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Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.
The structure of montmorillonite intercalated with [Al13O4(OH)24+x(H2O)12−x](7−x)+ cations ( for short), where x = 0, 2 and 4, has been studied using the Cerius2 modeling environment. The Crystal Packer module used in the present study takes into account only the nonbonded interactions between the silicate layer and the Keggin cations. Minimization of the total sublimation energy led to the following conclusions: the structure of the interlayer (that is, the orientation of Keggin cations and the basal spacing) depends on the charge of cations (that is, on the degree of hydrolysis, x). The values of basal spacings in the range 19.38–20.27 Å have been obtained, depending on the charge and arrangement of cations in the interlayer. The dominating contribution to the total sublimation energy comes from the electrostatic interactions. Translations of cations along the 2:1 layers give only small fluctuations of the total sublimation energy and basal spacings. No preference for the position of cations in the interlayer of montmorillonite was found during translation along the 2:1 layers. This result confirmed the inhomogeneous distribution of cations in the interlayer and turbostratic stacking of layers.
The Crystal Packer module in the Cerius2 modeling environment has been used to study the structure of montmorillonite intercalated with Al(OH)3-fragment (gibbsite-like) polymers. Basal spacings in gibbsite-like polymers arranged in 2 layers in the interlayer of montmorillonite varied in the range 19.54–20.13 Å, depending on the type and arrangement of Al(OH)3 fragments. The inhomogeneous distribution of intercalating species in the interlayer and, consequently, the turbostratic stacking of layers has been found for gibbsite-like polymers as well as in the case of Keggin cations (Čapková et al. 1998). The dominating contribution to the total sublimation energy comes from electrostatic interactions for both intercalating species, gibbsite-like polymers and Keggin cations.
Tail biting is a major problem in modern pig (Sus scrofa) production and results in a reduction of animal welfare and productive performance. Biting behaviour has been shown to be decreased by the use of enrichment objects. In this study, 108 pigs housed in a room with 12 pens were observed and a sequence of seven different enrichment materials was tested. Gilts and barrows were housed together and received a new enrichment object each week starting from three different points in the fattening period, ie 20, 40 or 70 kg bodyweight. Toy-contact and biting-penmate behaviour were observed during one hour at day of introduction and five days later. A continuous sequence of seven enrichment objects reduced biting-penmate behaviour and the number of wounds compared to providing only a single toy (chain). This study also confirmed that not every object was feasible as an enrichment object for growing pigs. Generally, the highest toy contact was observed together with the highest biting-penmate behaviour. Most toy-contact and biting-penmate behaviour was observed between 20 and 40 kg bodyweight and was decreasing over age. Providing a sequence of toys for the first time induced toy-contact behaviour while reducing bitingpenmate behaviour but decreased after applying the same sequence for the second or third time. The presence of a single chain or a sequence of different toys had no effect on growth and feed conversion. The ideal sequence should maintain toy-contact behaviour without competition in order to avoid biting-penmate behaviour and reduced animal welfare.
Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression.
Methods
For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level.
Results
Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = −0.49, 95% confidence interval (CI) −0.61 to −0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = −0.68, 95% CI −1.31 to −0.05, p = 0.03) and than 1–2 years (B = −0.86, 95% CI −1.66 to −0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias.
Conclusions
To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.
Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data.
Aims
This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602)
Method
Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes.
Conclusions
To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.
Hot, massive stars are known to host unstable, radiation-driven outflowing winds, giving rise to dense clumps of material which severely affect the diagnostic techniques used to derive wind properties of massive stars. Most of the current diagnostic models account for wind inhomogeneities by assuming a one-component medium consisting of optically thin clumps, and maintaining a smooth velocity-field. However, this neglects important light-leakage effects through porous channels in-between the clumps. These light-leakage effects have recently been incorporated in the stellar atmosphere modelling code FASTWIND, and here we will present quantitative mass-loss results from a combined Ultraviolet-Optical wind analysis of O-supergiants in the Galaxy. Using a genetic-algorithm fitting-approach, we systematically investigate the impact the wind physics has on derived stellar and wind parameters, and how this depends on metallicity and spectral type. We compare our findings with earlier results (which do not take into account such light-leakage effects), to standard mass-loss rates usually included in evolution model studies of massive stars, and with theoretical predictions of clumping properties. We will also present the first systematic empirical constraints on the new wind parameters, associated with light-leakage, and compare these with theoretical predictions.
To present an updated version of the ‘Post-acute Level Of Consciousness scale’ (PALOC-s), in accordance with the latest scientific insights.
Methods:
Within the context of a research project, 20 years ago, the PALOC-s was developed for the purpose of following the development of the level of consciousness of young unconscious patients participating in a rehabilitation program. Meanwhile, the understanding of the behavior related to different levels of consciousness has developed and terminology has changed, resulting in the need to revise the PALOC-s. With the preservation of the original description of the eight hierarchical levels of PALOC-s, adaptations are made in the terminology and grouping of these levels.
Results and conclusion:
This manuscript presents the revised version of PALOC-sr, which is suitable for use in clinical practice. The validation of this scale is recommended for its optimal use in future (international) research projects.
Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, ‘conventional’ meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis.
Aims
We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891).
Method
We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies.
Conclusions
This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.
