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Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
Large area, parallel beams of x-rays are potentially useful in many diffraction, imaging and other x-ray analysis applications. Diffraction, in typical experiments, uses only a small portion of the incident beam that is within a limited “rocking curve” of the crystal capable of diffracting, although the whole crystal may be illuminated by the incident beam. Signal intensity can be increased if the ”whole” crystal can be made to diffract simultaneously. Similarly for imaging, improved results also are possible if divergent beams are replaced with nearly parallel ones. Production of parallel beams of large areal extent has not been simple. Often this meant that the source had to be placed at great distances from the sample, reducing the incident intensity. Sometimes, asymmetric cuts of crystals can be used to increase beam cross-sectional areas.
Production of parallel beams of large area! extent has not been simple. Often this meant that the source had to be placed at great distances from the sample, reducing the incident intensity. Sometimes, asymmetric cuts of crystals can be used to increase beam cross-sectional areas.
An experiment was conducted to determine the effects of supplementing different amounts of daidzein in a diet on the growth performance, blood biochemical parameters and meat quality of finishing beef cattle. Thirty finishing Xianan steers were distributed in three groups equilibrated by weight and fed three different dietary treatments (concentrate ratio = 80%): (1) control; (2) 500 mg/kg daidzein and (3) 1000 mg/kg daidzein, respectively. Steers were slaughtered after an 80-day feeding trial. Results showed that daidzein supplementation had no effect on the final body weight, average daily gain and feed conversion rate of steers. Steers fed with 1000 mg/kg daidzein had greater dry matter intake than those fed with control diets. Compared with the control group, the 1000 mg/kg daidzein group had a higher fat thickness, lower shear force and lightness. The pH, drip loss, cooking loss, redness (a*), yellowness (b*), moisture, ash, crude protein and intramuscular fat of the Longissimus dorsi muscle were unaffected by daidzein supplementation. Compared with the control group, the 1000 mg/kg daidzein group significantly increased the serum concentrations of insulin, free fatty acid and Glutamic-pyruvic transaminase. The 500 mg/kg daidzein group significantly increased the serum concentration of tetraiodothyronine compared with the control group. Supplemental daidzein did not affect the blood antioxidant ability and blood immune parameters in serum. In conclusion, daidzein supplementation above 500 mg/day modifies feed intake and metabolic and hormonal profile, with positive and negative effects on meat quality.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
Relatively little is known about the physical mechanisms that drive the dynamics of the East Antarctic outlet glaciers. Here we conduct a remote-sensing investigation of the Polar Record Glacier (PRG), East Antarctica to analyze its ice flow acceleration, ice front variations and ice surface melting. Ice flow speeds at PRG increased by up to 15% from 2005 to 2015, with substantial interannual fluctuations. The ice velocities also showed seasonal variations, accelerating by up to 9% between September and January. Multiple mechanisms contribute to the observed seasonal variations: the initial acceleration may result from the lost back-stress provided by the sea ice in the austral spring and the later speedup relate to the surface meltwater that leads to weakened ice shelf and shear margins. The sensitivity of the PRG to oceanic forcing is confirmed by comparing the secular ice velocity increases with ocean temperatures. These measurements suggest that the dynamics of East Antarctic ice shelves are sensitive to melt at both the surface and base, at a range of timescales.
