasons. Higher concentrations on the flood tide suggest net assimilation of these nutrients in biota within the estuary. The dissolved organic nitrogen fraction dominated the dissolved nitrogen fraction in all tributaries. The median concentration of dissolved organic nitrogen was about twice as high on the on the ebb tide than the flood tide, indicating net export of dissolved organic nitrogen from the estuary. The weekly total oceanic inputs of nitrate, ammonium, and total dissolved phosphorus to the estuary were usually much larger than inputs from runoff or direct precipitation. The estuary was a net sink for nitrate and ammonium in most weeks during both years. Oceanic inputs of nitrate and ammonium were an important source of inorganic nitrogen to the estuary in both years. In both years, the total seasonal inputs of ammonium to the estuary in flood tides were much larger than the inputs from watershed runoff or direct precipitation. In 2011, the total seasonal input of nitrate from flood tides to the estuary was more than twice as large the inputs from watershed runoff and precipitation, but in 2012, the inputs from flood tides were only marginally larger than the inputs from watershed runoff and precipitation. Turbidity was measured intermittently in 2012, and the pattern that emerged from the measurements indicated that the estuary was a source of particulate matter to the ocean rather than the ocean being a source to the estuary. From the nutrient budgets determined for the estuary it is evident that oceanic sources of nitrate and ammonium are an important part of the supply of nutrients that are contributing to the growth of macroalgae in the estuary. The relative importance of these oceanic nutrients compared with sources within the watershed typically increases as the summer progresses and runoff decreases. It is likely that rising sea levels, estimated by the National Oceanic and Atmospheric Administration to be 11 centimeters from 1950 through 2006 in nearby Bar Harbor, have resulted in an increase in oceanic inputs (tidal volume and nutrients derived from oceanic sources).

Simulation and video animation of canal flushing created by a tide gate

USGS Publications Warehouse

Schoellhamer, David H.

1988-01-01

A tide-gate algorithm was added to a one-dimensional unsteady flow model that was calibrated, verified, and used to determine the locations of as many as five tide gates that would maximize flushing in two canal systems. Results from the flow model were used to run a branched Lagrangian transport model to simulate the flushing of a conservative constituent from the canal systems both with and without tide gates. A tide gate produces a part-time riverine flow through the canal system that improves flushing along the flow path created by the tide gate. Flushing with no tide gates and with a single optimally located tide gate are shown with a video animation.

The inverse problem: Ocean tides derived from earth tide observations

NASA Technical Reports Server (NTRS)

Kuo, J. T.

1978-01-01

Indirect mapping ocean tides by means of land and island-based tidal gravity measurements is presented. The inverse scheme of linear programming is used for indirect mapping of ocean tides. Open ocean tides were measured by the numerical integration of Laplace's tidal equations.

Does the Social Working Environment Predict Beginning Teachers' Self-Efficacy and Feelings of Depression?

ERIC Educational Resources Information Center

Devos, Christelle; Dupriez, Vincent; Paquay, Leopold

2012-01-01

We investigate how the social working environment predicts beginning teachers' self-efficacy and feelings of depression. Two quantitative studies are presented. The results show that the goal structure of the school culture (mastery or performance orientation) predicts both outcomes. Frequent collaborative interactions with colleagues are related…

An academic-marketing collaborative to promote depression care: a tale of two cultures.

PubMed

Kravitz, Richard L; Epstein, Ronald M; Bell, Robert A; Rochlen, Aaron B; Duberstein, Paul; Riby, Caroline H; Caccamo, Anthony F; Slee, Christina K; Cipri, Camille S; Paterniti, Debora A

2013-03-01

Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. An interdisciplinary group of academic researchers contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients' struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: (a) educating the patient to consider and investigate the possibility of depression; (b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and (c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, "Faces," involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the academic team was present and consulted closely during production. Challenges included reconciling the marketing tradition of audience segmentation with the overall project goal of reaching as broad an audience as possible; integrating research findings across dimensions of words, images, music, and tone; and dealing with misunderstandings related to project scope and budget. Mixed methods research can usefully inform PSAs that incorporate patient perspectives and are produced to professional standards. However, tensions between the academic and commercial worlds exist and must be addressed. While rewarding, academic-marketing collaborations introduce tensions which must be addressed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

An Academic-Marketing Collaborative to Promote Depression Care: A Tale of Two Cultures

PubMed Central

Kravitz, Richard L.; Epstein, Ronald M.; Bell, Robert A.; Rochlen, Aaron B.; Duberstein, Paul; Riby, Caroline H.; Caccamo, Anthony F.; Slee, Christina K.; Cipri, Camille S.; Paterniti, Debora A.

2011-01-01

Objectives Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. Methods An interdisciplinary group of academic researcherss contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. Results There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients’ struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: a) educating the patient to consider and investigate the possibility of depression; b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, “Faces,” involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the academic team was present and consulted closely during production. Challenges included reconciling the marketing tradition of audience segmentation with the overall project goal of reaching as broad an audience as possible; integrating research findings across dimensions of words, images, music, and tone; and dealing with misunderstandings related to project scope and budget. Conclusion Mixed methods research can usefully inform PSAs that incorporate patient perspectives and are produced to professional standards. However, tensions between the academic and commercial worlds exist and must be addressed. Practice implications With certain caveats, implementation and dissemination researchers should consider opporutnities to join forces with marketing specialists. The results of such collaborations should be rigorously evaluated. PMID:21862274

Ocean tides

NASA Technical Reports Server (NTRS)

Hendershott, M. C.

1975-01-01

A review of recent developments in the study of ocean tides and related phenomena is presented. Topics briefly discussed include: the mechanism by which tidal dissipation occurs; continental shelf, marginal sea, and baroclinic tides; estimation of the amount of energy stored in the tide; the distribution of energy over the ocean; the resonant frequencies and Q factors of oceanic normal modes; the relationship of earth tides and ocean tides; and numerical global tidal models.

Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer☆

PubMed Central

Duarte, A.; Walker, J.; Walker, S.; Richardson, G.; Holm Hansen, C.; Martin, P.; Murray, G.; Sculpher, M.; Sharpe, M.

2015-01-01

Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. Results DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. Conclusions Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings. PMID:26652589

Cost-effectiveness analysis of a collaborative care programme for depression in primary care.

PubMed

Aragonès, Enric; López-Cortacans, Germán; Sánchez-Iriso, Eduardo; Piñol, Josep-Lluís; Caballero, Antonia; Salvador-Carulla, Luis; Cabasés, Juan

2014-04-01

Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care. A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007-2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs). Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane. The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression. The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation. Copyright © 2014 Elsevier B.V. All rights reserved.

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis.

PubMed

van Eck van der Sluijs, Jonna F; Castelijns, Hilde; Eijsbroek, Vera; Rijnders, Cees A Th; van Marwijk, Harm W J; van der Feltz-Cornelis, Christina M

Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbiddepression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed. The protocol for this systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) on February 19th 2016: http://www.crd.york.ac.uk/PROSPERO/DisplayPDF.php?ID=CRD42016035553. Copyright © 2017 Elsevier Inc. All rights reserved.

What was learned: studies by the consortium for research in ECT (CORE) 1997-2011.

PubMed

Fink, M

2014-06-01

To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients. Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criteria. Successful ECT was followed by placebo, nortriptyline alone, or combined lithium, and nortriptyline. Relapse rates after remission were similar with fixed schedule ECT as with medications. Predictors of outcome (psychosis, suicide risk, polarity, melancholia, atypical depression, age) and technical aspects (electrode placement, seizure threshold, speed of response) are discussed, The findings offer criteria to optimize the selection of patients, the technique, and outcome of ECT for unipolar and bipolar depressed patients. Continuation ECT is an effective alternative to continuation treatment with lithium and nortriptyline. Bilateral electrode placement is more efficient than alternative placements. ECT relieves both bipolar and unipolar depression. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A stepped-wedge evaluation of an initiative to spread the collaborative care model for depression in primary care.

PubMed

Solberg, Leif I; Crain, A Lauren; Maciosek, Michael V; Unützer, Jürgen; Ohnsorg, Kris A; Beck, Arne; Rubenstein, Lisa; Whitebird, Robin R; Rossom, Rebecca C; Pietruszewski, Pamela B; Crabtree, Benjamin F; Joslyn, Kenneth; Van de Ven, Andrew; Glasgow, Russell E

2015-09-01

Scale-up and spread of evidence-based practices is one of the most important challenges facing health care. We tested whether a statewide initiative, Depression Improvement Across Minnesota-Offering a New Direction (DIAMOND), to implement the collaborative care model for depression in 75 primary care clinics resulted in patient outcome improvements corresponding to those reported in randomized controlled trials. Health plans provided a new monthly payment to participating clinics after a 6-month intensive training program with ongoing data submission, networking, and consultation. Implementation was staggered, with 5 sequences of 10 to 40 clinics every 6 months. Payers provided weekly contact information for members from participating clinics who were filling antidepressant prescriptions, and we conducted baseline and 6-month surveys of 1,578 patients about their care and outcomes. There were 466 patients in DIAMOND clinics who received usual care before implementation (UCB), 559 who received usual care in DIAMOND clinics after implementation (UCA), 245 who received DIAMOND care after implementation (DCA), and 308 who received usual care in comparison clinics (UC). Patients who received DIAMOND care after implementation reported more collaborative care depression services than the 3 comparison groups (10.9 vs 6.4-6.7, on a scale of 0 of 14, where higher numbers indicate more services; P <.001) and more satisfaction with their care (4.0 vs 3.4 on a scale 1 to 5, in which higher scores indicate higher satisfaction; P ≤.001). Depression remission rates, however, were not significantly different among the 4 groups (36.4% DCA vs 35.8% UCB, 35.0% UCA, 33.9% UC; P = .94). Despite the incentive of a supporting payment change and intensive training and support for clinics volunteering to participate, no difference in depression outcomes was documented. Specific unmeasured actions present in trials but not present in these clinics may be critical for successful outcome improvement. © 2015 Annals of Family Medicine, Inc.

Barometric Tides from ECMWF Operational Analyses

NASA Technical Reports Server (NTRS)

Ray, R. D.; Ponte, R. M.

2003-01-01

The solar diurnal and semidiurnal tidal oscillations in surface pressure are extracted from the the operational analysis product of the European Centre for Medium Range Weather Forecasting (ECMWF). For the semidiurnal tide this involves a special temporal interpolation, following Van den Dool and colleagues. The resulting tides are compared with a ground truth tide dataset, a compilation of well-determined tide estimates deduced from long time series of station barometer measurements. These comparisons show that the ECMWF tides are significantly more accurate than the tides deduced from two other widely available reanalysis products. Spectral analysis of ECMWF pressure series shows that the tides consist of sharp central peaks with modulating sidelines at integer multiples of 1 cycle/year, superimposed on a broad cusp of stochastic energy. The integrated energy in the cusp dominates that of the sidelines. This complicates development of a simple model that can characterize the full temporal variability of the tides.

