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Psychological treatment for functional somatic syndromes (FSS) has been found moderately effective. Information on how much treatment is needed to obtain improvement is sparse. We assessed the efficacy of a brief and extended version of group-based Acceptance and Commitment Therapy (ACT) v. enhanced care (EC) for patients with multiple FSS operationalised as Bodily Distress Syndrome multi-organ type.
In a randomised controlled three-armed trial, consecutively referred patients aged 20–50 with multiple FSS were randomly assigned to either (1) EC; (2) Brief ACT: EC plus 1-day workshop and one individual consultation; or (3) Extended ACT: EC plus nine 3-h group-based sessions. Primary outcome was patient-rated overall health improvement on the five-point clinical global improvement scale 14 months after randomisation. A proportional odds model was used for the analyses.
A total of 180 patients were randomised; 60 to EC, 61 to Brief ACT, and 59 to Extended ACT. Improvement on the primary outcome after Extended ACT was significantly greater than after EC with an unadjusted OR of 2.9 [95% CI (1.4–6.2), p = 0.006]. No significant differences were found between Brief ACT and EC. Of the 18 secondary outcomes, the only significant difference found was for physical functioning in the comparison of Extended ACT with EC.
Patients rated their overall health status as more improved after Extensive ACT than after EC; however, clinically relevant secondary outcome measures did not support this finding. Discrepancies between primary and secondary outcomes in this trial are discussed.
In this article we discuss the integration of international security assistance and rule of law promotion within larger state-building projects. Going beyond the widespread claim that both approaches should be closely linked within overarching security sector reform (SSR) efforts, this article inquires more systematically into their relationship both at a conceptual level and at the level of state-building practices. It argues that the creation of effective security institutions cannot be easily reconciled with programmes that promote mechanisms of legitimate political control as one dimension of the rule of law. Rationales behind security and rule of law support diverge: the former aims to strengthen a state's enforcement capacities, while the latter seeks to restrict them. The case of security and rule of law support to the Palestinian National Authority in the West Bank illustrates the tensions that can result. The article shows that in the Palestinian case, selectivity, fragmentation and timing issues have impeded the coherence of international assistance.
Although the hippocampus has been found to be smaller in people with
depression, the clinical relevance of this is unclear. We investigated
hippocampal volume (using high-resolution magnetic resonance imaging) and
2-year outcome in 57 patients with major depression. The left and right
hippocampal volumes of patients with a depression relapse were significantly
smaller than those of healthy controls. Our results support the hypothesis
that the hippocampus is crucial in the outcome of depression.
Two l·9 1 Upflow Anaerobic Sludge Blanket (USAB) reactors, operated at 35 °C, were used for the digestion of deproteinated cheese whey substrate. The C/N ratio was 19, and the alkalinity requirements of the two reactors were satisfied by adding Ca(OH)2 and Na2CO3 in two different ratios respectively. Gas and effluent parameters indicated that reactor 1 (receiving a higher level of calcium) was superior and eventually a loading rate of 7·1 kg COD m−3 d−1 could be obtained in this reactor, compared to a loading rate of 5 kg COD m−3 d−1 which was obtained in reactor 2. Pellets with good settling abilities formed in reactor 1, while the sludge in reactor 2 developed a granular slimy appearance and settled poorly. Investigation of the ultrastructure of the sludge particles revealed a difference in the types of bacteria present in the granules.
This paper provides a survey on a class of methods to obtain sufficient conditions for the inversemonotonicity of second-order differential operators. Pointwise differential inequalities as well as weak differential inequalities are treated. In particular, the theory yields results on the relation between inverse-mo no tone operators and monotone definite operators, i.e. monotone operators in the Browder–Minty sense. This presentation is restricted to ordinary differential operators. Most methods explained here can also be applied to elliptic-parabolic partial differential operators in essentially the same way.
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