The frequency of bioevents is increasing worldwide. In the United States, as elsewhere, control of contagion may require the cooperation of community members with emergency public health measures. The US general public is largely unfamiliar with these measures, and our understanding of factors that influence behaviors in this context is limited. The few previous reviews of research on this topic focused on non-US samples. For this review, we examined published research on the psychosocial influences of adherence in US sample populations. Of 153 articles identified, only 9 met the inclusion criteria. Adherence behaviors were categorized into 2 groups: self-protective behaviors (personal hygiene, social distancing, face mask use, seeking out health care advice, and vaccination) and protecting others (isolation, temperature screening, and quarantine). A lack of uniformity across studies regarding definitions and measures was noted. Only 5 of the 9 articles reported tests of association between adherence with emergency measures and psychosocial factors; perceived risk and perceived seriousness were found to be significantly associated with adherence or adherence intentions. Although it is well documented that psychosocial factors are important predictors of protective health behaviors in general, this has not been rigorously studied in the context of bioevents. (Disaster Med Public Health Preparedness. 2018;12:528–535)
Timing of seedling emergence is a critical aspect of a plant's life cycle, and it may influence the expression of other plant life history traits. However, most studies have been conducted at the population level, and thus little is known about timing of seedling emergence at the community level. In the field, we determined the peak emergence season for seedlings of 144 species collected from a subalpine meadow on the eastern Tibet Plateau in China. The proportion of species with seedlings emerging in autumn, spring and summer, seedling field emergence percentage (FE) and mean emergence time (MET) were analysed in relation to seed mass, life cycle type (annual/biennial and perennial) and phylogeny. The results showed that (1) the proportion of species with seedlings emerging in autumn (33%), spring (44%) and summer (23%) differed significantly; (2) overall, species with seedlings emerging in autumn had higher FE than those emerging during spring/summer; (3) there was a positive relationship between log-seed mass and log-MET, but log-seed mass had no significant effect on log-FE; (4) life cycle type did not affect seedling emergence; and (5) phylogeny significantly explained peak emergence season. These results suggest that seed mass and phylogenetic position are the main determinants of seedling emergence season. However, seedling peak emergence season affected FE, growing season length and resource utilization, and thus may be related to the importance of a species in the community.
To investigate the association of policy, systems and environmental factors with improvement in household food security among low-income Indiana households with children after a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) direct nutrition education intervention.
Household food security scores measured by the eighteen-item US Household Food Security Survey Module in a longitudinal randomized and controlled SNAP-Ed intervention study conducted from August 2013 to April 2015 were the response variable. Metrics to quantify environmental factors including classification of urban or rural county status; the number of SNAP-authorized stores, food pantries and recreational facilities; average fair market housing rental price; and natural amenity rank were collected from government websites and data sets covering the years 2012–2016 and used as covariates in mixed multiple linear regression modelling.
Thirty-seven Indiana counties, USA, 2012–2016.
SNAP-Ed eligible adults from households with children (n 328).
None of the environmental factors investigated were significantly associated with changes in household food security in this exploratory study.
SNAP-Ed improves food security regardless of urban or rural location or the environmental factors investigated. Expansion of SNAP-Ed in rural areas may support food access among the low-income population and reduce the prevalence of food insecurity in rural compared with urban areas. Further investigation into policy, systems and environmental factors of the Social Ecological Model are warranted to better understand their relationship with direct SNAP-Ed and their impact on diet-related behaviours and food security.
Knowledge regarding association of dietary branched-chain amino acid (BCAA) and type 2 diabetes (T2D), and the contribution of BCAA from meat to the risk of T2D are scarce. We evaluated associations between dietary BCAA intake, meat intake, interaction between BCAA and meat intake and risk of T2D. Data analyses were performed for 74 155 participants aged 50−79 years at baseline from the Women’s Health Initiative for up to 15 years of follow-up. We excluded from analysis participants with treated T2D, and factors potentially associated with T2D or missing covariate data. The BCAA and total meat intake was estimated from FFQ. Using Cox proportional hazards models, we assessed the relationship between BCAA intake, meat intake, and T2D, adjusting for confounders. A 20 % increment in total BCAA intake (g/d and %energy) was associated with a 7 % higher risk for T2D (hazard ratio (HR) 1·07; 95 % CI 1·05, 1·09). For total meat intake, a 20 % increment was associated with a 4 % higher risk of T2D (HR 1·04; 95 % CI 1·03, 1·05). The associations between BCAA intake and T2D were attenuated but remained significant after adjustment for total meat intake. These relations did not materially differ with or without adjustment for BMI. Our results suggest that dietary BCAA and meat intake are positively associated with T2D among postmenopausal women. The association of BCAA and diabetes risk was attenuated but remained positive after adjustment for meat intake suggesting that BCAA intake in part but not in full is contributing to the association of meat with T2D risk.
With the aid of the Green's function method and complex function method, the scattering problem of SH-wave by a circular inclusion near the two symmetrically permeable interfacial cracks in the piezoelectric bi-material half -space is considered to obtain the steady state response. Firstly, by means of the image method, the essential function of Green's function is constructed, which satisfies the stress free and electric insulation conditions on the horizontal boundaries in a right-angle space including a circular inclusion and bearing a harmonic out-plane line source force on the vertical boundary. Secondly, the bi-material media is divided into two parts along the vertical boundary. According to continuity condition, the first kind of Fredholm integral equations containing undetermined anti-plane forces are established by “the conjunction method” and “the crack-division technology”, then the integral equations are reduced to the algebraic equations including finite items by effective truncation. Finally, the dynamic stress concentration factor around the edge of circular inclusion and dynamic stress intensity factor at the crack tip are calculated, then the influences of the frequency of incident wave, the length of crack, the position of the crack, the position of circular inclusion, etc. on the dynamic stress concentration factor and dynamic stress intensity factor are discussed.