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial

PubMed Central

Llewellyn-Jones, Robert H; Baikie, Karen A; Smithers, Heather; Cohen, Jasmine; Snowdon, John; Tennant, Chris C

1999-01-01

Objective To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Design Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Setting Population of residential facility in Sydney living in self care units and hostels. Participants 220 depressed residents aged ⩾65 without severe cognitive impairment. Intervention The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Main outcome measure Geriatric depression scale. Results Intention to treat analysis was used. There was significantly more movement to “less depressed” levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). Conclusions The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents. Key messagesLarge numbers of depressed elderly people live in residential care but few receive appropriate managementA population based, multifaceted shared care intervention for late life depression was more effective than routine care in improving depression outcomeThe outcome of late life depression can be improved by enhancing the clinical skills of general practitioners and care staff and by providing depression related health education and activity programmes for residentsThe intervention needs further refining and evaluation to improve its effectiveness and to determine how best to implement it in other residential care settings PMID:10480824

Harmful algal toxins of the Florida red tide (Karenia brevis): natural chemical stressors in South Florida coastal ecosystems

PubMed Central

Henry, M. S.

2009-01-01

The Florida red tide is a descriptive name for high concentrations of the harmful marine alga, Karenia brevis. Although most prevalent along the south-west Florida coast, periodic blooms have occurred throughout the entire US and Mexico Gulf coasts and the Atlantic coast to North Carolina. This dinoflagellate produces a suite of polyether neurotoxins, called brevetoxins, that cause severe impacts to natural resources, as well as public health. These naturally produced biotoxins may represent one of the most common chemical stressors impacting South Florida coastal and marine ecosystems. Impacts include massive fish kills, marine mammal, sea turtle and sea bird mortalities, benthic community die-off and public health effects from shellfish contamination and inhalation of air-borne toxins. The primary mode of action is binding to voltage-gated sodium channels causing depolarization of nerve cells, thus interfering with nerve transmission. Other effects include immune depression, bronchial constriction and haemolysis. Parent algal toxins are synthesized within the unicellular organism, others are produced as metabolic products. Recent studies into the composition of brevetoxins in cells, water, air and organisms have shown PbTx-2 to be the primary intracellular brevetoxin that is converted over time to PbTx-3 when the cells are ruptured, releasing extracellular brevetoxins into the environment. Brevetoxins become aerosolized by bubble-mediated transport of extracellular toxins, the composition of which varies depending on the composition in the source water. Bivalved molluscs rapidly accumulate brevetoxins as they filter feed on K. brevis cells. However, the parent algal toxins are rapidly metabolized to other compounds, some of which are responsible for neurotoxic shellfish poisoning (NSP). These results provide new insight into the distribution, persistence and impacts of red tide toxins to south-west Florida ecosystems. PMID:18758951

Harmful algal toxins of the Florida red tide (Karenia brevis): natural chemical stressors in South Florida coastal ecosystems.

PubMed

Pierce, R H; Henry, M S

2008-10-01

The Florida red tide is a descriptive name for high concentrations of the harmful marine alga, Karenia brevis. Although most prevalent along the south-west Florida coast, periodic blooms have occurred throughout the entire US and Mexico Gulf coasts and the Atlantic coast to North Carolina. This dinoflagellate produces a suite of polyether neurotoxins, called brevetoxins, that cause severe impacts to natural resources, as well as public health. These naturally produced biotoxins may represent one of the most common chemical stressors impacting South Florida coastal and marine ecosystems. Impacts include massive fish kills, marine mammal, sea turtle and sea bird mortalities, benthic community die-off and public health effects from shellfish contamination and inhalation of air-borne toxins. The primary mode of action is binding to voltage-gated sodium channels causing depolarization of nerve cells, thus interfering with nerve transmission. Other effects include immune depression, bronchial constriction and haemolysis. Parent algal toxins are synthesized within the unicellular organism, others are produced as metabolic products. Recent studies into the composition of brevetoxins in cells, water, air and organisms have shown PbTx-2 to be the primary intracellular brevetoxin that is converted over time to PbTx-3 when the cells are ruptured, releasing extracellular brevetoxins into the environment. Brevetoxins become aerosolized by bubble-mediated transport of extracellular toxins, the composition of which varies depending on the composition in the source water. Bivalved molluscs rapidly accumulate brevetoxins as they filter feed on K. brevis cells. However, the parent algal toxins are rapidly metabolized to other compounds, some of which are responsible for neurotoxic shellfish poisoning (NSP). These results provide new insight into the distribution, persistence and impacts of red tide toxins to south-west Florida ecosystems.

Stakeholder Experiences in a Stepped Collaborative Care Study Within U.S. Army Clinics.

PubMed

Batka, Caroline; Tanielian, Terri; Woldetsadik, Mahlet A; Farmer, Carrie; Jaycox, Lisa H

This article examines stakeholder experiences with integrating treatment for posttraumatic stress disorder (PTSD) and depression within primary care clinics in the U.S. Army, the use-of-care facilitation to improve treatment, and the specific therapeutic tools used within the Stepped Treatment Enhanced PTSD Services Using Primary Care study. We conducted a series of qualitative interviews with health care providers, care facilitators, and patients within the context of a large randomized controlled trial being conducted across 18 Army primary care clinics at 6 military installations. Most of stakeholders' concerns clustered around the need to improve collaborative care tools and care facilitators and providers' comfort and abilities to treat behavioral health issues in the primary care setting. Although stakeholders generally recognize the value of collaborative care in overcoming barriers to care, their perspectives about the utility of different tools varied. The extent to which collaborative care mechanisms are well understood, navigated, and implemented by providers, care facilitators, and patients is critical to the success of the model. Improving the design of the web-based therapy tools, increasing the frequency of team meetings and case presentations, and expanding training for primary care providers on screening and treatment for PTSD and depression and the collaborative care model's structure, processes, and offerings may improve stakeholder perceptions and usage of collaborative care. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

The comparison of heavy metals (Pb and Cd) in the water and sediment during spring and neap tide tidal periods in Popoh Bay, Indonesia

NASA Astrophysics Data System (ADS)

Yona, D.; Febriana, R.; Handayani, M.

2018-04-01

This study attempted to investigate different concentration of lead (Pb) dan cadmium (Cd) in the water and sediment during spring and neap tidal periods in the Popoh Bay, Indonesia. Water and sediment samples were taken during spring and neap tides from eight sampling stations in the study area. The result shows higher concentration of Pb than the concentration of Cd in both spring and neap tides due to higher input of Pb from the oil pollution by boat and fisheries activities. Pb concentrations were doubled during neap tide in both water and sediments with the value of 0.51 and 0.28 ml/L in the water during neap and spring tide, respectively; and 0.27 ppm and 0.16 mg/kg in the sediment during neap and spring tide, respectively. On the other hand, Cd concentrations in the water were found in almost similar values between spring and neap tide (0.159 and 0.165 ml/L in spring tide and neap tide, respectively), but in the sediment, the concentration was a little higher during spring tide (0.09 and 0.05 mg/kg during spring and neap tide, respectively). This study shows that water movement during spring and neap tides has significant effect on the distribution of heavy metals.

Using self-reports of symptom severity to measure and manage workplace depression.

PubMed

Allen, Harris; Hyworon, Zorianna; Colombi, Alberto

2010-04-01

To test the workplace impact of depression when it is stratified by severity and considered in broader context. Structural equation models of health risk appraisal data (n = 39,097) involving 41 measures of contextual characteristics, depression severity, health, and job performance. Approximately 15.7% exhibited mild depression, whereas 6.9% recorded moderate to severe symptoms. Depression severity exerted large effects on general health and productivity loss, with the mild group posting the largest aggregate impact. Adverse personal life impact and financial concerns more significantly affected moderate to severe depression. In contrast, factors more directly amenable to employer health management efforts (eg, stressful job) better predicted mild depression. These results link depression to large health and productivity deficits. They call for public-private collaboration, parity in mental and physical health benefits, and resource allocation that is proportionate across the depression spectrum and facilitated by symptom severity screening.

Assessing the importance of internal tide scattering in the deep ocean

NASA Astrophysics Data System (ADS)

Haji, Maha; Peacock, Thomas; Carter, Glenn; Johnston, T. M. Shaun

2014-11-01

Tides are one of the main sources of energy input to the deep ocean, and the pathways of energy transfer from barotropic tides to turbulent mixing scales via internal tides are not well understood. Large-scale (low-mode) internal tides account for the bulk of energy extracted from barotropic tides and have been observed to propagate over 1000 km from their generation sites. We seek to examine the fate of these large-scale internal tides and the processes by which their energy is transferred, or ``scattered,'' to small-scale (high-mode) internal tides, which dissipate locally and are responsible for internal tide driven mixing. The EXperiment on Internal Tide Scattering (EXITS) field study conducted in 2010-2011 sought to examine the role of topographic scattering at the Line Islands Ridge. The scattering process was examined via data from three moorings equipped with moored profilers, spanning total depths of 3000--5000 m. The results of our field data analysis are rationalized via comparison to data from two- and three-dimensional numerical models and a two-dimensional analytical model based on Green function theory.

The influence of tide on sea surface temperature in the marginal sea of northwest Pacific Ocean

NASA Astrophysics Data System (ADS)

Huang, Shih-Jen; Tsai, Yun-Chan; Ho, Chung-Ru; Lo, Yao-Tsai; Kuo, Nan-Jung

2017-10-01

Tide gauge data provided by the University of Hawaii Sea Level Center and daily sea surface temperature (SST) data from the Moderate Resolution Imaging Spectroradiometer (MODIS) product are used in this study to analyze the influence of tide on the SST in the seas of Northwestern Pacific. In the marginal region, the climatology SST is lower in the northwestern area than that in the southeastern area. In the coastal region, the SST at spring tide is higher than that at neap tide in winter, but it is lower in other seasons. In the adjacent waters of East China Sea and Yellow Sea, the SST at spring tide is higher than that at neap tide in winter and summer but it is lower in spring and autumn. In the open ocean region, the SST at spring tide is higher than that at neap tide in winter, but it is lower in other seasons. In conclusion, not only the river discharge and topography, but also tides could influence the SST variations, especially in the open ocean region.

Bathymetry of the Hong and Luoc River Junction, Red River Delta, Vietnam, 2010

USGS Publications Warehouse

Kinzel, Paul J.; Nelson, Jonathan M.; Toan, Duong Duc; Thanh, Mung Dinh; Shimizu, Yasuyuki

2012-01-01

The U.S. Geological Survey, in collaboration with the Water Resources University in Hanoi, Vietnam, conducted a bathymetric survey of the junction of the Hong and Luoc Rivers. The survey was done to characterize the channel morphology of this delta distributary network and provide input for hydrodynamic and sediment transport models. The survey was carried out in December 2010 using a boat-mounted multibeam echo sounder integrated with a global positioning system. A bathymetric map of the Hong and Luoc River junction was produced which was referenced to the datum of the Trieu Duong tide gage on the Luoc River.

New analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program: do different treatments reflect different processes?

PubMed

Herbert, Gregory L; Callahan, Jennifer; Ruggero, Camilo J; Murrell, Amy R

2013-01-01

To determine whether or not different therapies have distinct patterns of change, it is useful to investigate not only the end result of psychotherapy (outcome) but also the processes by which outcomes are attained. The present study subjected data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program to survival analyses to examine whether the process of psychotherapy, as conceptualized by the phase model, differed between psychotherapy treatment approaches. Few differences in terms of progression through phases of psychotherapy were identified between cognitive behavior therapy and interpersonal therapy. Additionally, results indicate that phases of psychotherapy may not represent discrete, sequentially invariant processes.

