To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale.
We obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified corresponding scores of the HAMD and the BDI (369 patients from seven trials) or the BDI-II (683 patients from another seven trials) using the equipercentile linking method.
The HAMD total scores of 10, 20 and 30 corresponded approximately with the BDI scores of 10, 27 and 42 or with the BDI-II scores of 13, 32 and 50. The HAMD change scores of −20 and −10 with the BDI of −29 and −15 and with the BDI-II of −35 and −16.
The results can help clinicians interpret the HAMD or BDI scores of their patients in a more versatile manner and also help clinicians and researchers evaluate such scores reported in the literature or the database, when scores on only one of these scales are provided. We present a conversion table for future research.
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of “what works for whom” in attachment intervention.
Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression.
A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18).
The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome.
Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.
On 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.
We generalize several results of the classical theory of thermodynamic formalism by considering a compact metric space
as the state space. We analyze the shift acting on
and consider a general a priori probability for defining the transfer (Ruelle) operator. We study potentials
which can depend on the infinite set of coordinates in
. We define entropy and by its very nature it is always a non-positive number. The concepts of entropy and transfer operator are linked. If
is not a finite set there exist Gibbs states with arbitrary negative value of entropy. Invariant probabilities with support in a fixed point will have entropy equal to minus infinity. In the case
, and the a priori measure is Lebesgue
, the infinite product of
will have zero entropy. We analyze the Pressure problem for a Hölder potential
and its relation with eigenfunctions and eigenprobabilities of the Ruelle operator. Among other things we analyze the case where temperature goes to zero and we show some selection results. Our general setting can be adapted in order to analyze the thermodynamic formalism for the Bernoulli space with countable infinite symbols. Moreover, the so-called
model also fits under our setting. In this last case
is the unitary circle
. We explore the differentiable structure of
by considering a certain class of smooth potentials and we show some properties of the corresponding main eigenfunctions.
At the Institute of Microstructure Technology (IMT) of the Karlsruhe Institute of Technology (KIT), a new type of refractive X-ray optics has been developed. Owing to its comparably easy fabrication method and the large aperture, the so-called Rolled X-ray Prism Lenses (RXPL) have the potential to be used with X-ray tubes in an industrial environment as a low-cost alternative to existing optics. The lens itself is built out of a micro-structured foil which is cut into shape and rolled around a winding core to form a refracting element for X-rays. The resulting refractive structure can be used as illumination optics. Diffractometry experiments with an NIST 1976a sample were performed and showed up to an 18-fold enhanced integrated intensity compared to that acquired with a steel tube collimator.
Stressful life events have long been suspected to contribute to multiple sclerosis (MS) disease activity. The few studies examining the relationship between stressful events and neuroimaging markers have been small and inconsistent. This study examined whether different types of stressful events and perceived stress could predict the development of brain lesions.
This was a secondary analysis of 121 patients with MS followed for 48 weeks during a randomized controlled trial comparing stress management therapy for MS (SMT-MS) to a waitlist control (WLC). Patients underwent magnetic resonance imaging (MRI) scans every 8 weeks. Every month, patients completed an interview measure assessing stressful life events and self-report measures of perceived stress, anxiety and depressive symptoms, which were used to predict the presence of gadolinium-enhancing (Gd+) and T2 lesions on MRI scans 29–62 days later. Participants classified stressful events as positive or negative. Negative events were considered ‘major’ if they involved physical threat or threat to the patient's family structure, and ‘moderate’ otherwise.
Positive stressful events predicted decreased risk for subsequent Gd+ lesions in the control group [odds ratio (OR) 0.53 for each additional positive stressful event, 95% confidence interval (CI) 0.30–0.91] and less risk for new or enlarging T2 lesions regardless of group assignment (OR 0.74, 95% CI 0.55–0.99). Across groups, major negative stressful events predicted Gd+ lesions (OR 1.77, 95% CI 1.18–2.64) and new or enlarging T2 lesions (OR 1.57, 95% CI 1.11–2.23) whereas moderate negative stressful events, perceived stress, anxiety and depressive symptoms did not.
Major negative stressful events predict increased risk for Gd+ and T2 lesions whereas positive stressful events predict decreased risk.
The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo.
Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges’ g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.
The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14–0.36, I2 = 0%, 95% CI 0–58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00–12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.
Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.
