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To further elucidate the Late Pleistocene glacial history of mid-elevation mountainous regions in Central Europe, 10Be cosmic-ray exposure (CRE) dating was applied to moraines in the Zastler Tal Valley in the Southern Black Forest. Periods of glacier recession from moraines in this valley began no later than 16 ka, 15 ka, and 13 ka. CRE ages of moraines in this and other parts of the Southern Black Forest cluster around 17–16 ka and 15–14 ka, thus suggesting a common forcing of glacier recession. Equilibrium-line altitudes (ELAs) during moraine formation were calculated for precipitation reconstruction. Observed spatial discrepancies in ELAs at ca. 15–14 ka are explained best by the size of snow-contributing areas. The reconstructed annual precipitation at the ELA for ca. 16 ka and ca. 15 ka is affected by large uncertainties, representing a wide range from ~50% to ~150% of present-day values. Due to various factors, such as drifting snow, the lower bounds of the estimates appear most realistic, thus concurring with the common hypothesis of less precipitation during the last glacial termination than today in Central Europe. Further research is needed before ELAs of small ice masses can be employed for precise precipitation estimates.
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
Aims
To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
Method
This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
Results
The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
Conclusions
Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients.
Methods
We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected.
Results
Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ.
Conclusions
Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.
Despite increased research interest in smartphone mental health applications (MHapps), few studies have examined user engagement and its determinants. MoodMission is a MHapp that targets low mood and anxiety via evidence-based techniques including behavioural activation (BA).
Aims:
The present study aimed to investigate (i) whether BA interventions delivered with visual psychoeducation had greater engagement than BA interventions delivered with solely written psychoeducation, (ii) whether BA interventions targeting mastery would have greater engagement than those targeting pleasure, and (iii) the relationship between level of engagement and MHapp benefit.
Method:
Participants downloaded MoodMission and completed activities and within-app evaluations over a 30-day period. Data from 238 MoodMission users were analysed via multi-level modelling and linear regression.
Results:
The average number of app-based activities completed was 5.46 and the average self-reported engagement level was in the low to moderate range. As hypothesized, higher levels of engagement significantly predicted more positive activity appraisal.
Conclusions:
The results suggest that BA technique beliefs are involved in MHapp engagement and future research examining user appraisals of techniques is warranted.
A staple theme in clinical psychology, emotion regulation, or the ability to manage one's emotions, is directly linked with personal wellbeing and the ability to effectively navigate the social world. Until recently, this concept has been limited to a focus on intrapersonal processes, such as suppression. Less emphasis has been placed on developmental, social, and cultural aspects of emotion regulation. We argue here that as social beings, our engagement in emotion regulation may often occur interpersonally, with trusted others helping us to regulate our emotions. This review will highlight recent research on interpersonal emotion regulation processes.
Equivalence and non-inferiority trials are becoming more and more popular. Typically, they compare the effects of a treatment of interest with the current gold-standard treatment as the comparator. However, for this approach, the definition of equivalence or non-inferiority margins (NIM) is crucial, and no clear rules for their definition exist. We criticized the practice of these trials of being over-inflationary in favor of (erroneous) equivalence, and we outlined our critique with some study examples comparing psychodynamic treatments with current first-line treatments for mental disorders. Here we answer to a commentary of Leichsenring et al. to our paper. Although focusing on our commentary, these authors are less arguing against our conclusions, but they address issues of study conduct, and lack of appreciation of our examples. However, the crucial question is: What is the risk of erroneous equivalence conclusions that we want to accept as responsible clinicians and scientists? We conclude that the scientific community has to define better and clearer criteria for NIMs. We do not believe that it is ethically justifiable to recommend a treatment that is 10 or 20% less effective than the current gold standard interventions.
The origin of the Brγ-line emission in Herbig Ae/Be stars is still an open question and might be related e.g., to a disc wind or the stellar magnetosphere. The study of the continuum and Brγ-emitting region of Herbig Ae/Be stars with high-spectral and high-spatial resolution gives great insights into the sub-au scale hydrogen gas distribution.
We observed the Herbig Be star MWC 120 with the VLTI/AMBER instrument in different spectral channels across the Brγ line with a spectral resolution of R~1500. Using radiative transfer modeling we found a radius of the line emitting region of ~0.4 au that is only two times smaller than the K-band continuum region. This is consistent with a disc wind scenario rather than an origin of magnetospheric emission.
We present near-infrared AMBER (R~12000) observations of the Herbig B[e] star MWC297 in the Brγ-line. We found that the near-infrared continuum emission is ~3.6 times more compact than the expected dust-sublimation radius, possibly indicating the presence of highly refractory dust grains or optically thick gas emission in the inner disk. Our velocity-resolved channel maps marking the first time that kinematic effects in the sub-AU inner regions of a protoplanetary disk could be directly imaged.