A one-dimensional diffusion analogy model for estimation of tide heights in selected tidal marshes in Connecticut

USGS Publications Warehouse

Bjerklie, David M.; O’Brien, Kevin; Rozsa, Ron

2013-01-01

A one-dimensional diffusion analogy model for estimating tide heights in coastal marshes was developed and calibrated by using data from previous tidal-marsh studies. The method is simpler to use than other one- and two-dimensional hydrodynamic models because it does not require marsh depth and tidal prism information; however, the one-dimensional diffusion analogy model cannot be used to estimate tide heights, flow velocities, and tide arrival times for tide conditions other than the highest tide for which it is calibrated. Limited validation of the method indicates that it has an accuracy within 0.3 feet. The method can be applied with limited calibration information that is based entirely on remote sensing or geographic information system data layers. The method can be used to estimate high-tide heights in tidal wetlands drained by tide gates where tide levels cannot be observed directly by opening the gates without risk of flooding properties and structures. A geographic information system application of the method is demonstrated for Sybil Creek marsh in Branford, Connecticut. The tidal flux into this marsh is controlled by two tide gates that prevent full tidal inundation of the marsh. The method application shows reasonable tide heights for the gates-closed condition (the normal condition) and the one-gate-open condition on the basis of comparison with observed heights. The condition with all tide gates open (two gates) was simulated with the model; results indicate where several structures would be flooded if the gates were removed as part of restoration efforts or if the tide gates were to fail.

[Analysis on characteristics of red tide in Fujian coastal waters during the last 10 years].

PubMed

Li, Xue-Ding

2012-07-01

There were 161 red tide events collected during the last 10 years from 2001 to 2010 in Fujian coastal waters. Comprehensive analysis was performed using statistical methods and the results indicated the following characteristics of the temporal and spatial distribution of red tide in Fujian coastal waters: (1) Outbreaks of red tide often occurred between April and September, and the peak period was in May and June. Most red tide events lasted for 2 to 4 days, and the affected area was below 50 square kilometers. The first outbreak of red tide tended to occur earlier in recent years, and the lasting time became longer. (2) There were 20 species of organisms causing the red tides in Fujian coastal waters, among which 10 species were Bacillariophyta, 9 species were Dinophyta and 1 species was Protozoa. Prorocentrum donghaiense was the most frequent cause of red tides, followed by Noctiluca scintillans, Skeletonema costatum and Chaetoceros sp.. The species caused red tides obeyed the succession law and there were always new species involved. (2) In terms of spatial distribution, outbreaks of red tides mainly occurred in the coastal waters of Ningde, Fuzhou and Xiamen. The species causing red tides were Prorocentrum donghaiense and Noctiluca in the coastal waters in the north of Pingtan, Fujian Province, Skeletonema costatum and Chaetoceros in the coastal waters in the south of Pingtan, Fujian Province. The comprehensive analysis of the characteristics of red tides during the last 10 years is expected to provide scientific and reasonable basis for the prevention, reduction and forecast of red tides in Fujian coastal waters.

Observations and simulations of the ionospheric lunar tide: Seasonal variability

NASA Astrophysics Data System (ADS)

Pedatella, N. M.

2014-07-01

The seasonal variability of the ionospheric lunar tide is investigated using a combination of Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) observations and thermosphere-ionosphere-mesosphere electrodynamics general circulation model (TIME-GCM) simulations. The present study focuses on the seasonal variability of the lunar tide in the ionosphere and its potential connection to the occurrence of stratosphere sudden warmings (SSWs). COSMIC maximum F region electron density (NmF2) and total electron content observations reveal a primarily annual variation of the ionospheric lunar tide, with maximum amplitudes occurring at low latitudes during December-February. Simulations of the lunar tide climatology in TIME-GCM display a similar annual variability as the COSMIC observations. This leads to the conclusion that the annual variability of the lunar tide in the ionosphere is not solely due to the occurrence of SSWs. Rather, the annual variability of the lunar tide in the ionosphere is generated by the seasonal variability of the lunar tide at E region altitudes. However, compared to the observations, the ionospheric lunar tide annual variability is weaker in the climatological simulations which is attributed to the occurrence of SSWs during the majority of the years included in the observations. Introducing a SSW into the TIME-GCM simulation leads to an additional enhancement of the lunar tide during Northern Hemisphere winter, increasing the lunar tide annual variability and resulting in an annual variability that is more consistent with the observations. The occurrence of SSWs can therefore potentially bias lunar tide climatologies, and it is important to consider these effects in studies of the lunar tide in the atmosphere and ionosphere.

The Therapeutic Relationship in the Brief Treatment of Depression: Contributions to Clinical Improvement and Enhanced Adaptive Capacities

ERIC Educational Resources Information Center

Zuroff, David C.; Blatt, Sidney J.

2006-01-01

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed…

Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

PubMed

Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J

2013-06-01

Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new antidepressant prescribing and referral for behavioral health care. It is critical for policy planners to recognize changes in follow-up depression care when implementing screening programs to ensure adequate capacity. Pharmacists are poised to assume a role in collaborative depression care, particularly with antidepressant medication therapy management.

[Temporal and spatial distribution of red tide in Yangtze River Estuary and adjacent waters].

PubMed

Liu, Lu-San; Li, Zi-Cheng; Zhou, Juan; Zheng, Bing-Hui; Tang, Jing-Liang

2011-09-01

The events of red tide were collected in Yangtze River Estuary and adjacent waters from 1972 to 2009. Based on geographic information system (GIS) analysis on the temporal and spatial distribution of red tide, the distribution map was generated accordingly. The results show: (1) There are three red tide-prone areas, which are outside the Yangtze River estuary and the eastern of Sheshan, Huaniaoshan-Shengshan-Gouqi, Zhoushan and the eastern of Zhujiajian. The red tide occurred 174 times in total, in which there were 25 times covered the area was larger than 1 000 km2. After 2000, the frequency of red tide were significantly increasing; (2) The frequent occurrence of red tide was in May (51% of total occurrence) and June (20% of total occurrence); (3) In all of the red tide plankton, the dominant species were Prorocentrum danghaiense, Skeletonema costatum, Prorocentrum dantatum, Nactiluca scientillans. The red tides caused by these species were 38, 35, 15, 10 times separately.

Blalock FIRST: A Collaborative Project between Georgia State University & the Atlanta Public Schools. Final Report.

ERIC Educational Resources Information Center

Nurss, Joanne R.; And Others

This report describes Blalock FIRST, a 3-year collaborative research project designed to improve literacy skills of low-income, African American families living in a severely depressed urban housing project. Project implementation, and antecedents to the implementation, are described. Objectives of the project were to: (1) increase achievement in…

The recognition of ocean red tide with hyper-spectral-image based on EMD

NASA Astrophysics Data System (ADS)

Zhao, Wencang; Wei, Hongli; Shi, Changjiang; Ji, Guangrong

2008-05-01

A new technique is introduced in this paper regarding red tide recognition with remotely sensed hyper-spectral images based on empirical mode decomposition (EMD), from an artificial red tide experiment in the East China Sea in 2002. A set of characteristic parameters that describe absorbing crest and reflecting crest of the red tide and its recognition methods are put forward based on general picture data, with which the spectral information of certain non-dominant alga species of a red tide occurrence is analyzed for establishing the foundation to estimate the species. Comparative experiments have proved that the method is effective. Meanwhile, the transitional area between red-tide zone and non-red-tide zone can be detected with the information of thickness of algae influence, with which a red tide can be forecast.

Tides in the Black Sea: Observations and Numerical Modelling

NASA Astrophysics Data System (ADS)

Medvedev, Igor P.

2018-05-01

Longterm hourly data from 28 tide gauges were used to examine the main features of tides in the Black Sea. The tides in this basin are directly caused by tide-generating forces and the semidiurnal tides prevail over diurnal tides. Based on the Princeton Ocean Model (POM), a numerical model of tides in the Black Sea and adjacent Sea of Azov was developed and found to be in good agreement with tide gauge observations. Detailed tidal charts for amplitudes and phase lags of the major tidal harmonics in these two seas were constructed. The results of the numerical modelling and observations reveal for the semidiurnal tides the presence of an amphidromy with clockwise rotation and another one with counterclockwise rotation for the diurnal tides, both located in the central part of the sea near the Crimean Peninsula. Therefore, for this part of the sea the amplitudes of harmonics M 2 and K 1 are less than 0.1 cm. Relatively larger M 2 amplitudes are observed on the east and west coasts of the sea (2-3 cm). The maximum amplitude of the harmonic M 2 was found at Karkinit Bay—up to 4.5 cm—while the maximum tidal range varies from 1 cm near the Crimean Peninsula to 18-19 cm in the Dnieper-Bug Estuary and Karkinit Bay. Radiational tides, initiated mainly by sea breezes, make an important contribution to the formation of tidal oscillations in the Dnieper-Bug Estuary.

Constraints on Energy Dissipation in the Earth's Body Tide From Satellite Tracking and Altimetry

NASA Technical Reports Server (NTRS)

Ray, Richard D.; Eanes, Richard J.; Lemoine, Frank G.

1992-01-01

The phase lag by which the earth's body tide follows the tidal potential is estimated for the principal lunar semidiurnal tide M(sub 2). The estimate results from combining recent tidal solutions from satellite tracking data and from Topex/Poseidon satellite altimeter data. Each data type is sensitive to the body-tide lag: gravitationally for the tracking data, geometrically for the altimetry. Allowance is made for the lunar atmospheric tide. For the tidal potential Love number kappa(sub 2) we obtain a lag epsilon of 0.20 deg +/- 0.05 deg, implying an effective body-tide Q of 280 and body-tide energy dissipation of 110 +/- 25 gigawatts.

The Algorithm Theoretical Basis Document for Tidal Corrections

NASA Technical Reports Server (NTRS)

Fricker, Helen A.; Ridgway, Jeff R.; Minster, Jean-Bernard; Yi, Donghui; Bentley, Charles R.`

2012-01-01

This Algorithm Theoretical Basis Document deals with the tidal corrections that need to be applied to range measurements made by the Geoscience Laser Altimeter System (GLAS). These corrections result from the action of ocean tides and Earth tides which lead to deviations from an equilibrium surface. Since the effect of tides is dependent of the time of measurement, it is necessary to remove the instantaneous tide components when processing altimeter data, so that all measurements are made to the equilibrium surface. The three main tide components to consider are the ocean tide, the solid-earth tide and the ocean loading tide. There are also long period ocean tides and the pole tide. The approximate magnitudes of these components are illustrated in Table 1, together with estimates of their uncertainties (i.e. the residual error after correction). All of these components are important for GLAS measurements over the ice sheets since centimeter-level accuracy for surface elevation change detection is required. The effect of each tidal component is to be removed by approximating their magnitude using tidal prediction models. Conversely, assimilation of GLAS measurements into tidal models will help to improve them, especially at high latitudes.

