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No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment.
From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment.
Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043).
Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.
This study examined the use of degree-day models to predict alfalfa weevil Hypera postica (Gyllenhal) (Coleoptera: Curculionidae) population development on the Canadian prairies. Air temperatures, alfalfa weevil abundance, and instar data were collected in 2013 and 2014 from 13 alfalfa (Medicago sativa Linnaeus; Fabaceae) fields across Alberta, Saskatchewan, and Manitoba. We coupled three alfalfa weevil population prediction models with three temperature data sources to determine which combination most closely aligned with results observed. Our objective was to find the best prediction of peak occurrence of second instar alfalfa weevils, the optimum time for management decisions. Of the parameters analysed, prediction model had the greatest effect on the accuracy of peak instar prediction, with Harcourt and North Dakota models better at predicting population peaks than the Guppy–Mukerji model. Interactions between temperature source and prediction model significantly affected prediction accuracy. The probability of accurate prediction of population peaks to within 3.5 days of actual occurrence using in-field and multiple-site temperature data sets, combined with Harcourt and North Dakota development models, was 0.45–0.70. Lower predictability was found from fields in the Mixed Grass Ecoregion than in other ecoregions. The use of the recommended models can assist growers in timing their monitoring activities and deciding if pest management action is warranted.
Dignity therapy (DT) is designed to address psychological and existential challenges that terminally ill individuals face. DT guides patients in developing a written legacy project in which they record and share important memories and messages with those they will leave behind. DT has been demonstrated to ease existential concerns for adults with advanced-stage cancer; however, lack of institutional resources limits wide implementation of DT in clinical practice. This study explores qualitative outcomes of an abbreviated, less resource-intensive version of DT among participants with advanced-stage cancer and their legacy project recipients.
Qualitative methods were used to analyze postintervention interviews with 11 participants and their legacy recipients as well as the created legacy projects. Direct content analysis was used to assess feedback from the interviews about benefits, barriers, and recommendations regarding abbreviated DT. The legacy projects were coded for expression of core values.
Findings suggest that abbreviated DT effectively promotes (1) self-expression, (2) connection with loved ones, (3) sense of purpose, and (4) continuity of self. Participants observed that leading the development of their legacy projects promoted independent reflection, autonomy, and opportunities for family interaction when reviewing and discussing the projects. Consistent with traditional DT, participants expressed “family” as the most common core value in their legacy projects. Expression of “autonomy” was also a notable finding.
Significance of results
Abbreviated DT reduces resource barriers to conducting traditional DT while promoting similar benefits for participants and recipients, making it a promising adaptation warranting further research. The importance that patients place on family and autonomy should be honored as much as possible by those caring for adults with advanced-stage cancer.
Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement.
The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.
Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.
Significance of results
The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.
The Antarctic coast is an area of high cyclonic activity. Specifically, the regions of Terra Nova Bay, in the western Ross Sea, and Byrd Glacier, in the western Ross Ice Shelf, are prone to cyclone development. The United States, New Zealand, and Italian Antarctic programmes conduct extensive research activities in the region of the western Ross Sea. Due to the harsh weather conditions associated with the cyclonic systems that occur in this region and the abundant research activities in the area, it is important to be able to accurately predict the timing, location and strength of cyclones in this sector of Antarctica. This study evaluates the ability of the Antarctic Mesoscale Prediction System (from 2006–09) to accurately forecast cyclones in the region of the western Ross Sea by comparing the Antarctic Mesoscale Prediction System forecasts to cyclones identified in infrared satellite imagery. The results indicate that the Antarctic Mesoscale Prediction System is able to accurately predict the presence of cyclones about 40% of the time (at a minimum) and the presence of no cyclones about 70% of the time.
To provide Canadian physicians and allied health care professionals with the evidence they need to help them make treatment decisions in the management of patients with Alzheimer’s disease or other dementias.
The full range and quality of diagnostic and therapeutic modalities available to Canadian physicians for the management of dementia.
Improvement in the treatment of dementias, leading to reduced suffering, increased functional capacity and decreased economic burden.
Evidence and values:
The creation of these evidence-based consensus statements involved literature reviews of the subject by the authors; comparison of alternative clinical pathways and description of the methods whereby published data were analyzed; definition of the level of evidence for data in each case; evaluation and revision in a conference setting (involving primary care physicians, neurologists, psychiatrists, geriatricians, psychologists, consumers and other interested parties); insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all authors.
Benefits, harms, and costs:
A rational plan for the therapy of dementias is likely to lead to substantial benefits in both human and economic terms.
Treatment decisions should be made taking into account the severity or stage of the disease, the availability of caregivers, the presence of disease affecting other bodily systems and the ability of the subject to pay the cost of the medications. Donepezil is considered to have positive effects upon certain tests of neuropsychological function and may produce some improvement in Alzheimer’s disease of mild to moderate severity as measured by rating scales. Its ability to improve quality of life remains uncertain. No other drug treatments* (apart from symptomatic therapies) are at present approved for the treatment of Alzheimer’s disease.
These recommendations were created by a writing committee, evaluated and revised at a consensus conference and further reviewed and revised by the writing committee prior to publication.
These extracts are from chapters I.xvi, I.xviii and I.xxvi of De Natura Legis Naturae. They are slightly amended versions of the translation by Lord Clermont, published in his 1869 edition, volume I
Answer to the second cause of the war above mentioned. But the author first distinguishes the law (ius) of a king reigning royally from the law (ius) of a king ruling politically and royally
O Samuel, Prophet of the Lord, the Lord did not command you to proclaim to the people of Israel the law of what king soever they pleased, but He Himself, incited to that severity by the inconsiderate request of the people, said to you, ‘Hear you their voice, but take them to witness, and tell them beforehand the law of the king (ius regis), not of every king, but of the king who is to reign over them.’ Nor did you, the Prophet, set before them the law of a king in general, but following faithfully the command of God, you said to the people, ‘This is the law of the king (ius regis) who is to rule over you. He shall take your sons and put them in his chariots,’ etc.
Sir John Fortescue CJKB (c.1395–c.1477) was undoubtedly the foremost English political scientist of the fifteenth century. This convenient volume brings together for the first time new editions of his two major works - In Praise of the Laws of England and The Governance of England - with references and suggestions for further reading for the student. In her introduction, Shelley Lockwood presents a clear reassessment of the work of John Fortescue and places these key texts in their historical and intellectual contexts. These works, arguably the earliest in English political thought, were written from the perspective of a self-consciously analytical and highly experienced lawyer and government official during a time of war and political upheaval. They form a coherent argument for justice against tyranny and afford unique insights into the law and governance of fifteenth-century England.
This is an alternative version of chapter 16 of The Governance, above 117–18. It is taken from Yelverton MS 35 and was printed by Clermont (1869 edn) 475–6 and by Plummer (1885 edn), 347–8. I have modernised the spelling and punctuation of the original.
O what good wealth and prosperity should grow to the realm of England if such a council should be once perfectly established and the king guided thereby. The Romans who by wisdom and manhood got the lordship and monarchy of the world were first governed by kings; but when the kings through insolence, following their passions, left the council of the senate, the Romans rose upon them and put away their kings for evermore. And then they were ruled by the senators, and by consuls politically many years, by whose wisdom they got the lordship of a great part of the world. But after their great wealth, by division that fell between the consuls for lack of one head, they had amongst them civil battles, wherein at some one debate more than eighty thousand of them were slain and exiled. And after that they were governed by one head called an emperor, who, using in all his rule the council of the senate, got the monarchy of the world. So that at Christ's birth, the emperor commanded the whole world to be described as subjects unto him.