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According to cognitive behavioural theory, cognitive factors (i.e. underlying general dysfunctional beliefs and (situation) specific illness beliefs) are theorized to lead to outcomes like anxiety and depression. In clinical practice, general dysfunctional beliefs are generally not tackled directly in short-term-therapy.
The goal of the present study was to investigate the associations of general versus specific illness beliefs on anxiety and depressive symptoms and psychiatric disorders among a subgroup of patients with inflammatory bowel disease (IBD) with poor mental quality of life (QoL).
This study concerns cross-sectional data, collected at baseline from a randomized clinical trial. One hundred and eighteen patients, recruited at four Dutch hospitals, with poor QoL (score ≤23 on the mental health subscale of the Short-Form 36-item Health-Survey; SF-36) were included. General dysfunctional beliefs were measured by the Dysfunctional Attitude Scale (DAS), specific illness beliefs by the Illness Perceptions Questionnaire-Revised (IPQ-R), anxiety and depressive symptoms by the Hospital Anxiety and Depression Scale (HADS), and psychiatric disorders by the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I).
Univariate analyses showed associations between the level of anxiety and/or depression and general dysfunctional beliefs and four specific illness beliefs (consequences, personal control, emotional representations and treatment control). Among patients with IBD with psychiatric disorders, only the DAS was significantly associated with anxiety and depression (DAS added to IPQ-R and IPQ-R added to DAS).
Psychological interventions may have to target general dysfunctional beliefs of patients with IBD with co-morbid psychiatric disorders to be effective. These patients with IBD are especially in need of psychological treatment.
The more dynamic and unpredictable the development constraints, the more agile the development project should be to cope with and utilize inherent change. Especially in such contexts, aligning with the project's mission and vision, committing to next steps, and documenting the development path is challenging. To support the decision making process of self-organized agile development teams with an overview, a recent research paper proposes the Progress Map. The investigation at hand applies the Progress Map in semi-industrial development projects to empirically validate its applicability and performance in the form of a multi-case study. The results indicate that, given future refinements, this instrument can be valuable to plan, document, and communicate the progress of an agile development project.
This article proposes a new 14C chronology for the three-phase ceramic chronology from the settlement of Chavín de Huántar based on the AMS dating of collagen extracted from faunal remains recovered during my 1975 excavations. The chronometric estimates for the Chavín de Huántar ceramic chronology are as follows: Urabarriu Phase (950–800 cal BC), Chakinani Phase (800–700 cal BC), and Janabarriu Phase (700–400 cal BC). The new measurements confirm the sequence of the ceramic phases and indicate that the site was established around 950 cal BC and was abandoned by 400 cal BC. The results are consistent with the earlier hypothesis that the major developments at Chavín de Huántar largely postdate the Initial Period fluorescence of early coastal civilization during the second millennium BC, but they cast doubt on some current interpretations of the site's founding and cultural apogee.
Electroconvulsive therapy (ECT) is a fast-acting intervention for major depressive disorder. Previous studies indicated neurotrophic effects following ECT that might contribute to changes in white matter brain structure. We investigated the influence of ECT in a non-randomized prospective study focusing on white matter changes over time.
Twenty-nine severely depressed patients receiving ECT in addition to inpatient treatment, 69 severely depressed patients with inpatient treatment (NON-ECT) and 52 healthy controls (HC) took part in a non-randomized prospective study. Participants were scanned twice, approximately 6 weeks apart, using diffusion tensor imaging, applying tract-based spatial statistics. Additional correlational analyses were conducted in the ECT subsample to investigate the effects of seizure duration and therapeutic response.
Mean diffusivity (MD) increased after ECT in the right hemisphere, which was an ECT-group-specific effect. Seizure duration was associated with decreased fractional anisotropy (FA) following ECT. Longitudinal changes in ECT were not associated with therapy response. However, within the ECT group only, baseline FA was positively and MD negatively associated with post-ECT symptomatology.
Our data suggest that ECT changes white matter integrity, possibly reflecting increased permeability of the blood–brain barrier, resulting in disturbed communication of fibers. Further, baseline diffusion metrics were associated with therapy response. Coherent fiber structure could be a prerequisite for a generalized seizure and inhibitory brain signaling necessary to successfully inhibit increased seizure activity.
In the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.