Precise comparisons of bottom-pressure and altimetric ocean tides

NASA Astrophysics Data System (ADS)

Ray, R. D.

2013-09-01

A new set of pelagic tide determinations is constructed from seafloor pressure measurements obtained at 151 sites in the deep ocean. To maximize precision of estimated tides, only stations with long time series are used; median time series length is 567 days. Geographical coverage is considerably improved by use of the international tsunami network, but coverage in the Indian Ocean and South Pacific is still weak. As a tool for assessing global ocean tide models, the data set is considerably more reliable than older data sets: the root-mean-square difference with a recent altimetric tide model is approximately 5 mm for the M2 constituent. Precision is sufficiently high to allow secondary effects in altimetric and bottom-pressure tide differences to be studied. The atmospheric tide in bottom pressure is clearly detected at the S1, S2, and T2 frequencies. The altimetric tide model is improved if satellite altimetry is corrected for crustal loading by the atmospheric tide. Models of the solid body tide can also be constrained. The free core-nutation effect in the K1 Love number is easily detected, but the overall estimates are not as accurate as a recent determination with very long baseline interferometry.

Construction of Green Tide Monitoring System and Research on its Key Techniques

NASA Astrophysics Data System (ADS)

Xing, B.; Li, J.; Zhu, H.; Wei, P.; Zhao, Y.

2018-04-01

As a kind of marine natural disaster, Green Tide has been appearing every year along the Qingdao Coast, bringing great loss to this region, since the large-scale bloom in 2008. Therefore, it is of great value to obtain the real time dynamic information about green tide distribution. In this study, methods of optical remote sensing and microwave remote sensing are employed in Green Tide Monitoring Research. A specific remote sensing data processing flow and a green tide information extraction algorithm are designed, according to the optical and microwave data of different characteristics. In the aspect of green tide spatial distribution information extraction, an automatic extraction algorithm of green tide distribution boundaries is designed based on the principle of mathematical morphology dilation/erosion. And key issues in information extraction, including the division of green tide regions, the obtaining of basic distributions, the limitation of distribution boundary, and the elimination of islands, have been solved. The automatic generation of green tide distribution boundaries from the results of remote sensing information extraction is realized. Finally, a green tide monitoring system is built based on IDL/GIS secondary development in the integrated environment of RS and GIS, achieving the integration of RS monitoring and information extraction.

Precise Comparisons of Bottom-Pressure and Altimetric Ocean Tides

NASA Technical Reports Server (NTRS)

Ray, Richard D.

2013-01-01

A new set of pelagic tide determinations is constructed from seafloor pressure measurements obtained at 151 sites in the deep ocean. To maximize precision of estimated tides, only stations with long time series are used; median time series length is 567 days. Geographical coverage is considerably improved by use of the international tsunami network, but coverage in the Indian Ocean and South Pacific is still weak. As a tool for assessing global ocean tide models, the data set is considerably more reliable than older data sets : the root-mean-square difference with a recent altimetric tide model is approximately 5 mm for the M2 constituent. Precision is sufficiently high to allow secondary effects in altimetric and bottom-pressure tide differences to be studied. The atmospheric tide in bottom pressure is clearly detected at the S1, S2, and T2 frequencies. The altimetric tide model is improved if satellite altimetry is corrected for crustal loading by the atmospheric tide. Models of the solid body tide can also be constrained. The free corenutation effect in the K1 Love number is easily detected, but the overall estimates are not as accurate as a recent determination with very long baseline interferometry.

How do employees and managers perceive depression: a worksite case study.

PubMed

Hauck, Katelyn; Chard, Gill

2009-01-01

The impact of depression in the workplace is significant. If managers and employees understood depression better they could assist those with depression to achieve optimal work performance. The case study was a medium-sized, privately owned forest products company located in western Canada. Individual interviews were used to explore the views of employees and managers about depression and its impact on work performance. Suggest that how one perceives workplace support for depression is influenced by the interaction of the following factors: a) knowledge and understanding of depression, b) roles and responsibilities within the work environment, and c) perceptions of work role boundaries. Better links are needed between employees and managers to enhance workplace collaborations and achieve optimal work performance. The implementation of mental health support programs and the vocational role of occupational therapy in addressing the impact of depression in the workplace are discussed.

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

PubMed Central

2014-01-01

Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Conclusions Classification of patients’ depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement. PMID:24422622

REDUCING SUICIDAL IDEATION AND DEPRESSION IN OLDER PRIMARY CARE PATIENTS: 24-MONTH OUTCOMES OF THE PROSPECT STUDY

PubMed Central

Alexopoulos, George S.; Reynolds, Charles F.; Bruce, Martha L.; Katz, Ira R.; Raue, Patrick J.; Mulsant, Benoit H.; Oslin, David; Have, Thomas Ten

2010-01-01

Objective The PROSPECT Study evaluated the impact of a care management intervention on suicidal ideation and depression in older primary care patients. This is the first report of outcomes over a 2-year period. Method The subjects (N=599) were older (>=60 years) patients with major or minor depression selected after screening 9,072 randomly identified patients of 20 primary care practices randomly assigned to the PROSPECT intervention or usual care. The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months. Results Intervention patients had a higher likelihood to receive antidepressants and or psychotherapy (84.9–89% vs. 49–59%) and a 2.2 times greater decline in suicidal ideation than usual care patients over 24 months. Treatment response occurred earlier in intervention patients and continued to increase from the 18th to the 24th month, while there was no appreciable increase in usual care patients during the same period. Among patients with major depression, a greater number achieved remission in the intervention than the usual care group at 4 (26.6 vs. 15.2%), 8 (36% vs. 22.5%), and 24 (45.4% vs. 31.5%) months. Patients with minor depression had favorable outcomes regardless of treatment assignment. Conclusions Sustained collaborative care maintains high utilization of antidepressant treatment, reduces suicidal ideation, and improves the outcomes of major depression over two years. These observations suggest that sustained collaborative care increases depression-free days. PMID:19528195

Using an Altimeter-Derived Internal Tide Model to Remove Tides from in Situ Data

NASA Technical Reports Server (NTRS)

Zaron, Edward D.; Ray, Richard D.

2017-01-01

Internal waves at tidal frequencies, i.e., the internal tides, are a prominent source of variability in the ocean associated with significant vertical isopycnal displacements and currents. Because the isopycnal displacements are caused by ageostrophic dynamics, they contribute uncertainty to geostrophic transport inferred from vertical profiles in the ocean. Here it is demonstrated that a newly developed model of the main semidiurnal (M2) internal tide derived from satellite altimetry may be used to partially remove the tide from vertical profile data, as measured by the reduction of steric height variance inferred from the profiles. It is further demonstrated that the internal tide model can account for a component of the near-surface velocity as measured by drogued drifters. These comparisons represent a validation of the internal tide model using independent data and highlight its potential use in removing internal tide signals from in situ observations.

Clinician Approaches and Strategies for Engaging Older Men in Depression Care

PubMed Central

Apesoa-Varano, Ester Carolina; Hinton, Ladson; Barker, Judith C.; Unützer, Jürgen

2010-01-01

OBJECTIVE The aim of this study is to explore primary care physicians’ (PCPs) and depression care managers’ (DCMs) approaches to diagnosing and treating depression in older men. The authors focus on older men because studies have shown that they are under-treated compared with women and younger groups. The authors contribute to previous research by identifying facilitators of care for older men from the perspective of clinicians. METHODS Participants in this study were part of the Improving Mood-Promoting access to Collaborative Treatment (IMPACT) trial, an effectiveness study of collaborative care for late-life depression in 18 diverse primary care practices. Nine PCPs and 11 DCMs were interviewed to collect information on specific roles in caring for depressed patients and their experiences in working with depressed older men. All interviews were tape-recorded, transcribed verbatim and analyzed thematically in several steps using standard qualitative data analysis techniques. RESULTS The authors identified three general approaches to building trust and talking about the depression: 1) an indirect approach (“call it something else”), 2) a gradual approach (“building up to depression”), and 3) a direct approach (“shock and awe”). The authors also found specific strategies that PCPs and DCMs used to manage depression among elderly male patients, such as increased monitoring of mood, treating somatic symptoms first, medicalizing depression, and enlisting the cooperation of family. In our interviews, enlisting family involvement was the most prominent strategy used by clinicians. CONCLUSIONS A variety of approaches and strategies are used by clinicians for diagnosing and treating depressed older men. Clinicians change strategies as a response to a patient's compliance with treatment and the decision about which strategy to pursue is usually made on an “on-the-go” basis throughout the course of clinician-patient interaction. Based on clinicians’ experience, depression management requires concerted efforts and persistence, and the family seems to play an important role in how older men receive the diagnosis of depression and adhere to clinicians’ prescribed treatment. However, more research is needed to discover the best way of engaging and working with family members to facilitate effective depression care for older adults. PMID:20220598

Improved water-level forecasting for the Northwest European Shelf and North Sea through direct modelling of tide, surge and non-linear interaction

NASA Astrophysics Data System (ADS)

Zijl, Firmijn; Verlaan, Martin; Gerritsen, Herman

2013-07-01

In real-time operational coastal forecasting systems for the northwest European shelf, the representation accuracy of tide-surge models commonly suffers from insufficiently accurate tidal representation, especially in shallow near-shore areas with complex bathymetry and geometry. Therefore, in conventional operational systems, the surge component from numerical model simulations is used, while the harmonically predicted tide, accurately known from harmonic analysis of tide gauge measurements, is added to forecast the full water-level signal at tide gauge locations. Although there are errors associated with this so-called astronomical correction (e.g. because of the assumption of linearity of tide and surge), for current operational models, astronomical correction has nevertheless been shown to increase the representation accuracy of the full water-level signal. The simulated modulation of the surge through non-linear tide-surge interaction is affected by the poor representation of the tide signal in the tide-surge model, which astronomical correction does not improve. Furthermore, astronomical correction can only be applied to locations where the astronomic tide is known through a harmonic analysis of in situ measurements at tide gauge stations. This provides a strong motivation to improve both tide and surge representation of numerical models used in forecasting. In the present paper, we propose a new generation tide-surge model for the northwest European Shelf (DCSMv6). This is the first application on this scale in which the tidal representation is such that astronomical correction no longer improves the accuracy of the total water-level representation and where, consequently, the straightforward direct model forecasting of total water levels is better. The methodology applied to improve both tide and surge representation of the model is discussed, with emphasis on the use of satellite altimeter data and data assimilation techniques for reducing parameter uncertainty. Historic DCSMv6 model simulations are compared against shelf wide observations for a full calendar year. For a selection of stations, these results are compared to those with astronomical correction, which confirms that the tide representation in coastal regions has sufficient accuracy, and that forecasting total water levels directly yields superior results.

Environmental exposures to Florida red tides: Effects on emergency room respiratory diagnoses admissions.

