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Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.
Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.
Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.
Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
Characterisation of genetic diversity in a large number of European pig populations has been undertaken with EC support. The populations sampled included local (rare) breeds, national varieties of the major international breeds, commercial lines and the Chinese Meishan breed. A second phase of the project will sample a further 50 Chinese breeds. Neutral genetic markers (AFLP and microsatellites), with individual or bulk typing, were used and compared.
DNA from 59 European pig populations was extracted on samples of about 50 individuals per population. Individuals were typed for 50 microsatellites and for 148 AFLP bands. A subset of 25 populations was typed for 20 microsatellites on pools of DNA. Allele frequencies were estimated by direct allele counting for the co-dominant markers. Frequencies of AFLP negative alleles (absent bands) were obtained by taking the square root of absent band frequencies. Within-breed variability was summarised using standard statistics: expected and observed heterozygosity, mean observed and effective numbers of alleles, and F statistics. Between-breed diversity analysis was based on a bootstrapped Neighbor-Joining (NJ) tree derived from Reynolds distances (DR). The standard distance of Nei (DS) was also calculated.
A superconductor of paired protons is thought to form in the core of neutron stars soon after their birth. Minimum energy conditions suggest that magnetic flux is expelled from the superconducting region due to the Meissner effect, such that the neutron star core retains or is largely devoid of magnetic fields for some nuclear equation of state and proton pairing models. We show via neutron star cooling simulations that the superconducting region expands faster than flux is expected to be expelled because cooling timescales are much shorter than timescales of magnetic field diffusion. Thus magnetic fields remain in the bulk of the neutron star core for at least 106 − 107yr. We estimate the size of flux free regions at 107yr to be ≲ 100m for a magnetic field of 1011G and possibly smaller for stronger field strengths.
We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS).
Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes.
Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status.
The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.
Visual processing problems may be one underlying factor for cognitive impairments related to autism spectrum disorders (ASDs). We examined associations between ASD-traits (Autism-Spectrum Quotient) and visual processing performance (Rey–Osterrieth Complex Figure Test; Block Design task of the Wechsler Adult Intelligence Scale-III) in young adults (mean age=25.0, s.d.=2.1 years) born preterm at very low birth weight (VLBW; <1500 g) (n=101) or at term (n=104). A higher level of ASD-traits was associated with slower global visual processing speed among the preterm VLBW, but not among the term-born group (P<0.04 for interaction). Our findings suggest that the associations between ASD-traits and visual processing may be restricted to individuals born preterm, and related specifically to global, not local visual processing. Our findings point to cumulative social and neurocognitive problems in those born preterm at VLBW.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
The self-similarity law for axisymmetric wakes has for the first time been examined and verified in a complex helical vortex in the far part of an asymmetric wake by means of direct numerical simulation (DNS). The helical vortex is the main coherent flow structure in the transitional non-axisymmetric wake behind an inclined 6:1 prolate spheroid at Reynolds number 3000 based on the minor axis. The gradual development of the complex helical vortex structure has been described in detail all the way from its inception at the spheroid and into the far wake. We observed a complex vortex composition in the generation stage, a rare jet-like wake pattern in the near wake and an abrupt change of helical symmetry in the vortex core without an accompanying change in flow topology, i.e. with no recirculation bubble.
We investigate the early development of instabilities in the oscillatory viscous flow past cylinders with elliptic cross-sections using three-dimensional direct numerical simulations. This is a classical hydrodynamic problem for circular cylinders, but other configurations have received only marginal attention. Computed results for some different aspect ratios
from 1 : 1 to 1 : 3, all with the major axis of the ellipse aligned in the main flow direction, show good qualitative agreement with Hall’s stability theory (J. Fluid Mech., vol. 146, 1984, pp. 347–367), which predicts a cusp-shaped curve for the onset of the primary instability. The three-dimensional flow structures for aspect ratios larger than 2 : 3 resemble those of a circular cylinder, whereas the elliptical cross-section with the lowest aspect ratio of 1 : 3 exhibits oblate rather than tubular three-dimensional flow structures as well as a pair of counter-rotating spanwise vortices which emerges near the tips of the ellipse. Contrary to a circular cylinder, instabilities for an elliptic cylinder with sufficiently high eccentricity emerge from four rather than two different locations in accordance with the Hall theory.
Multicolour imaging polarimetry of the main sequence star BD+31°643 shows that the Kalas & Jewitt (1997) disc extends to at least 13000AU. A disc of this radius must be dynamically very young compared to the central star, unlike the situation found in the β Pictoris system. A striking linear filament of 850μm emission detected 50″ south, that parallels the dust disk, is probably not physically associated.
Autoimmune diseases are associated with substantial morbidity and mortality, yet the etiology remains unclear. Depression has been implicated as a risk factor for various immune-related disorders but little is known about the risk of autoimmune disease. This study examined the association between depression and the risk of autoimmune disease, and investigated the temporal and dose-response nature of these relationships.
