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Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.
Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
Declaration of interest
P.L. and D.L.B. have been involved in the training and dissemination of MBT.
The commentaries on our target article are insightful and constructive. There were some critical notes, but many commentaries agreed with, or even amplified our message. The first section of our response addresses comments pertaining to specific parts of the target article. The second section provides a response to the commentaries' suggestions to make replication mainstream. The final section contains concluding remarks.
Many philosophers of science and methodologists have argued that the ability to repeat studies and obtain similar results is an essential component of science. A finding is elevated from single observation to scientific evidence when the procedures that were used to obtain it can be reproduced and the finding itself can be replicated. Recent replication attempts show that some high profile results – most notably in psychology, but in many other disciplines as well – cannot be replicated consistently. These replication attempts have generated a considerable amount of controversy, and the issue of whether direct replications have value has, in particular, proven to be contentious. However, much of this discussion has occurred in published commentaries and social media outlets, resulting in a fragmented discourse. To address the need for an integrative summary, we review various types of replication studies and then discuss the most commonly voiced concerns about direct replication. We provide detailed responses to these concerns and consider different statistical ways to evaluate replications. We conclude there are no theoretical or statistical obstacles to making direct replication a routine aspect of psychological science.
Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.
The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.
Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends.
Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
The Atacama Large Millimeter/submillimeter Array (ALMA) is currently being constructed at the 5000 m Chajnantor plateau in the Chilean Andes. ALMA has been designed and is being built to deliver transformational science in the millimeter and submillimeter
regime for many years to come.
We briefly describe the project status and timeline.
The Atacama Pathfinder Experiment (APEX), built at the same site, is already operational and proves to be an effective survey instrument. We
discuss which niches in millimeter/submillimeter astronomy will remain open for a possible facility in Antarctica.
We calculate in detail the expected properties of low redshift DLAs under the assumption that they arise in the gaseous disks of galaxies like those in the $z\approx 0$ population. A sample of 355 nearby galaxies were analysed, for which high quality H I 21-cm emission line maps are available as part of an extensive survey with the Westerbork telescope (WHISP). We find that expected luminosities, impact parameters between quasars and DLA host galaxies, and metal abundances are in good agreement with the observed properties of DLAs and DLA galaxies. The measured redshift number density of $z=0$ gas above the DLA limit is $dN/dz=0.045\pm 0.006$, which compared to higher $z$ measurements implies that there is no evolution in the co-moving density of DLAs along a line of sight between $z\sim 1.5$ and $z=0$, and a decrease of only a factor of two from $z\sim 4$ to the present time. We conclude that the local galaxy population can explain all properties of low redshift DLAs.
Carbon and strontium isotope stratigraphy has been applied to constrain the depositional
ages of high-grade marble sequences in the Ofoten district of the North-Central Norwegian
Caledonides. Two marble formations hosted by diverse schists from the Bogen Group, all previously
correlated over long distances with a Late Ordovician–Early Silurian, low-grade, fossiliferous succession,
have been studied for carbon, oxygen and strontium isotopes. The least altered 87Sr/86Sr ratios
ranging between 0.7062 and 0.7068, and the best preserved δ13C values falling between +5.0 and
+6.5‰ obtained from two marble formations, are consistent with a seawater composition in the time
interval 700–600 Ma. The results obtained do not support the previously proposed correlation of the
Bogen Group with an Ordovician–Silurian lithostratigraphic succession further north. The apparent
depositional ages suggest that the tectonostratigraphic succession studied is inverted and that the
tectonostratigraphy of the region requires revision. The Neoproterozoic depositional ages combined
with the palaeogeographic position of Baltica imply that carbonates were initially accumulated in seas
on a continental shelf, probably Laurentia, and were tectonically transported onto Baltica during
Early Silurian, Scandian collision, at c. 425 Ma. Prospecting for new dolomite marble deposits of the
Hekkelstrand type and carbonate-hosted manganese–iron ores should be restricted to 700–600 Ma
sequences in the Uppermost Allochthon of the Norwegian Caledonides.
This paper is concerned with some mathematical aspects of magnetic resonance imaging (MRI) of the beating human heart. In particular, we investigate the so-called retrospective gating technique which is a non-triggered technique for data acquisition and reconstruction of (approximately) periodically changing organs like the heart. We formulate the reconstruction problem as a moment problem in a Hilbert space and give the solution method. The stability of the solution is investigated and various error estimates are given. The reconstruction method consists of temporal interpolation followed by spatial Fourier inversion. Different choices for the Hilbert space ℋ of interpolating functions are possible. In particular, we study the case where ℋ is (i) the space of bandlimited functions, or (ii) the space of spline functions of odd degree. The theory is applied to reconstructions from synthetic data as well as real MRI data.
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