PubMed

Kirkpatrick, Barbara; Fleming, Lora E; Backer, Lorraine C; Bean, Judy A; Tamer, Robert; Kirkpatrick, Gary; Kane, Terrance; Wanner, Adam; Dalpra, Dana; Reich, Andrew; Baden, Daniel G

2006-10-01

Human exposure to Florida red tides formed by Karenia brevis, occurs from eating contaminated shellfish and inhaling aerosolized brevetoxins. Recent studies have documented acute symptom changes and pulmonary function responses after inhalation of the toxic aerosols, particularly among asthmatics. These findings suggest that there are increases in medical care facility visits for respiratory complaints and for exacerbations of underlying respiratory diseases associated with the occurrence of Florida red tides.This study examined whether the presence of a Florida red tide affected the rates of admission with a respiratory diagnosis to a hospital emergency room in Sarasota, FL. The rate of respiratory diagnoses admissions were compared for a 3-month time period when there was an onshore red tide in 2001 (red tide period) and during the same 3-month period in 2002 when no red tide bloom occurred (non-red tide period). There was no significant increase in the total number of respiratory admissions between the two time periods. However, there was a 19% increase in the rate of pneumonia cases diagnosed during the red tide period compared with the non-red tide period. We categorized home residence zip codes as coastal (within 1.6 km from the shore) or inland (>1.6 km from shore). Compared with the non-red tide period, the coastal residents had a significantly higher (54%) rate of respiratory diagnoses admissions than during the red tide period. We then divided the diagnoses into subcategories (i.e. pneumonia, bronchitis, asthma, and upper airway disease). When compared with the non-red tide period, the coastal zip codes had increases in the rates of admission of each of the subcategories during the red tide period (i.e. 31, 56, 44, and 64%, respectively). This increase was not observed seen in the inland zip codes.These results suggest that the healthcare community has a significant burden from patients, particularly those who live along the coast, needing emergency medical care for both acute and potentially chronic respiratory illnesses during red tide blooms.

State of the Science: Depression and Type 2 Diabetes

PubMed Central

Penckofer, Sue; Doyle, Todd; Byrn, Mary; Lustman, Patrick J.

2014-01-01

Depression is a significant comorbid condition in diabetes. Individuals with type 2 diabetes (T2DM) are 2 times more likely to experience depression or elevated depressive symptoms compared to those without T2DM. The aims of this state of the science review were to summarize the putative links between diabetes and depression and review empirically supported treatments of depression in diabetes. Findings suggest that a bidirectional association between depression and T2DM exists and that several biological and psychosocial mediators underlie these conditions. Available data indicate that conventional treatments (antidepressant medication, cognitive behavioral therapy, and collaborative care) reduce depression and symptoms of depression; however more controlled studies and development of novel therapies are needed. Glycemic outcomes have most frequently been examined, but findings have been mixed. Self-care and adherence outcomes have been less well studied. Emerging evidence suggests that these outcomes may be important targets for future depression research in T2DM. PMID:24577866

Application of the Convolution Formalism to the Ocean Tide Potential: Results from the Gravity and Recovery and Climate Experiment (GRACE)

NASA Technical Reports Server (NTRS)

Desai, S. D.; Yuan, D. -N.

2006-01-01

A computationally efficient approach to reducing omission errors in ocean tide potential models is derived and evaluated using data from the Gravity Recovery and Climate Experiment (GRACE) mission. Ocean tide height models are usually explicitly available at a few frequencies, and a smooth unit response is assumed to infer the response across the tidal spectrum. The convolution formalism of Munk and Cartwright (1966) models this response function with a Fourier series. This allows the total ocean tide height, and therefore the total ocean tide potential, to be modeled as a weighted sum of past, present, and future values of the tide-generating potential. Previous applications of the convolution formalism have usually been limited to tide height models, but we extend it to ocean tide potential models. We use luni-solar ephemerides to derive the required tide-generating potential so that the complete spectrum of the ocean tide potential is efficiently represented. In contrast, the traditionally adopted harmonic model of the ocean tide potential requires the explicit sum of the contributions from individual tidal frequencies. It is therefore subject to omission errors from neglected frequencies and is computationally more intensive. Intersatellite range rate data from the GRACE mission are used to compare convolution and harmonic models of the ocean tide potential. The monthly range rate residual variance is smaller by 4-5%, and the daily residual variance is smaller by as much as 15% when using the convolution model than when using a harmonic model that is defined by twice the number of parameters.

Implementing Dementia Care Models in Primary Care Settings: The Aging Brain Care Medical Home (Special Supplement)

PubMed Central

Callahan, Christopher M.; Boustani, Malaz A.; Weiner, Michael; Beck, Robin A.; Livin, Lee R.; Kellams, Jeffrey J.; Willis, Deanna R.; Hendrie, Hugh C.

2010-01-01

Objectives The purpose of this paper is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression. Methods Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model. We also provide a description of the core components of this innovative memory care program. Results Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. We used the reflective adaptive process as a relationship building framework that recognizes primary care practices as complex adaptive systems. This framework allows for local adaptation of the protocols and procedures developed in the clinical trials. Tailored care for individual patients is facilitated through a care manager working in collaboration with a primary care physician and supported by specialists in a memory care clinic as well as by information technology resources. Conclusions We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care. Spontaneous adoption of new models of care is unlikely without specific attention to the complexities and resource constraints of health care systems. PMID:20945236

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial.

PubMed

Bekelman, David B; Plomondon, Mary E; Sullivan, Mark D; Nelson, Karin; Hattler, Brack; McBryde, Connor; Lehmann, Kenneth G; Potfay, Jonathan; Heidenreich, Paul; Rumsfeld, John S

2013-07-09

Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status. Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful. Unique identifier: NCT00461513.

Energetics of global ocean tides from Geosat altimetry

NASA Technical Reports Server (NTRS)

Cartwright, David E.; Ray, Richard D.

1991-01-01

The present paper focuses on resonance and energetics of the daily tides, especially in the southern ocean, the distribution of gravitational power input of daily and half-daily tides, and comparison with other estimates of global dissipation rates. The present global tidal maps, derived from Geosat altimetry, compare favorably with ground truth data at about the same rms level as the models of Schwiderski (1983), and are slightly better in lunar than in solar tides. Diurnal admittances clearly show Kelvin wave structure in the southern ocean and confirm the resonant mode of Platzman (1984) at 28.5 + or - 0.1 hr with an apparent Q of about 4. Driving energy is found to enter dominantly in the North Pacific for the daily tides and is strongly peaked in the tropical oceans for the half-daily tides. Global rates of working on all major tide constituents except S2 agree well with independent results from analyses of gravity through satellite tracking. Comparison at S2 is improved by allowing for the air tide in gravitational results but suggests deficiencies in all solar tide models.

Interferometric Water Level Tilt Meter Development in Finland and Comparison with Combined Earth Tide and Ocean Loading Models

NASA Astrophysics Data System (ADS)

Ruotsalainen, Hannu

2018-05-01

A modern third-generation interferometric water level tilt meter was developed at the Finnish Geodetic Institute in 2000. The tilt meter has absolute scale and can do high-precision tilt measurements on earth tides, ocean tide loading and atmospheric loading. Additionally, it can be applied in various kinds of geodynamic and geophysical research. The principles and results of the historical 100-year-old Michelson-Gale tilt meter, as well as the development of interferometric water tube tilt meters of the Finnish Geodetic Institute, Finland, are reviewed. Modern Earth tide model tilt combined with Schwiderski ocean tide loading model explains the uncertainty in historical tilt observations by Michelson and Gale. Earth tide tilt observations in Lohja2 geodynamic station, southern Finland, are compared with the combined model earth tide and four ocean tide loading models. The observed diurnal and semidiurnal harmonic constituents do not fit well with combined models. The reason could be a result of the improper harmonic modelling of the Baltic Sea tides in those models.

Water-surface elevations for the high tide of December 15, 1977, in the Puget Sound region, Washington

USGS Publications Warehouse

Nelson, L.M.

1985-01-01

An unusually high oceanic tide on December 15, 1977, caused flooding of lowlying, nearshore parts of western Washington, including several areas in the Puget Sound region. At Seattle, the December 15 high tide of 14.8 feet above MLLW (mean lower low water datum; 8.55 feet above the National Geodetic Vertical Daltum of 1929, or NGVD) was 0.1 foot higher than the 100-year high tide. At Neah Bay, near the western end of the Straits of Juan de Fuca, however, the high tide of 8.77 feet MLLW (4.55 feet NGVD) on that date was 3.2 feet lower than the 100-year high tide. This study has identified the observed December 15 high-tide elevations at many locations in the Puget Sound region. The observed high tide then was much higher than predicted in most of the Puget Sound region, primarily as the result of a very low barametric pressure. Little damage from wind waves was reported. Elevation profiles for the predicted and observed high tides on December 15 and for several other selected tide levels indicate an increase in the maximum height in the inland direction, except near Port Angeles, and show abrupt changes in tidal elevations at three constrictions - Admiralty Inlet, Tacoma Narrows, and Deception Pass. (USGS)

East Coast/West Coast Art Project: A Constructivist and Technological Approach to Middle Level and Higher Education Collaboration

ERIC Educational Resources Information Center

Johnson, Margaret H.; Kieling, Linda W.; Cooper, Susan L.

2014-01-01

In this article, the authors report on usage of 21st-century technology, and a collaborative project that allowed middle school art students and preservice teachers to share their artwork and receive feedback in a constructivist learning environment. Middle school students often deal with issues such as bullying, divorce, and depression; they can…

The Working Alliance Between Patients With Bipolar Disorder and the Nurse: Helpful and Obstructive Elements During a Depressive Episode From the Patients' Perspective.

PubMed

Stegink, Eva E; van der Voort, Trijntje Y G Nienke; van der Hooft, Truus; Kupka, Ralph W; Goossens, Peter J J; Beekman, Aartjan T F; van Meijel, Berno

2015-10-01

Despite treatment, many patients with bipolar disorder experience impaired functioning and a decreased quality of life. Optimal collaboration between patient and mental health care providers could enhance treatment outcomes. The goal of this qualitative study, performed in a trial investigating the effect of collaborative care, was to gain more insight in patients' experiences regarding the helpful and obstructive elements of the working alliance between the patient recovering from a depressive episode and their nurse. Three core themes underpinned the nurses' support during recovery: a safe and supportive environment, assistance in clarifying thoughts and feelings, and support in undertaking physical activities. Copyright © 2015 Elsevier Inc. All rights reserved.

Modelling the influence of tides on ice-shelf melt rates in the Amundsen Sea, Antarctica.

NASA Astrophysics Data System (ADS)

Jourdain, Nicolas C.; Molines, Jean-Marc; Le Sommer, Julien; Mathiot, Pierre; Chanut, Jérome; Madec, Gurvan

2017-04-01

Variations in melt beneath ice- shelves may trigger ice-sheet instabilities, in particular in West Antarctica. Therefore, improving the understanding and modelling of ice-shelf basal melt rates has been a major focus over the last decades. In this presentation, we provide further insight into the role of tides on basal melt rates, and we assess several methods to account for tides in models that do not include an explicit representation of tides. First, we use an explicit representation of tides in a regional configuration of the NEMO-3.6 model deployed over the Amundsen Sea. We show that most of the tidal influence on ice-shelf melt is explained by four tidal constituents. Tides enhance melt by more than 30% in some cavities like Abbot, Cosgrove and Dotson, but by less than 10% in others like Thwaites and Pine Island. Over the entire Amundsen Sea sector, tides enhance melt by 92 Gt/yr, which is mostly induced by tidal velocities along ice drafts (+148 Gt/yr), partly compensated by tide-induced change in thermal forcing (-31 Gt/yr) and co-variations between tidal velocities and thermal forcing (-26 Gt/yr). In the second part of this presentation, we show that using uniform tidal velocities to account for tides effects in ocean models with no explicit tides produces large biases in melt rates. By contrast, prescribing non-uniform tidal velocities allows an accurate representation of the dynamical effects of tides on melt rates.

Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer.

PubMed

Walker, Jane; Hansen, Christian Holm; Martin, Paul; Symeonides, Stefan; Gourley, Charlie; Wall, Lucy; Weller, David; Murray, Gordon; Sharpe, Michael

2014-09-01

The management of depression in patients with poor prognosis cancers, such as lung cancer, creates specific challenges. We aimed to assess the efficacy of an integrated treatment programme for major depression in patients with lung cancer compared with usual care. Symptom Management Research Trials (SMaRT) Oncology-3 is a parallel-group, multicentre, randomised controlled trial. We enrolled patients with lung cancer and major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with lung cancer treatment programme or usual care by a database software algorithm that used stratification (by trial centre) and minimisation (by age, sex, and cancer type) with allocation concealment. Depression care for people with lung cancer is a manualised, multicomponent collaborative care treatment that is systematically delivered by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. The primary outcome was depression severity (on the Symptom Checklist Depression Scale [SCL-20], range 0-4) averaged over the patient's time in the trial (up to a maximum of 32 weeks). Trial statisticians and data collection staff were masked to treatment allocation, but patients and clinicians could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN75905964. 142 participants were recruited between Jan 5, 2009, and Sept 9, 2011; 68 were randomly allocated to depression care for people with lung cancer and 74 to usual care. 43 (30%) of 142 patients had died by 32 weeks, all of which were cancer-related deaths. No intervention-related serious adverse events occurred. 131 (92%) of 142 patients provided outcome data (59 in the depression care for people with lung cancer group and 72 in the usual care group) and were included in the intention-to-treat primary analysis. Average depression severity was significantly lower in patients allocated to depression care for people with lung cancer (mean score on the SCL-20 1·24 [SD 0·64]) than in those allocated to usual care (mean score 1·61 [SD 0·58]); difference -0·38 (95% CI -0·58 to -0·18); standardised mean difference -0·62 (95% CI -0·94 to -0·29). Self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly better in the depression care for people with lung cancer group than in the usual care group. Our findings suggest that major depression can be treated effectively in patients with a poor prognosis cancer; integrated depression care for people with lung cancer was substantially more efficacious than was usual care. Larger trials are now needed to estimate the effectiveness and cost-effectiveness of this care programme in this patient population, and further adaptation of the treatment will be necessary to address the unmet needs of patients with major depression and even shorter life expectancy. Cancer Research UK and Chief Scientist Office of the Scottish Government. Copyright © 2014 Elsevier Ltd. All rights reserved.

Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.

PubMed

Wells, Kenneth B; Jones, Loretta; Chung, Bowen; Dixon, Elizabeth L; Tang, Lingqi; Gilmore, Jim; Sherbourne, Cathy; Ngo, Victoria K; Ong, Michael K; Stockdale, Susan; Ramos, Esmeralda; Belin, Thomas R; Miranda, Jeanne

2013-10-01

Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05). Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

Tides and Decadal Variability

NASA Technical Reports Server (NTRS)

Ray, Richard D.

2003-01-01

This paper reviews the mechanisms by which oceanic tides and decadal variability in the oceans are connected. We distinguish between variability caused by tides and variability observed in the tides themselves. Both effects have been detected at some level. The most obvious connection with decadal timescales is through the 18.6-year precession of the moon's orbit plane. This precession gives rise to a small tide of the same period and to 18.6-year modulations in the phase and amplitudes of short-period tides. The 18.6-year "node tide" is very small, no more than 2 cm anywhere, and in sea level data it is dominated by the ocean's natural Variability. Some authors have naively attributed climate variations with periods near 19 years directly to the node tide, but the amplitude of the tide is too small for this mechanism to be operative. The more likely explanation (Loder and Garrett, JGR, 83, 1967-70, 1978) is that the 18.6-y modulations in short-period tides, especially h e principal tide M2, cause variations in ocean mixing, which is then observed in temperature and other climatic indicators. Tidally forced variability has also been proposed by some authors, either in response to occasional (and highly predictable) tidal extremes or as a nonlinear low-frequency oscillation caused by interactions between short-period tides. The former mechanism can produce only short-duration events hardly more significant than normal tidal ranges, but the latter mechanism can in principle induce low-frequency oscillations. The most recent proposal of this type is by Keeling and Whorf, who highlight the 1800-year spectral peak discovered by Bond et al. (1997). But the proposal appears contrived and should be considered, in the words of Munk et al. (2002), "as the most likely among unlikely candidates."

The double high tide at Port Ellen: Doodson's criterion revisited

NASA Astrophysics Data System (ADS)

Byrne, Hannah A. M.; Mattias Green, J. A.; Bowers, David G.

2017-07-01

Doodson proposed a minimum criterion to predict the occurrence of double high (or double low) waters when a higher-frequency tidal harmonic is added to the semi-diurnal tide. If the phasing of the harmonic is optimal, the condition for a double high water can be written bn2/a > 1 where b is the amplitude of the higher harmonic, a is the amplitude of the semi-diurnal tide, and n is the ratio of their frequencies. Here we expand this criterion to allow for (i) a phase difference ϕ between the semi-diurnal tide and the harmonic and (ii) the fact that the double high water will disappear in the event that b/a becomes large enough for the higher harmonic to be the dominant component of the tide. This can happen, for example, at places or times where the semi-diurnal tide is very small. The revised parameter is br2/a, where r is a number generally less than n, although equal to n when ϕ = 0. The theory predicts that a double high tide will form when this parameter exceeds 1 and then disappear when it exceeds a value of order n2 and the higher harmonic becomes dominant. We test these predictions against observations at Port Ellen in the Inner Hebrides of Scotland. For most of the data set, the largest harmonic of the semi-diurnal tide is the sixth diurnal component, for which n = 3. The principal lunar and solar semi-diurnal tides are about equal at Port Ellen and so the semi-diurnal tide becomes very small twice a month at neap tides (here defined as the smallest fortnightly tidal range). A double high water forms when br2/a first exceeds a minimum value of about 1.5 as neap tides are approached and then disappears as br2/a then exceeds a second limiting value of about 10 at neap tides in agreement with the revised criterion.

Recruitment of fish larvae and juveniles into two estuarine nursery areas with evidence of ebb tide use

NASA Astrophysics Data System (ADS)

Pattrick, Paula; Strydom, Nadine

2014-08-01

Recruitment of larvae and early juveniles, against the ebb tide in the shallower, slower-flowing marginal areas of two permanently open estuaries in the Eastern Cape, South Africa was observed. To determine tidal, diel and seasonal variations of larval and juvenile fish recruitment, fyke nets were used during a 24-hour cycle over two years from December 2010 to October 2012. On either side of each estuary bank, two fyke nets with mouth openings facing opposite directions (i.e. one net facing the incoming or outgoing tide and the other facing the opposing direction) were used to sample fishes. The aims of this study were to determine if 1) on the flood tide, were the nets facing the incoming tide collecting more larvae and early juveniles recruiting into the estuarine nursery area, than the nets facing the opposing direction and 2) on the ebb tide, were the nets facing the sea, and hence the opposing direction of the outgoing ebb tide, collecting more fishes recruiting into the nursery against the ebb tide, than the nets facing the outgoing ebb tide? Larval and juvenile fish CPUE, species diversity and richness varied seasonally between estuarine systems and between diel and tidal conditions. Highest catches were recorded on the flood tide, which coincided with sunrise in the Swartkops Estuary. Greatest catches of larvae and early juveniles were observed during the ebb tide at night in the Sundays Estuary. On the ebb tide, higher catches of several dominant species and several commercially important fishery species, occurred in the fyke nets which faced the sea, indicating the early developmental stages of these fish species are not necessarily being lost from the nursery. These larvae and juveniles are actively swimming against the ebb tide in the shallower, slower-flowing marginal areas facilitating recruitment against ebb flow.

A tide prediction and tide height control system for laboratory mesocosms

PubMed Central

Long, Jeremy D.

2015-01-01

Experimental mesocosm studies of rocky shore and estuarine intertidal systems may benefit from the application of natural tide cycles to better replicate variation in immersion time, water depth, and attendant fluctuations in abiotic and edaphic conditions. Here we describe a stand-alone microcontroller tide prediction open-source software program, coupled with a mechanical tidal elevation control system, which allows continuous adjustment of aquarium water depths in synchrony with local tide cycles. We used this system to monitor the growth of Spartina foliosa marsh cordgrass and scale insect herbivores at three simulated shore elevations in laboratory mesocosms. Plant growth decreased with increasing shore elevation, while scale insect population growth on the plants was not strongly affected by immersion time. This system shows promise for a range of laboratory mesocosm studies where natural tide cycling could impact organism performance or behavior, while the tide prediction system could additionally be utilized in field experiments where treatments need to be applied at certain stages of the tide cycle. PMID:26623195

Mapping the nonstationary internal tide with satellite altimetry

NASA Astrophysics Data System (ADS)

Zaron, Edward D.

2017-01-01

Temporal variability of the internal tide has been inferred from the 23 year long combined records of the TOPEX/Poseidon, Jason-1, and Jason-2 satellite altimeters by combining harmonic analysis with an analysis of along-track wavenumber spectra of sea-surface height (SSH). Conventional harmonic analysis is first applied to estimate and remove the stationary components of the tide at each point along the reference ground tracks. The wavenumber spectrum of the residual SSH is then computed, and the variance in a neighborhood around the wavenumber of the mode-1 baroclinic M2 tide is interpreted as the sum of noise, broadband nontidal processes, and the nonstationary tide. At many sites a bump in the spectrum associated with the internal tide is noted, and an empirical model for the noise and nontidal processes is used to estimate the nonstationary semidiurnal tidal variance. The results indicate a spatially inhomogeneous pattern of tidal variability. Nonstationary tides are larger than stationary tides throughout much of the equatorial Pacific and Indian Oceans.

Some dinophycean red tide plankton species generate a superoxide scavenging substance.

PubMed

Sato, Emiko; Niwano, Yoshimi; Matsuyama, Yukihiko; Kim, Daekyung; Nakashima, Takuji; Oda, Tatsuya; Kohno, Masahiro

2007-03-01

Recent studies indicate that some raphidophycean red tide flagellates produce substances able to scavenge superoxide, whereas there have been no reports on superoxide scavenger production by dinophycean red tide flagellates. In this study, we examined the superoxide-scavenging activity of aqueous extracts from dinophycean red tide flagellates, Gymnodinium spp., Scrippsiella trochoidea, and Karenia sp., by a luminol analog L-012-dependent chemiluminescence (CL) method and an electron spin resonance (ESR)-spin trapping method, and compared the activity to that of raphidophycean red tide flagellates, Chattonella spp., Heterosigma akashiwo, and Fibrocapsa japonica. In the experiment applying the L-012-dependent CL method, only the aqueous extracts from raphidophycean red tide flagellates showed superoxide-scavenging activity. On the other hand, applying the ESR-spin trapping method, we found that the aqueous extracts from dinophycean red tide flagellates also showed superoxide-scavenging activity. This is the first report on the production of a superoxide-scavenger by dinophycean red tide flagellates.

