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Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap.
Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable.
Major depressive disorder (p < 0.001) and subtype switch from the restrictive to the bingeing/purging type (p < 0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR = 15) when compared to patients with neither major depressive disorder nor bingeing/purging type.
Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.
The Beck Depression Inventory, 2nd edition (BDI-II) is widely used in research on depression. However, the minimal clinically important difference (MCID) is unknown. MCID can be estimated in several ways. Here we take a patient-centred approach, anchoring the change on the BDI-II to the patient's global report of improvement.
We used data collected (n = 1039) from three randomized controlled trials for the management of depression. Improvement on a ‘global rating of change’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency, assessing whether MCID is best measured in absolute terms (i.e. difference) or as percent reduction in scores from baseline (i.e. ratio), and receiver operator characteristics (ROC) to estimate MCID according to the optimal threshold above which individuals report feeling ‘better’.
Improvement in BDI-II scores associated with reporting feeling ‘better’ depended on initial depression severity, and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score. We estimated a MCID of a 17.5% reduction in scores from baseline from ROC analyses. The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32%.
MCID on the BDI-II is dependent on baseline severity, is best measured on a ratio scale, and the MCID for treatment-resistant depression is larger than that for more typical depression. This has important implications for clinical trials and practice.
SPIRE, the Spectral and Photometric Imaging Receiver, is Herschel's submillimetre camera and spectrometer. It comprises a three-band imaging photometer operating at 250, 350 and 500 μm, and an imaging Fourier Transform Spectrometer (FTS) covering 194–672 μm. The design of SPIRE is described, and the expected scientific performance is summarised, based on modelling and flight instrument test results.
La anorexia nerviosa tiene la tasa de mortalidad por suicidio más alta de todos los trastornos psiquiátricos, asociándose el suicidio con muchos factores. Evaluamos la primera aparición de estos factores en la vida del paciente, teniendo en cuenta su posible solapamiento.
Trescientos cuatro pacientes ingresados y ambulatorios con anorexia nerviosa (DSM-IV) fueron seleccionados sistemáticamente en tres hospitales de las afueras de París, entre diciembre de 1999 y enero de 2003. Los pacientes fueron evaluados con una entrevista personal (DIGS). Se midieron las dimensiones del trastorno de la alimentación y los pacientes fueron entrevistados por un clínico entrenado para evaluar el IMC mínimo y determinar, retrospectivamente, la edad en que se produjeron por primera vez la anorexia nerviosa, el trastorno depresivo mayor, los trastornos de ansiedad y el cambio al tipo atracón/purga.
El trastorno depresivo mayor (p < 0,001) y el cambio desde el subtipo restrictivo al tipo atracón/purga (p < 0,001) fueron los dos factores que se produjeron significativamente con más frecuencia antes de los intentos de suicidio y siguieron estando implicados en un análisis multivariante, usando medidas sindrómicas o dimensionales. Teniendo en cuenta la incidencia a lo largo de la vida con un análisis de supervivencia, el cambio de la anorexia al tipo atracón/purga parece ser un factor predictivo fundamental, con un aumento grande de la frecuencia de intentos de suicidio (CP=15) comparados con los pacientes sin trastorno depresivo mayor ni anorexia del tipo atracón/purga.
La anorexia nerviosa de tipo atracón/purga se asocia significativamente con intentos de suicidio y podría merecer especial atención. Si se confirma en un estudio con diseño prospectivo, estos resultados abogarían por la necesidad de detección precoz y/o intervención terapéutica más intensiva y específica sobre la conducta de atracones y purgas.
BOOMERanG has recently resolved structures on the last scattering surface at redshift ˜ 1100 with high signal to noise ratio. We review the technical advances which made this possible, and we focus on the current results for maps and power spectra, with special attention to the determination of the total mass-energy density in the Universe and of other cosmological parameters.
The ClOVER instrument (described elsewhere in this volume) is
being built to measure the B-mode polarisation of the Cosmic Microwave
Background. Each of the 256 pixels is made up a pseudo-correlation
receiver that can be realised using either waveguide or microstrip
technology. In this work we present a design study for a possible
waveguide-based solution. Each of the individual components has been
optimised using electromagnetic finite-element modelling software
We present a new, fully-funded ground-based instrument designed to measure
the B-mode polarization of the Cosmic Microwave Background (CMB). The concept
is based on three independent sub-systems operating at 90, 150 and 220 GHz,
each comprising a telescope and a focal plane of horn-coupled background-limited bolometers. This highly-sensitive experiment, planned to be based at Dome C station in Antarctica, is optimised to produce very low systematic
effects. It will allow the detection of the CMB polarization over angular multipoles 20<l<1000
accurately enough to measure the B-mode signature from gravitational
waves to a lensing-confusion-limited tensor-to-scalar ratio r ~ 0.005.
The Arcminute Cosmology Bolometer Array Receiver (Acbar) is a multifrequency millimeter-wave receiver optimized for observations of the Cosmic Microwave Background (CMB) and the Sunyaev-Zel'dovich (SZ) effect in clusters of galaxies. Acbar was installed on the 2.1 m Viper telescope at the South Pole in January 2001 and the results presented here incorporate data through July 2002. The power spectrum of the CMB at 150 GHz over the range ℓ = 150 — 3000 measured by Acbar is presented along with estimates for the values of the cosmological parameters within the context of ΛCDM models. The inclusion of ΩΛ greatly improves the fit to the power spectrum. Three-frequency images of the SZ decrement/increment are also presented for the galaxy cluster 1E0657–67.
We show how estimates of parameters characterizing inflation-based theories of structure formation localized over the past year when large scale structure (LSS) information from galaxy and cluster surveys was combined with the rapidly developing cosmic microwave background (CMB) data, especially from the recent Boomerang and Maxima balloon experiments. All current CMB data plus a relatively weak prior probability on the Hubble constant, age and LSS points to little mean curvature (Ωtot = 1.08±0.06) and nearly scale invariant initial fluctuations (ns = 1.03±0.08), both predictions of (non-baroque) inflation theory. We emphasize the role that degeneracy among parameters in the Lpk = 212 ± 7 position of the (first acoustic) peak plays in defining the Ωtot range upon marginalization over other variables. Though the CDM density is in the expected range (Ωcdmh2 = 0.17 ± 0.02), the baryon density Ωbh2 = 0.030 ± 0.005 is somewhat above the independent 0.019 ± 0.002 nucleosynthesis estimates. CMB+LSS gives independent evidence for dark energy (ΩΛ = 0.66 ± 0.06) at the same level as from supernova (SN1) observations, with a phenomenological quintessence equation of state limited by SN1+CMB+LSS to wQ < −0.7 cf. the wQ=−1 cosmological constant case.