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Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health disparities related to insomnia; however, the efficacy of digital CBT-I (dCBT-I) across a range of demographic groups has not yet been adequately examined. This randomized placebo-controlled trial examined the efficacy of dCBT-I in reducing both insomnia and depression across a wide range of demographic groups.
Of 1358 individuals with insomnia randomized, a final sample of 358 were retained in the dCBT-I condition and 300 in the online sleep education condition. Severity of insomnia and depression was examined as a dependent variable. Race, socioeconomic status (SES; household income and education), gender, and age were also tested as independent moderators of treatment effects.
The dCBT-I condition yielded greater reductions in both insomnia and depression severity than sleep education, with significantly higher rates of remission following treatment. Demographic variables (i.e. income, race, sex, age, education) were not significant moderators of the treatment effects, suggesting that dCBT-I is comparably efficacious across a wide range of demographic groups. Furthermore, while differences in attrition were found based on SES, attrition did not differ between white and black participants.
Results provide evidence that the wide dissemination of dCBT-I may effectively target both insomnia and comorbid depression across a wide spectrum of the population.
This article describes a formal proof of the Kepler conjecture on dense sphere packings in a combination of the HOL Light and Isabelle proof assistants. This paper constitutes the official published account of the now completed Flyspeck project.
Written for trainees who are preparing to take the Anesthesia Oral Board exam, Rapid Review Anesthesiology Oral Boards is focused on the most commonly tested topics on the ABA oral board exam. Presented in a question-and-answer format, the book covers 39 different clinical scenarios encountered in the exam, including the Parkland formula to calculate fluid resuscitation in burn patients, ICP monitoring in craniotomy and hemodynamic goals in patients with cardiac disease. Questions follow the normal course of a case, from pre-operative assessment to intra-operative management and post-operative care. The answers to the questions are carefully structured to not only help the reader understand the medicine of anesthesia but also to provide the correct terminology needed to successfully pass the exam. This book is essential reading for trainees preparing for one of the toughest exams of their careers.