The BRIGHTEN program: implementation and evaluation of a program to bridge resources of an interdisciplinary geriatric health team via electronic networking.

PubMed

Emery, Erin E; Lapidos, Stan; Eisenstein, Amy R; Ivan, Iulia I; Golden, Robyn L

2012-12-01

To demonstrate the feasibility of the BRIGHTEN Program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), an interdisciplinary team intervention for assessing and treating older adults for depression in outpatient primary and specialty medical clinics. The BRIGHTEN team collaborates "virtually" to review patient assessment results, develop a treatment plan, and refer to appropriate team members for follow-up care. Older adults in 9 academic medical center clinics and 2 community-based clinics completed screening forms for symptoms of depression and anxiety. Those with positive screens engaged in comprehensive assessment with the BRIGHTEN Program Coordinator; the BRIGHTEN virtual team provided treatment recommendations based on the results of assessment. A collaborative treatment plan was developed with each participant, who was then connected to appropriate services. Two thousand four hundred twenty-two older adults were screened in participating clinics over a 40-month period. Eight hundred fifty-nine older adults screened positive, and 150 elected to enroll in BRIGHTEN. From baseline to 6 months, significant improvements were found in depression symptoms (Geriatric Depression Scale, p < .01) and general mental health (SF-12 Mental Component, p < .01). The BRIGHTEN Program demonstrated that an interdisciplinary virtual team linked with outpatient medical clinics can be an effective, nonthreatening, and seamless approach to enable older adults to access treatment for depression.

Effects of the oceans on polar motion: Extended investigations

NASA Technical Reports Server (NTRS)

Dickman, Steven R.

1986-01-01

A method was found for expressing the tide current velocities in terms of the tide height (with all variables expanded in spherical harmonics). All time equations were then combined into a single, nondifferential matrix equation involving only the unknown tide height. The pole tide was constrained so that no tidewater flows across continental boundaries. The constraint was derived for the case of turbulent oceans; with the tide velocities expressed in terms of the tide height. The two matrix equations were combined. Simple matrix inversion then yielded the constrained solution. Programs to construct and invert the matrix equations were written. Preliminary results were obtained and are discussed.

Global ocean tide models on the eve of Topex/Poseidon

NASA Technical Reports Server (NTRS)

Ray, Richard D.

1993-01-01

Some existing global ocean tide models that can provide tide corrections to Topex/Poseidon altimeter data are described. Emphasis is given to the Schwiderski and Cartwright-Ray models, as these are the most comprehensive, highest resolution models, but other models that will soon appear are mentioned. Differences between models for M2 often exceed 10 cm over vast stretches of the ocean. Comparisons to 80 selected pelagic and island gauge measurements indicate the Schwiderski model is more accurate for the major solar tides, Cartwright-Ray for the major lunar tides. The adequacy of available tide models for studying basin-scale motions is probably marginal at best.

New Miscellaneous Results in Tides from Topex/Poseidon

NASA Technical Reports Server (NTRS)

Ray, Richard D.; Egbert, G.; Cartwright, D.; Smith, David E. (Technical Monitor)

2000-01-01

This paper describes a variety of new results concerning ocean tides that have been derived from Topex/Poseidon satellite altimeter data. Most of these results are based on new tidal solutions employing nearly 8 years of data. The topics covered include internal tides and long-period tides.

Effects of internal tidal dissipation and self-attraction and loading on semidiurnal tides in the Bohai Sea, Yellow Sea and East China Sea: a numerical study

NASA Astrophysics Data System (ADS)

Teng, Fei; Fang, Guohong; Xu, Xiaoqing

2017-09-01

A parameterized internal tide dissipation term and self-attraction and loading (SAL) tide term are introduced in a barotropic numerical model to investigate the dynamics of semidiurnal tidal constituents M 2 and S 2 in the Bohai Sea, Yellow Sea and East China Sea (BYECS). The optimal parameters for bottom friction and internal dissipation are obtained through a series of numerical computations. Numerical simulation shows that the tide-generating force contributes 1.2% of M 2 power for the entire BYECS and up to 2.8% for the East China Sea deep basin. SAL tide contributes 4.4% of M 2 power for the BYECS and up to 9.3% for the East China Sea deep basin. Bottom friction plays a major role in dissipating tidal energy in the shelf regions, and the internal tide effect is important in the deep water regions. Numerical experiments show that artificial removal of tide-generating force in the BYECS can cause a significant difference (as much as 30 cm) in model output. Artificial removal of SAL tide in the BYECS can cause even greater difference, up to 40 cm. This indicates that SAL tide should be taken into account in numerical simulations, especially if the tide-generating force is considered.

Impacts of tides on tsunami propagation due to potential Nankai Trough earthquakes in the Seto Inland Sea, Japan

NASA Astrophysics Data System (ADS)

Lee, Han Soo; Shimoyama, Tomohisa; Popinet, Stéphane

2015-10-01

The impacts of tides on extreme tsunami propagation due to potential Nankai Trough earthquakes in the Seto Inland Sea (SIS), Japan, are investigated through numerical experiments. Tsunami experiments are conducted based on five scenarios that consider tides at four different phases, such as flood, high, ebb, and low tides. The probes that were selected arbitrarily in the Bungo and Kii Channels show less significant effects of tides on tsunami heights and the arrival times of the first waves than those that experience large tidal ranges in inner basins and bays of the SIS. For instance, the maximum tsunami height and the arrival time at Toyomaesi differ by more than 0.5 m and nearly 1 h, respectively, depending on the tidal phase. The uncertainties defined in terms of calculated maximum tsunami heights due to tides illustrate that the calculated maximum tsunami heights in the inner SIS with standing tides have much larger uncertainties than those of two channels with propagating tides. Particularly in Harima Nada, the uncertainties due to the impacts of tides are greater than 50% of the tsunami heights without tidal interaction. The results recommend simulate tsunamis together with tides in shallow water environments to reduce the uncertainties involved with tsunami modeling and predictions for tsunami hazards preparedness. This article was corrected on 26 OCT 2015. See the end of the full text for details.

Effectiveness of Problem-Solving Therapy for Older, Primary Care Patients with Depression: Results from the IMPACT Project

ERIC Educational Resources Information Center

Arean, Patricia; Hegel, Mark; Vannoy, Steven; Fan, Ming-Yu; Unuzter, Jurgen

2008-01-01

Purpose: We compared a primary-care-based psychotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psychotherapy in treating late-life major depression and dysthymia. Design and Methods: The data here are from the IMPACT study, which compared collaborative care within a primary care clinic to care as usual in…

Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting.

PubMed

Steel, Jennifer L; Geller, David A; Kim, Kevin H; Butterfield, Lisa H; Spring, Michael; Grady, Jonathan; Sun, Weiing; Marsh, Wallis; Antoni, Michael; Dew, Mary Amanda; Helgeson, Vicki; Schulz, Richard; Tsung, Allan

2016-04-15

The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life. A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression. At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm. The integration of screening and symptom management into cancer care is recommended. © 2016 American Cancer Society.

Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial.

PubMed

Zatzick, Douglas; Russo, Joan; Lord, Sarah Peregrine; Varley, Christopher; Wang, Jin; Berliner, Lucy; Jurkovich, Gregory; Whiteside, Lauren K; O'Connor, Stephen; Rivara, Frederick P

2014-06-01

Violence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. To test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury. A pragmatic randomized clinical trial was conducted at a single US level I trauma center. Participants included 120 adolescents aged 12 to 18 years randomized to intervention (n = 59) and control (n = 61) conditions. Stepped collaborative care intervention included motivational interviewing elements targeting risk behaviors and substance use as well as medication and cognitive behavioral therapy elements targeting PTSD and depressive symptoms. Adolescents were assessed at baseline before randomization and 2, 5, and 12 months after injury hospitalization. Standardized instruments were used to assess violence risk behaviors, alcohol and drug use, and PTSD and depressive symptoms. The investigation attained more than 95% adolescent follow-up at each assessment point. At baseline, approximately one-third of the participants endorsed the violence risk behavior of carrying a weapon. Regression analyses demonstrated that intervention patients experienced significant reductions in weapon carrying compared with controls during the year after injury (group × time effect, F3,344 = 3.0; P = .03). At 12 months after the injury, 4 (7.3%) intervention patients vs 13 (21.3%) control patients reported currently carrying a weapon (relative risk, 0.31; 95% CI, 0.11-0.90). The intervention was equally effective in reducing the risk of weapon carrying among injured adolescents with and without traumatic brain injury. Other treatment targets, including alcohol and drug use problems and high levels of PTSD and depressive symptoms, occurred less frequently in the cohort relative to weapon carrying and were not significantly affected by the intervention. Collaborative care intervention reduced the risk of adolescent weapon carrying during the year after the injury hospitalization. Future investigation should replicate this preliminary observation. If the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at US trauma centers. clinicaltrials.gov identifier: NCT00619255.

Who needs collaborative care treatment? A qualitative study exploring attitudes towards and experiences with mental healthcare among general practitioners and care managers.

PubMed

Møller, Marlene Christina Rosengaard; Mygind, Anna; Bro, Flemming

2018-05-30

Collaborative care treatment is widely recognized as an effective approach to improve the quality of mental healthcare through enhanced and structured collaboration between general practice and specialized psychiatry. However, studies indicate that the complexity of collaborative care treatment interventions challenge the implementation in real-life general practice settings. Four Danish Collaborative Care Models were launched in 2014 for patients with mild/moderate anxiety and depression. These involved collaboration between general practitioners, care managers and consultant psychiatrists. Taking a multi-practice bottom-up approach, this paper aims to explore the perceived barriers and enablers related to collaborative care for patients with mental health problems and to investigate the actual experiences with a Danish collaborative care model in a single-case study in order to identify enablers and barriers for successful implementation. Combining interviews and observations of usual treatment practices, we conducted a multi-practice study among general practitioners who were not involved in the Danish collaborative care models to explore their perspectives on existing mental health treatment and to investigate (from a bottom-up approach) their perceptions of and need for collaborative care in mental health treatment. Additionally, by combining observations and qualitative interviews, we followed the implementation of a Danish collaborative care model in a single-case study to convey identified barriers and enablers of the collaborative care model. Experienced and perceived enablers of the Danish collaborative care model mainly consisted of a need for new treatment options to deal with mild/moderate anxiety and depression. The model was considered to meet the need for a free fast track to high-quality treatment. Experienced barriers included: poor adaptation of the model to the working conditions and needs in daily general practice, time consumption, unsustainable logistical set-up and unclear care manager role. General practitioners in the multi-practice study considered access to treatment and not collaboration with specialised psychiatry to be essential for this group of patients. The study calls for increased attention to implementation processes and better adaptation of collaborative care models to the clinical reality of general practice. Future interventions should address the treatment needs of specific patient populations and should involve relevant stakeholders in the design and implementation processes.

