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Excessive worry is a common phenomenon. Our research group has previously developed an online intervention for excessive worry based on operant principles of extinction (IbET; internet-based extinction therapy) and tested it against a waiting-list. The aim of this study was to evaluate IbET against an active control comparator (CTRL).
A 10-week parallel participant blind randomised controlled trial with health-economical evaluation and mediation analyses. Participants (N = 311) were randomised (ratio 4.5:4.5:1) to IbET, to CTRL (an internet-based stress-management training program) or to waiting-list. The nation-wide trial included self-referred adults with excessive worry. The primary outcome was change in worry assessed with the Penn State Worry Questionnaire from baseline to 10 weeks.
IbET had greater reductions in worry compared to CTRL [−3.6 point difference, (95% CI −2.4 to −4.9)] and also a significantly larger degree of treatment responders [63% v. 51%; risk ratio = 1.24 (95% CI 1.01–1.53)]. Both IbET and CTRL made large reductions in worry compared to waiting-list and effects were sustained up to 1 year. Treatment credibility, therapist attention, compliance and working alliance were equal between IbET and CTRL. Data attrition was 4% at the primary endpoint. The effects of IbET were mediated by the hypothesized causal mechanism (reduced thought suppression) but not by competing mediators. Health-economical evaluation indicated that IbET had a 99% chance of being cost-effective compared to CTRL given societal willingness to pay of 1000€.
IbET is more effective than active comparator to treat excessive worry. Replication and extensions to real-world setting are warranted.
The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.
The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.
A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.
Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.
Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.
Internet-delivered cognitive behavioural therapy (ICBT) is a promising approach for increasing access to evidence-based treatments.
To develop and evaluate the feasibility and preliminary efficacy of an ICBT programme for young children with obsessive–compulsive disorder (OCD), named BIP OCD Junior.
Eleven children aged 7–11 years were enrolled in a 12-week open trial of parent- and therapist-guided ICBT for OCD. The primary outcome measure was the Children's Yale–Brown Obsessive–Compulsive Scale (CY-BOCS).
There was a significant improvement in OCD symptoms post-treatment, with a large within-group effect size on the CY-BOCS (Cohen's d = 1.86, 95% CI 0.83 to 2.86). Results were maintained at 3-month follow-up. Both children and parents rated the treatment as credible and were highly satisfied with the intervention.
BIP OCD Junior is a feasible and credible treatment option for young children with OCD. Randomised controlled trials are needed to further establish its efficacy and cost-effectiveness relative to gold standard face-to-face CBT.
Comparative models suggest that effects of dietary tryptophan (Trp) on brain serotonin (5-hydroxytryptamine; 5-HT) neurochemistry and stress responsiveness are present throughout the vertebrate lineage. Moreover, hypothalamic 5-HT seems to play a central role in control of the neuroendocrine stress axis in all vertebrates. Still, recent fish studies suggest long-term effects of dietary Trp on stress responsiveness, which are independent of hypothalamic 5-HT. Here, we investigated if dietary Trp treatment may result in long-lasting effects on stress responsiveness, including changes in plasma cortisol levels and 5-HT neurochemistry in the telencephalon and hypothalamus of Atlantic salmon. Fish were fed diets containing one, two or three times the Trp content in normal feed for 1 week. Subsequently, fish were reintroduced to control feed and were exposed to acute crowding stress for 1 h, 8 and 21 d post Trp treatment. Generally, acute crowding resulted in lower plasma cortisol levels in fish treated with 3×Trp compared with 1×Trp- and 2×Trp-treated fish. The same general pattern was reflected in telencephalic 5-HTergic turnover, for which 3×Trp-treated fish showed decreased values compared with 2×Trp-treated fish. These long-term effects on post-stress plasma cortisol levels and concomitant 5-HT turnover in the telencephalon lends further support to the fact that the extrahypothalamic control of the neuroendocrine stress response is conserved within the vertebrate lineage. Moreover, they indicate that trophic/structural effects in the brain underlie the effects of dietary Trp treatment on stress reactivity.
The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group.
There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis.
Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records.
In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years.
The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent).
Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate.
TärnqvistJ, DahlénE, NorbergG, MagnussonC, HerlitzJ, StrömsöeA, AxelssonC, Andersson HagiwaraM. On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions. Prehosp Disaster Med. 2017;32(5):528–535.