Representations of feeling in medieval literature are varied and complex. This new collection of essays demonstrates that the history of emotions and affect theory are similarly insufficient for investigating the intersection of body and mind that late Middle English literatures evoke. While medieval studies has generated a rich scholarly literature on 'affective piety', this collection charts an intersectional new investigation of affects, feelings, and emotions in non-religious contexts. From Geoffrey Chaucer to Gavin Douglas, and from practices of witnessing to the adoration of objects, essays in this volume analyze the coexistence of emotion and affect in late medieval representations of feeling.
We have explored the merits of using a Hgl2 spectrometer as a detector in x-ray diffraction systems instead of a proportional gas counter, or a scintillation counter. The full width at half maximum energy resolution of the HgI2 spectrometer used was about 1.1 keV for the CuKα line (8.1 keV), and about 1.5 keV for the MoKα line (17.4 keV), The energy resolution was utilised to eliminate x-ray fluorescence background from powder diffraction spectra. We demonstrate the suppression of Fe x-ray fluorescence in diffraction patterns of ErFe03 obtained with a Cu x-ray tube, and of Y x-ray fluorescence in diffraction patterns of Y2O3 obtained with a Mo x-ray tube. The peak height to background ratios were improved by about an order of magnitude in both cases.
Conceptual metaphor theory and other important theories in metaphor research are often experimentally tested by studying the effects of metaphorical frames on individuals’ reasoning. Metaphorical frames can be identified by at least two levels of analysis: words vs. concepts. Previous overviews of metaphorical-framing effects have mostly focused on metaphorical framing through words (metaphorical-words frames) rather than through concepts (metaphorical-concepts frames). This means that these overviews included only experimental studies that looked at variations in individual words instead of at the broader logic of messages. For this reason, we conducted a meta-analysis (k = 91, N = 34,783) to compare the persuasive impact of both types of metaphorical frames. Given that patterns of metaphor usage differ across discourse domains, and that effects may differ across modalities and discourse domains, we focused on one mode of presentation and one discourse domain only: verbal metaphorical framing in political discourse. Results showed that, compared to non-metaphorical frames, both metaphorical-words and metaphorical-concepts frames positively influenced beliefs and attitudes. Yet, these effects were larger for metaphorical-concepts frames. We therefore argue that future research should more explicitly describe and justify which level of analysis is chosen to examine the nature and effects of metaphorical framing.
As depression has a recurrent course, relapse and recurrence prevention is essential.
In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.
Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.
Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.
Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.
Declaration of interest
C.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.
Archaeological survey and excavations in the mangrove-estuary zone south of Izapa have generated an understanding of how the environment and human exploitation patterns changed during the Archaic and Formative periods. Archaic-period archaeological remains are not present, but the sedimentary record shows that Archaic people were clearing the coastal-plain forest for agricultural purposes. This activity augmented delivery of sediments to the littoral zone, which expanded the mangrove forest and created a productive environment that could be colonized by Early Formative villagers by around 1600 cal b.c. Population growth during the Early Formative created conditions that favored emergence of specialized pyro-industries, especially salt production, by around 1000 cal b.c. Production intensity increased thereafter, especially during the Late Formative period, coincident with the apogee of Izapa. Salt production became more episodic during the Terminal Formative period, when interior populations were declining to a nadir after cal a.d. 250.
Under existing international and domestic law, governments and private actors have obligations to individuals and communities affected by climate change impacts on public health. This chapter discusses such obligations and the legal authorities – international, constitutional, statutory, and common law – under which they arise.
Information is a powerful tool that government can use to inform the public about the risks of climate change, how to mitigate those risks, and how to reduce emissions of the greenhouse gases responsible for climate change. This chapter addresses the role the First Amendment plays when the government uses information to promote public policies on climate change. The chapter explains that the government has vast leeway to collect and disseminate information and the First Amendment presents no barrier to the government’s use of information tools when the government itself is the speaker. But the First Amendment does come into play when the government enlists or compels others to carry the government’s message. The First Amendment may, in some cases, limit the government’s power to compel speakers to engage in speech on matters of opinion or on subjects that might be considered controversial. The First Amendment generally limits government’s ability to force speakers to adhere to the government’s views. And the First Amendment may constrain the government’s ability to rid the marketplace of advertising claims that may over-promise environmental benefits, but are not demonstrably false or misleading. These constraints, however, do not pose a serious obstacle to the government’s ability to use information tools to help in the fight against climate change.