A prospective population-based study including approximately 1.1 million people was conducted using linked Danish registries. Depression and autoimmune diseases were diagnosed by physicians and documented in medical records. In total, 145 217 individuals with depression were identified between 1995 and 2012. Survival analyses were used to estimate the relative risk of autoimmune disease among those with, compared to without, depression. Analyses were adjusted for gender, age, and co-morbid mental disorders.
Depression was associated with a significantly increased risk of autoimmune disease [incidence rate ratio (IRR) 1.25, 95% CI 1.19–1.31], compared to those without a history of depression. Results suggest a general increased risk of autoimmune diseases following the onset of depression during first year (IRR 1.29, 95% CI 1.05–1.58), which remained elevated for the ensuing 11 years and beyond (IRR 1.53, 95% CI 1.34–1.76). Findings did not support a dose-response relationship.
Depression appears to be associated with an increased risk of a range of autoimmune diseases. Depression may play a role in the etiology of certain autoimmune conditions. If replicated, findings could highlight additional clinical implications in the treatment and management of depression. Future studies are needed to investigate the possible social, genetic, and neurobiological underpinnings of these relationships.
The Australian Centre for Advanced Photovoltaics (ACAP) co-ordinates the activities of the six Australian research institutions and a group of industrial partners in the Australia-US Institute for Advanced Photovoltaics (AUSIAPV) to develop the next generations of photovoltaic device technology and to provide a pipeline of opportunities for performance increase and cost reduction. AUSIAPV links ACAP with US-based partners. These national and international research collaborations provide a pathway for highly visible, structured photovoltaic research collaboration between Australian and US researchers, institutes and agencies with significant joint programs based on the clear synergies between the participating organizations. The research program is organized in five collaborative Program Packages (PPs). PP1 deals with silicon wafer-based cells, focusing on three main areas: cells from solar grade silicon, rear contact and silicon-based tandem cells. PP2 involves research into a range of organic solar cells, organic/inorganic hybrid cells, "earth abundant" thin-film materials and "third generation" approaches. PP3 is concerned with optics and characterization. PP4 will deliver a substantiated methodology for assessing manufacturing costs of the different technologies and PP5 involves education, training and outreach. The main research topics, results and plans for the future are presented.
It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.
A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.
Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94).
Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
This paper reports results from a direct numerical simulation of the flow past a circular cylinder with axial curvature. The main objective is to explore the effects of spanwise curvature on the stability of the shear layers and the turbulent wake at the subcritical Reynolds number of 3900. The bluff-body geometry is adapted from a previous study conducted at lower Reynolds numbers, in which a quarter segment of a ring represented the deformed cylinder. A convex configuration in which the free-stream direction is towards the outer face of the ring is adopted here. The present results show a striking distinction between the upper and lower wake regions. Despite the turbulent character of the wake, the upper wake region is more coherent due to the periodic vortex shedding of primary vortical structures, which are in close alignment with the axial curvature. A mild axial flow develops upwards along the lee face of the curved cylinder, displacing the vortex formation region further downstream from the location expected for a straight cylinder at the same Reynolds number. In the lower wake region the vortex shedding strength is drastically reduced due to larger local inclination, resulting in higher three-dimensionality and loss of coherence. A strong downdraft with a swirling pattern is the dominating feature in the lower base region. This is associated with a substantial decrease of the base suction, and the suppression of the characteristic recirculating backflow.
Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).
A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).
Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.
This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.
For the purpose of developing a national system for outbreak surveillance, local outbreak signals were compared in three sources of syndromic data – telephone triage of acute gastroenteritis, web queries about symptoms of gastrointestinal illness, and over-the-counter (OTC) pharmacy sales of antidiarrhoeal medication. The data sources were compared against nine known waterborne and foodborne outbreaks in Sweden in 2007–2011. Outbreak signals were identified for the four largest outbreaks in the telephone triage data and the two largest outbreaks in the data on OTC sales of antidiarrhoeal medication. No signals could be identified in the data on web queries. The signal magnitude for the fourth largest outbreak indicated a tenfold larger outbreak than officially reported, supporting the use of telephone triage data for situational awareness. For the two largest outbreaks, telephone triage data on adult diarrhoea provided outbreak signals at an early stage, weeks and months in advance, respectively, potentially serving the purpose of early event detection. In conclusion, telephone triage data provided the most promising source for surveillance of point-source outbreaks.
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.
The electronic response of actinide systems under high-pressure conditions is undoubtedly of broad scientific interest but simultaneously very difficult to qualify. We will focus here on the use of inelastic x-ray scattering and its significance for actinides research through recent examples. IXS indeed combines several advantages that turn it into a powerful probe of the electronic and valence properties of f-electron systems. Besides element and orbital selectivity, resonant IXS can overcome core-hole lifetime broadening thus providing sharper spectral features and finer details about the electronic structure. Second, non-dipolar transitions are allowed in non-resonant IXS at high momentum transfer; thus “giant dipolar” Fano-like resonances that overwhelms the electron response at the O4,5 edges can be avoided. Recent results of IXS under pressure in Am and U under pressure are presented along with perspectives for actinides research at SOLEIL synchrotron.