Site measurements were collected at Mount John University Observatory in 2005 and 2007 using a purpose-built scintillation detection and ranging system. C2N(h) profiling indicates a weak layer located at 12–14 km above sea level and strong low altitude turbulence extending up to 5 km. During calm weather conditions, an additional layer was detected at 6–8 km above sea level. V(h) profiling suggests that tropopause layer velocities are nominally 12–30m s−1, and near-ground velocities range between 2 and 20m s−1, dependent on weather. Little seasonal variation was detected in either C2N(h) and V(h) profiles. The average coherence length, r0, was found to be 7±1 cm for the full profile at a wavelength of 589 nm. The average isoplanatic angle, θ0, was 1.0±0.1 arcsec. The mean turbulence altitude, , was found to be 2.0±0.7 km above sea level. No average in the Greenwood frequency, fG, could be established due to the gaps present in the V(h) profiles obtained. A modified Hufnagel-Valley model was developed to describe the C2N(h) profiles at Mount John, which estimates r0 at 6 cm and θ0 at 0.9 arcsec. A series of V(h) models were developed, based on the Greenwood wind model with an additional peak located at low altitudes. Using the C2N(h) model and the suggested V(h) model for moderate ground wind speeds, fG is estimated at 79 Hz.
Theta cordance is a novel quantitative electroencephalography (QEEG) measure that correlates with cerebral perfusion. A series of clinical studies has demonstrated that the prefrontal theta cordance value decreases after 1 week of treatment in responders to antidepressants and that this effect precedes clinical improvement. Ketamine, a non-competitive antagonist of N-methyl-d-aspartate (NMDA) receptors, has a unique rapid antidepressant effect but its influence on theta cordance is unknown.
In a double-blind, cross-over, placebo-controlled experiment we studied the acute effect of ketamine (0.54 mg/kg within 30 min) on theta cordance in a group of 20 healthy volunteers.
Ketamine infusion induced a decrease in prefrontal theta cordance and an increase in the central region theta cordance after 10 and 30 min. The change in prefrontal theta cordance correlated with ketamine and norketamine blood levels after 10 min of ketamine infusion.
Our data indicate that ketamine infusion immediately induces changes similar to those that monoamineric-based antidepressants induce gradually. The reduction in theta cordance could be a marker and a predictor of the fast-acting antidepressant effect of ketamine, a hypothesis that could be tested in depressive patients treated with ketamine.
Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made.
The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls.
Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation.
We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.
Unique physiological, developmental, and psychological attributes of children make them one of the more vulnerable populations during mass-casualty incidents. Because of their distinctive vulnerabilities, it is crucial that pediatric needs are incorporated into every stage of disaster planning. Individuals, families, and communities can help mitigate the effects of disasters on pediatric populations through ongoing awareness and preventive practices. Mitigation efforts also can be achieved through education and training of the healthcare workforce. Preparedness activities include gaining Emergency Medical Services for Children Pediatric Facility Recognition, conducting pediatric disaster drills, improving pediatric surge capacity, and ensuring that the needs children are incorporated into all levels of disaster plans. Pediatric response can be improved in a number of ways, including: (1) enhanced pediatric disaster expertise; (2) altered decontamination protocols that reflect pediatric needs; and (3) minimized parent-child separation. Recovery efforts at the pediatric level include promoting specific mental health therapies for children and incorporating children into disaster relief and recovery efforts. Improving pediatric emergency care needs should be at the forefront of every disaster planner's agenda.
Variability in glyphosate efficacy has been observed following late day field applications, but the influence of this “time-of-day effect” on weed control and soybean yield is unknown. Additionally, the basis for differences in weed control due to application time of day has not been fully elucidated. In field trials, broadleaf weed biomass was ≥5-fold greater when glyphosate was applied at 6:00 A.M. compared to 6:00 P.M. in three of four site–years. No consistent time-of-day effect was observed on treated grass weeds. Soybean yield was unaffected by treatments, and was similar to the weed-free control. In a greenhouse study, both barnyardgrass and velvetleaf biomass were as much as 25 to 80% greater when glyphosate was applied at 8:00 P.M. vs. 2:00 P.M. Examination of individual components of the time-of-day effect for velvetleaf indicated that leaf angle and time of application accounted for 82 and 18%, respectively, of the biomass change. This research suggests that diurnal changes in leaf movement of velvetleaf account for much of the time-of-day effect, with the remainder likely due to an unknown physiological component.