Analysis of groundwater response to tidal fluctuations, Operable Unit 2, Area 8, Naval Base Kitsap, Keyport, Washington

USGS Publications Warehouse

Opatz, Chad C.; Dinicola, Richard S.

2018-05-21

Operable Unit 2, Area 8, at Naval Base Kitsap, Keyport is the site of a former chrome-plating facility that released metals (primarily chromium and cadmium), chlorinated volatile organic compounds, and petroleum compounds into the local environment. To ensure long-term protectiveness, as stipulated in the Fourth Five-Year Review for the site, Naval Facilities Engineering Command Northwest collaborated with the U.S. Environmental Protection Agency, the Washington State Department of Ecology, and the Suquamish Tribe, to collect data to monitor the contamination left in place and to ensure the site does not pose a risk to human health or the environment. To support these efforts, refined information was needed on the interaction of fresh groundwater with seawater in response to the up-to 13-ft tidal fluctuations at this nearshore site adjacent to Port Orchard Bay. The information was analyzed to meet the primary objective of this investigation, which was to determine the optimal time during the semi-diurnal and the neap-spring tidal cycles to sample groundwater for freshwater contaminants in Area 8 monitoring wells.Groundwater levels and specific conductance in five monitoring wells, along with marine water-levels (tidal levels) in Port Orchard Bay, were monitored every 15 minutes during a 3-week duration to determine how nearshore groundwater responds to tidal forcing. Time series data were collected from October 24, 2017, to November 16, 2017, a period that included neap and spring tides. Vertical profiles of specific conductance were also measured once in the screened interval of each well prior to instrument deployment to determine if a freshwater/saltwater interface was present in the well during that particular time.The vertical profiles of specific conductance were measured only one time during an ebbing tide at approximately the top, middle, and bottom of the saturated thickness within the screened interval of each well. The landward-most well, MW8-8, was completely freshwater, while one of the most seaward wells, MW8-9, was completely saline. A distinct saltwater interface was measured in the three other shallow wells (MW8-11, MW8-12, and MW8-14), with the topmost groundwater occurring fresh underlain by higher conductivity water.Lag times between minimum spring-tide level and minimum groundwater levels in wells ranged from about 2 to 4.5 hours in the less-than 20-ft deep wells screened across the water table, and was about 7 hours for the single 48-ft deep well screened below the water table. Those lag times were surprisingly long considering the wells are all located within 200-ft of the shoreline and the local geology is largely coarse-grained glacial outwash deposits. Various manmade subsurface features, such as slurry walls and backfilled excavations, likely influence and confuse the connectivity between seawater and groundwater.The specific-conductance time-series data showed clear evidence of substantial saltwater intrusion into the screened intervals of most shallow wells. Unexpectedly, the intrusion was associated with the neap part of the tidal cycle around November 13–16, when relatively low barometric pressure and high southerly winds led to the highest high and low tides measured during the monitoring period. The data consistently indicated that the groundwater had the lowest specific conductance (was least mixed with seawater) during the prior neap tides around October 30, the same period when the shallow groundwater levels were lowest. Although the specific conductance response is somewhat different between wells, the data do suggest that it is the heights of the actual high-high and low-low tides, regardless of whether or not they occur during the neap or spring part of the cycle, that allows seawater intrusion into the nearshore aquifer at Area 8.With all the data taken into consideration, the optimal time for sampling the shallow monitoring wells at Area 8 would be centered on a 2–5-hour period following the predicted low-low tide during neap tide, with due consideration of local atmospheric pressure and wind conditions that have the potential to generate tides that can be substantially higher than those predicted from lunar-solar tidal forces. The optimal time for sampling the deeper monitoring wells at Area 8 would be during the 6–8-hour period following a predicted low-low tide, also during the neap tide part of the tidal cycle. The specific time window to sample each well following a low tide can be found in table 5. Those periods are when groundwater in the wells is most fresh and least diluted by seawater intrusion. In addition to timing, consideration should be given to collecting undisturbed samples from the top of the screened interval (or top of the water table if below the top of the interval) to best characterize contaminant concentrations in freshwater. A downhole conductivity probe could be used to identify the saltwater interface, above which would be the ideal depth for sampling.

Effective Implementation of Collaborative Care for Depression: What is Needed?

PubMed Central

Whitebird, Robin R.; Solberg, Leif I.; Jaeckels, Nancy A.; Pietruszewski, Pamela B.; Hadzic, Senka; Unützer, Jürgen; Ohnsorg, Kris A.; Rossom, Rebecca C.; Beck, Arne; Joslyn, Ken; Rubenstein, Lisa V.

2014-01-01

Objective To identify the care model factors that were key for successful implementation of collaborative depression care in a statewide Minnesota primary care initiative. Study Design We used a mixed-methods design incorporating both qualitative data from clinic site visits and quantitative measures of patient activation and 6-month remission rates. Methods Care model factors identified from the site visits were tested for association with rates of activation into the program and remission rates. Results Nine factors were identified as important for successful implementation of collaborative care by the consultants who had trained and interviewed participating clinic teams. Factors correlated with higher patient activation rates were: strong leadership support (0.63), well-defined and implemented care manager roles (0.62), a strong primary care physician champion (0.60), and an on-site and accessible care manager (0.59). However, remission rates at six months were correlated with: an engaged psychiatrist (0.62), not seeing operating costs as a barrier to participation (0.56), and face-to-face communication (warm handoffs) between the care-manager and primary care physician for new patients (0.54). Conclusions Care model factors most important for successful program implementation differ for patient activation into the program versus remission at six months. Knowing which implementation factors are most important for successful implementation will be useful for those interested in adopting this evidence-based approach to improve primary care for patients with depression. PMID:25365745

The pole tide in deep oceans

NASA Technical Reports Server (NTRS)

Dickman, S. R.

1990-01-01

The fluid-dynamical theory of the pole tide is examined by describing the oceanic response to the Chandler wobble and assessing its implications for mantle anelasticity and low-frequency ocean dynamics. The Laplace tide equations accounting for bottom friction are given, and a spherical harmonic approach is delineated in which the time-independent portion of the tide height is expanded. Pole-tide height and related inertia products are linearly proportional to wobble amplitude, and the final equations are modified to account for mantle elasticity and oceanic loading. Results for pole tide effects are given for various earth models with attention to the role of boundary constraints. A dynamic effect is identified which lengthens the Chandler period by about 1 day more than static lengthening, a contribution that suggests a vigorous low-frequency response. The values derived are shown to agree with previous models that do not incorporate the effects of the pole tide.

[Retrieve of red tide distributions from MODIS data based on the characteristics of water spectrum].

PubMed

Qiu, Zhong-Feng; Cui, Ting-Wei; He, Yi-Jun

2011-08-01

After comparing the spectral differences between red tide water and normal water, we developed a method to retrieve red tide distributions from MODIS data based on the characteristics of red tide water spectrum. The authors used the 119 series of in situ observations to validate the method and found that only one observation has not been detected correctly. The authors then applied this method to MODIS data on April 4, 2005. In the research areas three locations of red tide water were apparently detected with the total areas about 2 000 km2. The retrieved red tide distributions are in good agreement with the distributions of high chlorophyll a concentrations. The research suggests that the method is available to eliminating the influence of suspended sediments and can be used to retrieve the locations and areas of red tide water.

Lunar tidal acceleration obtained from satellite-derived ocean tide parameters

NASA Technical Reports Server (NTRS)

Goad, C. C.; Douglas, B. C.

1978-01-01

One hundred sets of mean elements of GEOS-3 computed at 2-day intervals yielded observation equations for the M sub 2 ocean tide from the long periodic variations of the inclination and node of the orbit. The 2nd degree Love number was given the value k sub 2 = 0.30 and the solid tide phase angle was taken to be zero. Combining obtained equations with results for the satellite 1967-92A gives the M sub 2 ocean tide parameter values. Under the same assumption of zero solid tide phase lag, the lunar tidal acceleration was found mostly due to the C sub 22 term in the expansion of the M sub 2 tide with additional small contributions from the 0 sub 1 and N sub 2 tides. Using Lambeck's (1975) estimates for the latter, the obtained acceleration in lunar longitudal in excellent agreement with the most recent determinations from ancient and modern astronomical data.

Impacts of exotic mangroves and mangrove control on tide pool fish assemblages

Treesearch

Richard A. MacKenzie; Cailtin L. Kryss

2013-01-01

Fish were sampled from tide pools in Hawaii to determine how exotic mangroves Rhizophora mangle and the use of herbicides to chemically eradicate them are impacting tide pool fish assemblages. Ecological parameters were compared among mangrove-invaded, native vegetated, and non-vegetated tide pools before and after mangroves had been chemically...

Mapping nonlinear shallow-water tides: a look at the past and future

NASA Astrophysics Data System (ADS)

Andersen, Ole B.; Egbert, Gary D.; Erofeeva, Svetlana Y.; Ray, Richard D.

2006-12-01

Overtides and compound tides are generated by nonlinear mechanisms operative primarily in shallow waters. Their presence complicates tidal analysis owing to the multitude of new constituents and their possible frequency overlap with astronomical tides. The science of nonlinear tides was greatly advanced by the pioneering researches of Christian Le Provost who employed analytical theory, physical modeling, and numerical modeling in many extensive studies, especially of the tides of the English Channel. Le Provost’s complementary work with satellite altimetry motivates our attempts to merge these two interests. After a brief review, we describe initial steps toward the assimilation of altimetry into models of nonlinear tides via generalized inverse methods. A series of barotropic inverse solutions is computed for the M_4 tide over the northwest European Shelf. Future applications of altimetry to regions with fewer in situ measurements will require improved understanding of error covariance models because these control the tradeoffs between fitting hydrodynamics and data, a delicate issue in coastal regions. While M_4 can now be robustly determined along the Topex/Poseidon satellite ground tracks, many other compound tides face serious aliasing problems.

Modeling influence of tide stages on forecasts of the 2010 Chilean tsunami

NASA Astrophysics Data System (ADS)

Uslu, B. U.; Chamberlin, C.; Walsh, D.; Eble, M. C.

2010-12-01

The impact of the 2010 Chilean tsunami is studied using the NOAA high-resolution tsunami forecast model augmented to include modeled tide heights in addition to deep-water tsunami propagation as boundary-condition input. The Chilean tsunami was observed at the Los Angeles tide station at mean low water, Hilo at low, Pago Pago at mid tide and Wake Island near high tide. Because the tsunami arrived at coastal communities at a representative variety of tide stages, 2010 Chile tsunami provides opportunity to study the tsunami impacts at different tide levels to different communities. The current forecast models are computed with a constant tidal stage, and this study evaluates techniques for adding an additional varying predicted tidal component in a forecasting context. Computed wave amplitudes, wave currents and flooding are compared at locations around the Pacific, and the difference in tsunami impact due to tidal stage is studied. This study focuses on how tsunami impacts vary with different tide levels, and helps us understand how the inclusion of tidal components can improve real-time forecast accuracy.

Impact of tides in a baroclinic circulation model of the Adriatic Sea

NASA Astrophysics Data System (ADS)

Guarnieri, A.; Pinardi, N.; Oddo, P.; Bortoluzzi, G.; Ravaioli, M.

2013-01-01