Ronny Berndtsson, Center for Middle Eastern Studies, Lund University, Lund, Sweden, and Department of Water Resources Engineering, Lund University, Lund, Sweden,
Kaveh Madani, Centre for Environmental Policy, Imperial College London, London, UK,
Karin Aggestam, Peace & Conflict Studies, Lund University, Lund, Sweden,
Dan-Erik Andersson, Center for Middle Eastern Studies, Lund University, Lund, Sweden
The soon- to- be completed Grand Ethiopian Renaissance Dam (GERD) is abruptly modifying the hydropolitical map of the Nile Basin. Egypt, the historical hydro- hegemon that has preserved a strong position in the basin is challenged by Ethiopia, which seems to have decided to become a major African hydropower producer. Theoretical analysis indicates the risk for Egypt if it retaliates against Ethiopian intentions. However, it is obvious that retaliation does not lead to a sustainable future. Long- term sustainability includes collaboration between all riparians in the Nile Basin. Eventually, this will lead to greater prosperity for all involved countries and a more efficient use of the water but also a decrease in the flow of the Nile. Increasing the efficiency of water use means a larger volume of water for food production, better health of the population and sustainable economic development.
In October 2014, the Ethiopian government announced that the Grand Ethiopian Renaissance Dam (GERD) was 40 percent complete. The dam will be the largest hydroelectric power plant and one of the largest reservoirs in Africa. The GERD will store a maximum of 74 km3 of water corresponding to a bit less than the average annual inflow of the Nile to the Aswan high dam (a total storage of about 84 km3). The dam surface area will be 1,680 km2 at full supply level. The project has foreseen a power plant capacity of 6,000 MW and 15,692 GWh annual energy amount. The GERD is vital for energy production and a key factor for food production, economic development and poverty reduction in Ethiopia and the Nile Basin. However, the GERD is also a political statement that has already largely rewritten the hydropolitical map of the Nile Basin. The GERD has become a symbol of Ethiopian nationalism, or “renaissance” (hidase in Amharic). Historically, the Nile Basin has witnessed a rivalry between Egypt and Ethiopia, on the one hand, but also uniting and cultural elements such as the relationships between the Coptic Church and the Orthodox Ethiopian Church on the other (e.g., Rubenson 2009). The Nile has also been the connecting link between Egypt and Ethiopia for thousands of years. Starting in the 3rd century, the Nile connected early Ethiopian Christianity with the Alexandrian Coptic Church, a link that continued uninterrupted for 1600 years (Ayele 1988, Erlich 2002).
In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive–behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility.
To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy.
A randomised controlled trial (RCT) where participants (n = 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705).
Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80–1.27).
ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.
In the present work, the microstructure and mechanical properties of Gilsocarbon graphite have been characterized over a range of length-scales. Optical imaging, combined with 3D X-ray computed tomography and 3D high-resolution tomography based on focus ion beam milling has been adopted for microstructural characterization. A range of small-scale mechanical testing approaches are applied including an in situ micro-cantilever technique based in a Dualbeam workstation. It was found that pores ranging in size from nanometers to tens of micrometers in diameter are present which modify the deformation and fracture characteristics of the material. This multi-scale mechanical testing approach revealed the significant change of mechanical properties, for example flexural strength, of this graphite over the length-scale from a micrometer to tens of centimeters. Such differences emphasize why input parameters to numerical models have to be undertaken at the appropriate length-scale to allow predictions of the deformation, fracture and the stochastic features of the strength of the graphite with the required confidence. Finally, the results from a multi-scale model demonstrated that these data derived from the micro-scale tests can be extrapolated, with high confidence, to large components with realistic dimensions.
Exposure-based cognitive–behavioural therapy (CBT) delivered via the internet has been shown to be effective for severe health anxiety (hypochondriasis) but has not been compared with an active, effective and credible psychological treatment, such as behavioural stress management (BSM).
To investigate two internet-delivered treatments – exposure-based CBT v. BSM – for severe health anxiety in a randomised controlled trial (trial registration: NCT01673035).
Participants (n = 158) with a principal diagnosis of severe health anxiety were allocated to 12 weeks of exposure-based CBT (n = 79) or BSM (n = 79) delivered via the internet. The Health Anxiety Inventory (HAI) was the primary outcome.
Internet-delivered exposure-based CBT led to a significantly greater improvement on the HAI compared with BSM. However, both treatment groups made large improvements on the HAI (pre-to-post-treatment Cohen's d: exposure-based CBT, 1.78; BSM, 1.22).
Exposure-based CBT delivered via the internet is an efficacious treatment for severe health anxiety.