Experiments on plate-like specimens have established that across-column cracks from within S2 (columnar) salt-water ice when compressed uniaxially along a direction inclined to the long axis of the grains. Wing cracks initiate from the across-column cracks and lengthen into axial splits when the ice is rapidly deformed; correspondingly; the macroscopic behavior changes from ductile to brittle. The across-column cracking is attributed to grain-boundary sliding, and the splitting to the suppression of crack-tip creep.
We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation.
We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder.
After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower “emergency preparedness safety climate” scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress.
Improving the “emergency preparedness safety climate” of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326–336)
With the aid of the Green's function method and complex function method, the scattering problem of SH-wave by a cylindrical inclusion and a semi-cylindrical hollow in the bi-material half space is considered to obtain the steady state response. Firstly, by the means of the image method, the essential solution of displacement field as well as Green's function is constructed which satisfies the stress free on the horizontal boundary in a right-angle space including a cylindrical inclusion and a semi-cylindrical hollow and bearing a harmonic out-plane line source force at any point on the vertical boundary. Secondly, the bi-material half space is divided into two parts along the vertical interface, and the first kind of Fredholm integral equations containing undetermined anti-plane forces at the linking section is established by “the conjunction method” and “the crack-division method”, the integral equations are reduced to the algebraic equations consisting of finite items by effective truncation. Finally, dynamic stress concentration factor around the edge of cylindrical inclusion and dynamic stress intensity factor at crack tip are calculated, and the influences of effect of interface and different combination of material parameters, etc. on dynamic stress concentration factor and dynamic stress intensity factor are discussed.
Imaging atmospheric Cherenkov telescopes (IACTs) are sensitive to rare gamma-ray photons, buried in the background of charged cosmic-ray (CR) particles, the flux of which is several orders of magnitude greater. The ability to separate gamma rays from CR particles is important, as it is directly related to the sensitivity of the instrument. This gamma-ray/CR-particle classification problem in IACT data analysis can be treated with the rapidly-advancing machine learning algorithms, which have the potential to outperform the traditional box-cut methods on image parameters. We present preliminary results of a precise classification of a small set of muon events using a convolutional neural networks model with the raw images as input features. We also show the possibility of using the convolutional neural networks model for regression problems, such as the radius and brightness measurement of muon events, which can be used to calibrate the throughput efficiency of IACTs.
We report on a study, employing direct numerical simulations, of the turbulent/non-turbulent interface of a wake in a stably stratified fluid. It is found that thresholds for both enstrophy and potential enstrophy are needed to identify the interface. Using conditional averaging relative to the location of the interface, various quantities of interest are examined. The thickness of the interface is found to scale with the Kolmogorov scale. From an examination of the Ozmidov and Kolmogorov length scales as well as the buoyancy Reynolds number, it is found that the buoyancy Reynolds number decreases and becomes of order 1 near the interface, indicating the suppression of the turbulence there by the stable stratification. Finally the overall rate of loss of energy due to internal wave radiation is found to be comparable to the overall rate of loss due to turbulent kinetic energy dissipation.
Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one’s family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality.
Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security.
Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012–2014.
The sample included 827 adolescents (55·1 % girls) in grades 9–10 who reported eating breakfast on at most three days per school week.
On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (P<0·001) and positive attitudes (P≤0·01) about mealtime importance, interactions and structure. Family breakfast frequency was unrelated to most diet quality markers.
Family meals may be one important context of opportunity for promoting healthy food patterns at breakfast. Additional research is needed to better inform and evaluate strategies.
Bipolar disorder is a highly heritable polygenic disorder. Recent
enrichment analyses suggest that there may be true risk variants for
bipolar disorder in the expression quantitative trait loci (eQTL) in the
We sought to assess the impact of eQTL variants on bipolar disorder risk
by combining data from both bipolar disorder genome-wide association
studies (GWAS) and brain eQTL.
