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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.
When analysing the fermentative breakdown of cell wall material in plants it is important to realize that it is not homogeneous. The cell walls are composed of different cell wall types which can differ in both their breakdown characteristics and composition. In this experiment in vitro cumulative gas production (Theodorou et al., 1994) was measured to study breakdown characteristics of cell walls from hulls and endosperm of soya beans.
Johan J Dempers, Department of Pathology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa,
Elsie H Burger, Department of Forensic Medicine, Forensic and Analytical Science Service, New South Wales Health Pathology, Sydney, Australia,
Lorraine Du Toit-Prinsloo, Department of Forensic Medicine, University of Pretoria, Pretoria, South Africa,
Janette Verster, Department of Pathology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa NSW Forensic Institute, NSW Government, Sydney, Australia
South Africa, at the southern tip of the African continent, is often referred to as “a world in one country” — a multicultural, biodiverse country with a vibrant economy. It is home to eight World Heritage Sites and seven different biomes. The country is divided into nine provinces, each with its own legislature, premier, and executive council. Eleven official languages are recognized (1).
The country covers some 1,219,602 km2 and is home to around 55.91 million people, of which close to 11% are under 4 years of age. The infant mortality rate is estimated at 33.7 per 1,000 live births (2016), a figure which has seen a steady decline from around 48.2 per 1,000 live births in 2002. Similarly, the under-5 mortality rate declined from 70.8 child deaths per 1,000 live births to 44.4 child deaths per 1,000 live births between 2002 and 2016 (2). Despite the decline in these rates over the years, South Africa is still faced with an immense challenge if it wishes to decrease the high death rate in infants. Investigation into unexpected deaths in children are complicated by multiple factors, however, including a significant variation in population density in different regions of the country, a lack of standardized national death investigation protocols, language and culture barriers, and a paucity of resources and funding for medico-legal death investigation and qualified forensic pathologists, especially in the rural regions of the country.
It is nearly impossible to understand the medico-legal death investigation process in South Africa without being mindful of the political history and development of the country, specifically the most recent 100 years or so. The South African political arena is most significantly marked by the process of segregation and the ideology of apartheid, which was consolidated after the 1948 general election, won by the National Party. Government regulated the job market, often with only the white minority being allowed skilled work opportunities. Legislation culminated in the Natives (Urban Areas) Act 1923, entrenching urban segregation. Pass laws controlled African mobility.
Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects.
In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained.
Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (rspearman = −0.48, p = 0.044), and by tendency also for the MED sample (rspearman = −0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample.
In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.
The locality of Langenboom (eastern Noord-Brabant, the Netherlands), also known as Mill, is famous for its Neogene molluscs, shark teeth, teleost remains, birds and marine mammals. The stratigraphic context of the fossils, which have been collected from sand suppletions, was hitherto poorly understood. Here we report on a section which has been sampled by divers in the adjacent flooded sandpit ‘De Kuilen’ from which the Langenboom sands have been extracted. The studied section covers part of the marine Miocene Breda Formation and Pliocene Oosterhout Formation, and is topped by fluvial Quaternary deposits of presumably the Beegden Formation. The Breda Formation (15 – 18 m below lake surface) in this section is, based on organic walled dinoflagellate cysts, of an early-middle Tortonian age. The Oosterhout Formation (7 – 15 m below lake surface) comprises two depositional sequences, the lower of which (12 – 15 m below lake surface) presumably is the source of most Langenboom fossils. Combined dinoflagellate cyst and benthic mollusc indicators point to an early Zanclean - early Piacenzian age for this lower cycle. Its basal transgressive lag and (to lesser extent) top comprise reworked Tortonian taxa as well, Dinoflagellate cysts and a single benthic mollusc point to a Piacenzian age for the upper Oosterhout Formation sequence (7 – 12 m below lake surface).
In order to obtain a better understanding of the infilling of the Saalian glacial basins during the Eemian, particularly following the recent research in the Amsterdam Basin (Terminal borehole), it was necessary to re-investigate the type locality of the Eemian at Amersfoort. Both published and unpublished data from various biota (diatoms, foraminifers, molluscs, ostracods, pollen) provide new information on the changing sedimentary environments during the Eemian. Although the organic and clastic sediments of the infilling represent nearly all the pollen zones, the sedimentary sequence at Amersfoort is discontinuous: four breaks at least are recognised at the type locality.
The successive sedimentary environments and the breaks in the record are linked with the transgression of the Eemian sea, the topographic position at the margin of an ice-pushed ridge, and the changes in hydrodynamic conditions. Local conditions, such as a sandy sea bed, shallow water and a reduced water exchange near the North Sea margin, influenced the salinity of the basin. Rib counts of Cerastoderma edule shells indicate a higher salinity at the end of the Taxus (E4b) and the beginning of the Carpinus (E5) zones than that present in the modern North Sea. Local conditions were responsible for the higher salinity following the climate optimum.
During the Abies phase (the later part of regional pollen zone E5), the sea level had already fallen. The change from eu-trophic peat growth (with Alnus and Salix) to an oligotrophic Ericaceae/Sphagnum community at the end of the Eemian resulted from the change from a marine to a fresh-water environment, probably coherent with a deterioration of the climate.
