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Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
The US federal government invests in the development of medical countermeasures for addressing adverse health effects to the civilian population from chemical, biological, and radiological or nuclear threats. We model the potential economic spillover effects in day-to-day burn care for a federal investment in a burn debridement product for responding to an improvised nuclear device.
We identify and assess 4 primary components for projecting the potential economic spillover benefits of a burn debridement product: (1) market size, (2) clinical effectiveness and cost-effectiveness, (3) product cost, and (4) market adoption rates. Primary data sources were the American Burn Association’s 2015 National Burn Repository Annual Report of Data and published clinical studies used to gain European approval for the burn debridement product.
The study results showed that if approved for use in the United States, the burn debridement product has potential economic spillover benefits exceeding the federal government’s initial investment of $24 million a few years after introduction into the burn care market.
Economic spillover analyses can help to inform the prioritizing of scarce resources for research and development of medical countermeasures by the federal government. Future federal medical countermeasure research and development investments could incorporate economic spillover analysis to assess investment options. (Disaster Med Public Health Preparedness. 2017;11:711–719)
A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use.
We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level.
Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning.
The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems’ capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need. (Disaster Med Public Health Preparedness. 2015;9:634–641)
We present the results of eighteen non-continuous nights of time series photometric observations of a 1.25 deg2 field in Cygnus centered on the NASA Kepler Mission field of view. Using the Case Western Burrell Schmidt telescope we gathered a dataset containing light curves of roughly 30,000 stars with 14 < r < 19. We have statistically examined each light curve to test for variability, periodicity, and unusual light curve trends, including exoplanet transits. We present a summary of our photometric project including a characterization of the level and content of stellar variability in this field. We will also discuss our potential exoplanet candidates.
Performance on some neuropsychological tests is best expressed as an
intra-individual measure of association (such as a parametric or
non-parametric correlation coefficient or the slope of a regression
line). Examples of the use of intra-individual measures of association
(IIMAs) include the quantification of performance on tests designed to
assess temporal order memory or the accuracy of time estimation. The
present paper presents methods for comparing a patient's
performance with a control or normative sample when performance is
expressed as an IIMA. The methods test if there is a significant
difference between a patient's IIMA and those obtained from
controls, yield an estimate of the abnormality of the patient's
IIMA, and provide confidence limits on the level of abnormality. The
methods can be used with normative or control samples of any size and
will therefore be of particular relevance to single-case researchers. A
method for comparing the difference between a patient's scores on
two measures with the differences observed in controls is also
described (one or both measures can be IIMAs). All the methods require
only summary statistics (rather than the raw data from the normative or
control sample); it is hoped that this feature will encourage the
development of norms for tasks that use IIMAs to quantify performance.
Worked examples of the statistical methods are provided using data from
a clinical case and controls. A computer program (for PCs) that
implements the methods is described and made available. (JINS,
2003, 9, 989–1000.)
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