To detect single nucleotide polymorphisms (SNPs) that influence
expression levels of genes associated with bipolar disorder, we jointly
analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls)
and a genome-wide brain (cortical) eQTL (193 healthy controls) using a
Bayesian statistical method, with independent follow-up replications. The
identified risk SNP was then further tested for association with
hippocampal volume (n = 5775) and cognitive performance
(n = 342) among healthy individuals.
Integrative analysis revealed a significant association between a brain
eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes
factor = 5.48; bipolar disorder P =
5.85×10–5). Follow-up studies across multiple independent
samples confirmed the association of the risk SNP (rs6088662) with gene
expression and bipolar disorder susceptibility (P =
3.54×10–8). Further exploratory analysis revealed that
rs6088662 is also associated with hippocampal volume and cognitive
performance in healthy individuals.
Our findings suggest that 20q11.22 is likely a risk region for bipolar
disorder; they also highlight the informative value of integrating
functional annotation of genetic variants for gene expression in
advancing our understanding of the biological basis underlying complex
disorders, such as bipolar disorder.
This chapter introduces novel approaches in heterogeneous networks (HetNets) where both large and small cells are deployed in a mixed manner to satisfy the increasing traffic demand and, at the same time, to improve the energy efficiency (EE) of future cellular networks.
In recent years, there has been a tremendous increase in the number of mobile handsets, in particular smart phones, supporting a wide range of applications, such as image and video transfer, cloud services, and cloud storage. The average smart phone usage rate has nearly been tripled and the overall amount of mobile data traffic demand grew 2.3 times in 2011 . Furthermore, the amount of mobile data traffic is expected to increase dramatically in the coming years; recent forecasts are expecting the data traffic to increase more than 500 times in the next ten years [2, 3]. The current cellular systems would not be able to cope with the expected traffic demand increase. This huge amount of traffic demand leads to the need for further densification of the networks, for example in hotspot areas where traffic demand is concentrated as seen in Figure 18.1.
However, traffic load varies from time to time because of the typical night–day behavior due to the users’ daily activities in offices and being back to residential areas during the night . In the current cellular networks, the power consumption of the radio access network (RAN) does not effectively scale with the traffic variations as shown in Figure 18.2. The traffic variations create the opportunities for the design of an adaptive network paradigm that can dynamically scale its power consumption according to the traffic variations.
Generally speaking, the power consumption of the RAN scales with the number of deployed base stations (BSs), each with offset power consumption. In cellular networks, only 10% of the overall power consumption stems from the user equipments (UEs) whereas nearly 90% of power consumption is incurred by the operator networks . Figure 18.3 gives an idea on how the power consumption is distributed across the different parts of a typical cellular network. It is obvious that the RAN and the operation of data centers that provide computations, storage, applications, and data transfer are the most energy intensive parts of the entire network.
Evidence suggests a role of Mg and the ratio of Ca:Mg intakes in the prevention of colonic carcinogenesis. The association between these nutrients and oesophageal adenocarcinoma – a tumour with increasing incidence in developed countries and poor survival rates – has yet to be explored. The aim of this investigation was to explore the association between Mg intake and related nutrients and risk of oesophageal adenocarcinoma and its precursor conditions, Barrett’s oesophagus and reflux oesophagitis. This analysis included cases of oesophageal adenocarcinoma (n 218), Barrett’s oesophagus (n 212), reflux oesophagitis (n 208) and population-based controls (n 252) recruited between 2002 and 2005 throughout the island of Ireland. All the subjects completed a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of disease according to dietary intakes of Mg, Ca and Ca:Mg ratio. After adjustment for potential confounders, individuals consuming the highest amounts of Mg from foods had significant reductions in the odds of reflux oesophagitis (OR 0·31; 95 % CI 0·11, 0·87) and Barrett’s oesophagus (OR 0·29; 95 % CI 0·12, 0·71) compared with individuals consuming the lowest amounts of Mg. The protective effect of Mg was more apparent in the context of a low Ca:Mg intake ratio. No significant associations were observed for Mg intake and oesophageal adenocarcinoma risk (OR 0·77; 95 % CI 0·30, 1·99 comparing the highest and the lowest tertiles of consumption). In conclusion, dietary Mg intakes were inversely associated with reflux oesophagitis and Barrett’s oesophagus risk in this Irish population.