The Utrecht Orbiting Ultraviolet Stellar Spectrophotometer S59 on board the ESRO TD-1A satellite has observed ultraviolet spectra of about 200 stars in the wavelength regions 2060–2160 Å. 2490–2590 Å and 2770–2870 Å with a resolution of 1.8 Å (cf. de Jager et al., 1974). The spectra are analyzed in order to find UV criteria for stellar classification. Particular attention has been given to Fe III lines since no strong lines of this ion occur in the visible part of the spectrum. As one of the most striking results, it is found that the feature at 2078 Å, which is mainly due to Fe III, is very sensitive to luminosity.
Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.
Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.
At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.
Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
We present preliminary results of models of terrestrial planet formation using on the one hand classical numerical integration of hundreds of small bodies on CPUs and on the other hand—for comparison—the results of our GPU code with thousands of small bodies which then merge to larger ones. To be able to determine the outcome of collision events we use our smooth particle hydrodynamics (SPH) code which tracks how water is lost during such events.
A cosmic ray detector, sensitive to γ-Rays with energies greater than 500 MeV is being flown on board the OGO-5 satellite. The spacecraft was launched into a highly eccentric orbit, apogee 145000 km, on March 4, 1968. γ-Ray observations are restricted to altitudes higher than 80000 km, thereby excluding interference from the radiation belts and reducing the influence from the earth albedo flux. A description of the instrument is published in the literature (Rogowski et al., 1969).
To characterise auditory involvement secondary to excessive craniotubular bone growth in individuals with sclerosteosis in South Africa.
This cross-sectional study assessed the auditory profile of 10 participants with sclerosteosis. An auditory test battery was used and results for each ear were recorded using descriptive and comparative analyses.
All participants presented with bilateral, mixed hearing losses. Of the 20 ears, hearing loss was moderate in 5 per cent (n = 1), severe in 55 per cent (n = 11) and profound in 40 per cent (n = 8). Air–bone gaps were smaller in older participants, although the difference was not statistically significant (p > 0.05). Computed tomography scans indicated pervasive abnormalities of the external auditory canal, tympanic membrane, middle-ear space, ossicles, oval window, round window and internal auditory canal. Narrowed internal auditory canals corresponded to poor speech discrimination, indicative of retrocochlear pathology and absent auditory brainstem response waves.
Progressive abnormal bone formation in sclerosteosis involves the middle ear, the round and oval windows of the cochlea, and the internal auditory canal. The condition compromises conductive, sensory and neural auditory pathways, which results in moderate to profound, mixed hearing loss.
Silicon carbide has long been a promising material for semiconductor applications in high-temperature environments. Although silicon carbide radiation detectors were demonstrated more than a half century ago, the unavailability of high-quality materials and device manufacturing techniques hindered further development until about twenty years ago. In the late twentieth century, the development of advanced SiC crystal growth and epitaxial chemical vapor deposition methods spurred rapid development of silicon carbide charged particle, X-ray and neutron detectors. The history and status of silicon carbide radiation detectors as well as the influence of materials and device packaging limitations on future detector development will be discussed. Specific silicon carbide materials development needs will be identified.
We present two-wave mixing results obtained with CdSSe:V crystals. A large photorefractive gain of 0.24 cm-1 was observed at 633 nm with an optical intensity of 60 mW/cm2 and a grating period of 1.6 μrm. At this wavelength, we measured the photorefractive gain as a function of the grating period and incident optical intensity. To our knowledge, this is the first observation of the photorefractive effect in vanadium doped CdSSe crystals. The CdSSe crystals were grown by physical vapor transport (PVT) and doped with 150 ppm (nominal) vanadium for creating trap centers. The grown crystal has a large crystal size, good optical quality and a medium resistivity of 10-5 - 108 Ω-cm. Room temperature absorption and low temperature photoluminescence spectroscopy measurements are also discussed. With a significant photorefractive effect, the CdSSe:V crystals are promising for many device applications based on photorefractive effect, including optical limiting devices in the visible region.
Residual impurities in manganese (Mn) are a big obstacle to obtaining high- performance CdMnTe (CMT) X-ray and gamma-ray detectors. Generally, the zone-refining method is an effective way to improve the material’s purity. In this work, we purified the MnTe compounds combining the zone-refining method with molten Te that has a very high solubility. We confirmed the improved purity of the material by glow-discharge mass spectrometry (GDMS). We also found that CMT crystals from a multiple refined MnTe source, grown by the vertical Bridgman method, yielded better performing detectors.
We investigated defects in CdZnTe crystals produced from various conditions and their impact on fabricated devices. In this study, we employed transmission and scanning transmission electron microscope (TEM and STEM), because defects at the nano-scale are not observed readily under an optical or infrared microscope, or by most other techniques. Our approach revealed several types of defects in the crystals, such as low-angle boundaries, dislocations and precipitates, which likely are major causes in degrading the electrical properties of CdZnTe devices, and eventually limiting their performance.
In this paper, cross-sectional TEM is used to investigate the quality of silicon epitaxial films grown by ultra-low pressure chemical vapor deposition at 750°C. The dislocation density and epi.- substrate interface width were investigated for different predeposition Argon sputter cleaning condltions. Epitaxial films with dislocation densities of less than 10 cm−2 and interfacial width of about 13 Å were obtained.