In virtually every field of medicine, non-inferiority trials and meta-analyses with non-inferiority conclusions are increasingly common. This non-inferiority approach has been frequently used by a group of authors favoring psychodynamic therapies (PDTs), concluding that PDTs are just as effective as cognitive-behavioral therapies (CBT). We focus on these examples to exemplify some problems associated with non-inferiority tests of psychological treatments, although the problems also apply to psychopharmacotherapy research, CBT research, and others. We conclude that non-inferiority trials have specific risks of different types of validity problems, usually favoring an (erroneous) non-inferiority conclusion. Non-inferiority trials require the definition of non-inferiority margins, and currently used thresholds have a tendency to be inflationary, not protecting sufficiently against degradation. The use of non-inferiority approaches can lead to the astonishing result that one single analysis can suggest both, superiority of the comparator (here: CBT) and non-inferiority of the other treatment (here PDT) at the same time. We provide recommendations how to improve the quality of non-inferiority trials, and we recommend to consider them among other criteria when evaluating manuscripts examining non-inferiority trials. If psychotherapeutic families (such as PDT and CBT) differ on the number of investigating trials, and in the fields of clinical applications, and in other validity aspects mentioned above, conclusions about their general non-inferiority are no more than a best guess, typically expressing the favored approach of the lead author.
The influence of baseline severity has been examined for antidepressant
medications but has not been studied properly for cognitive–behavioural
therapy (CBT) in comparison with pill placebo.
Aims
To synthesise evidence regarding the influence of initial severity on
efficacy of CBT from all randomised controlled trials (RCTs) in which
CBT, in face-to-face individual or group format, was compared with
pill-placebo control in adults with major depression.
Method
A systematic review and an individual-participant data meta-analysis
using mixed models that included trial effects as random effects. We used
multiple imputation to handle missing data.
Results
We identified five RCTs, and we were given access to individual-level
data (n = 509) for all five. The analyses revealed that
the difference in changes in Hamilton Rating Scale for Depression between
CBT and pill placebo was not influenced by baseline severity (interaction
P = 0.43). Removing the non-significant interaction
term from the model, the difference between CBT and pill placebo was a
standardised mean difference of –0.22 (95% CI –0.42 to –0.02,
P = 0.03, I2 = 0%).
Conclusions
Patients suffering from major depression can expect as much benefit from
CBT across the wide range of baseline severity. This finding can help
inform individualised treatment decisions by patients and their
clinicians.
In a particular success for translational research agendas, characterization of the neuronal circuits underlying fear extinction, and basic research in animal extinction paradigms, has led to intervention studies examining the use of D-cycloserine (DCS) to enhance therapeutic learning from exposure-based cognitive-behavioral therapy (CBT). In this article, we review these intervention studies, and discuss DCS augmentation of CBT relative to more traditional combination-treatment strategies in the treatment of anxiety disorders. We offer an accounting, based on evidence for internal context effects, of current limitations in the combination of antidepressant or benzodiazepine medications with CBT and discuss the advantages of isolated-dosing strategies with DCS relative to these limitations. This strategy is contrasted with the chronic-dosing applications of DCS for schizophrenia and Alzheimer's disease, and future directions for isolated-dosing strategies are discussed.
The presence of multiple fields during inflation might seed a detectable amount of non-Gaussianity in the curvature perturbations, which in turn becomes observable in present data sets like the cosmic microwave background (CMB) or the large scale structure (LSS). Within this proceeding we present a fully analytic method to infer inflationary parameters from observations by exploiting higher-order statistics of the curvature perturbations. To keep this analyticity, and thereby to dispense with numerically expensive sampling techniques, a saddle-point approximation is introduced whose precision has been validated for a numerical toy example. Applied to real data, this approach might enable to discriminate among the still viable models of inflation.
We apply infrared spectroscopic ellipsometry (IRSE) in combination with near-infrared to vacuum-ultraviolet ellipsometry to study the concentration and mobility of holes in a set of Mg-doped In-polar InN samples of different Mg-concentrations. P-type behavior is found in the IRSE spectra for Mg-concentrations between 1x1018 cm-3 and 3x1019 cm-3. The free-charge carrier parameters are determined using a parameterized model that accounts for phonon-plasmon coupling. From the NIR-VUV data information about layer thicknesses, surface roughness, and structural InN layer properties are extracted and related to the IRSE results.
Cognitive-behavioral therapy has developed hugely over the past 30 years and is the branch of psychotherapy which has most successfully transferred into the mainstream of treating mental health problems. In this volume, readers will be provided with an integrated, systematic approach for conceptualizing and treating disorders commonly encountered in clinical practice. A strong emphasis is placed on empirically supported approaches to assessment and intervention while offering readers hands-on recommendations for treating common mental disorders, grounded in evidence-based medicine. Practical chapters written by a variety of international experts include numerous case studies demonstrating the specific techniques and addressing common problems encountered and how to overcome them. Cognitive-behavioral Therapy with Adults is an essential guide for practising clinicians and students of cognitive-behavioral therapy as well as educated consumers and those interested in psychotherapy for common mental disorders.