The effect of reduced balanced protein (RP) diet in the F0 and F1 generation of broiler breeders on the learning ability and memory retention of the F2 generation was investigated by means of a reward v. no reward discrimination T-maze test. There were two treatments for the F0 generation: control (C) group, reared on standard commercial diets, and reduced balanced protein (RP) group, fed with RP diets (25% reduction in CP and amino acids). The female F0-progeny of each treatment was again separated into the two dietary treatments, resulting in four treatments for the F1 generation: C/C, C/RP, RP/C and RP/RP (breeder feed in F0/F1 generation). The RP diets fed breeders received on average 10% more feed than C diets fed breeders to achieve a similar target BW. The F2 generation was composed of four treatments coming from the female F1-progeny of the four treatments and were all fed with C diet (namely C/C/C, C/RP/C, RP/C/C and RP/RP/C). All four F2 generation groups were able to complete the T-maze learning test with a slight difference in success rate but a significant difference within groups was observed regarding the time needed to complete the test. In general, the RP/RP/C group needed more time for completing the test compared with the other three groups and the shortest time was recorded for the RP/C/C group. At similar ages, breeders with early learning experience spent significantly less time in completing the test compared with unexperienced breeders. Long-term memory retention was observed in all four groups whereas the learning ability in solving the test decreased with age. It took longer for the breeders to complete the test at older ages. In conclusion, under our experimental conditions, the RP dietary treatment in previous generations had no influence on the T-maze learning ability and memory retention of broiler breeders of the third generation, although it might have effects on the working performance in the T-maze learning test of F2 generation breeders.
Learning and mental abilities of farm animals are important for their adaptation to new environments and could serve as an indicator for welfare and performance. This study assessed the learning ability and memory retention of broiler breeders through a T-maze test with a reward v. no reward set-up. Feed supplemented with or without meal worms served as a reward. Two trials were conducted with either parent stock (PS) breeders or pure line A (PL) breeders and with the same dietary treatment namely a control (C) group fed with standard commercial diets and a reduced balanced protein (RP) group fed with RP diets (25% reduction of CP and amino acids). To maintain similar target BW, the RP group received on average 10% more feed. A tonic immobility (TI) test was performed to estimate the fearfulness of PS breeders. Most breeders were capable of completing the T-maze tests, but the C group needed less time compared with the RP group when their own feed was given as a reward. However, when meal worms were provided as an extra incentive, the RP group completed the maze significantly faster than the C group. Compared to the C breeders, the RP breeders remained longer in a TI state, indicating a higher level of fearfulness. Long-term memory retention in the T-maze test was observed in both groups. It is concluded that the RP diet had no influences on the learning ability of the reward v. no reward discrimination test and its memory retention of broiler breeders. The increased amount of time the RP breeders needed to solve the test was probably due to a higher sense of fear. Furthermore, the RP diet enhanced the motivation of breeders to obtain an alternative feed such as meal worms.
The arterial switch operation for transposition of the great arteries was initially believed to be an anatomical correction. Recent evidence shows reduced exercise capacity and left ventricular function in varying degrees in the long term after an arterial switch operation.
Objective
To perform a meta-analysis on long-term exercise capacity and left ventricular ejection fraction after an arterial switch operation.
Methods
A literature search was performed to cover all studies on patients who had undergone a minimum of 6 years of follow-up that reported either left ventricular ejection fraction, peak oxygen uptake, peak workload, and/or peak heart rate. A meta-analysis was performed if more than three studies reported the outcome of interest.
Results
A total of 21 studies reported on the outcomes of interest. Oxygen uptake was consistently lower in patients who had undergone an arterial switch operation compared with healthy controls, with a pooled average peak oxygen uptake of 87.5±2.9% of predicted. The peak heart rate was also lower compared with that of controls, at 92±2% of predicted. Peak workload was significantly reduced in two studies. Pooled left ventricular ejection fraction was normal at 60.7±7.2%.
Conclusion
Exercise capacity is reduced and left ventricular ejection fraction is preserved in the long term after an arterial switch operation for transposition of the great arteries.
An evolution of the low-frequency pulse profile of PSR B2217+47 is observed during a six-year observing campaign with the LOFAR telescope at 150 MHz. The evolution is manifested as a new component in the profile trailing the main peak. The leading part of the profile, including a newly-observed weak component, is steady during the campaign. The transient component is not visible in simultaneous observations at 1500 MHz using the Lovell telescope, implying a chromatic effect. A variation in the dispersion measure of the source is detected in the same timespan. Precession of the pulsar and changes in the magnetosphere are investigated to explain the profile evolution. However, the listed properties favour a model based on turbulence in the interstellar medium (ISM). This interpretation is confirmed by a strong correlation between the intensity of the transient component and main peak in single pulses. Since PSR B2217+47 is the fourth brightest pulsar visible to LOFAR, we speculate that ISM-induced pulse profile evolution might be relatively common but subtle and that SKA-Low will detect many similar examples. In this scenario, similar studies of pulse profile evolution could be used in parallel with scintillation arcs to characterize the properties of the ISM.
Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors.
Method
We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure.
Results
While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychotherapy only who showed low baseline co-morbid anxiety levels (d = −0.40) and among severely depressed patients receiving psychotherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = −0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83).
Conclusions
Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychotherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and psychodynamic therapy.
There are few epidemiological data on the dietary risk factors of Barrett's oesophagus, a precursor of oesophageal adenocarcinoma. The present study investigated the association between vegetable, fruit and nitrate intake and Barrett's oesophagus risk in a large prospective cohort. The Netherlands Cohort Study recruited 120 852 individuals aged 55–69 years in 1986. Vegetable and fruit intake was assessed using a 150-item FFQ, and nitrate intake from dietary sources and drinking water was determined. After 16·3 years of follow-up, 433 cases (241 men and 192 women) of Barrett's oesophagus with specialised intestinal metaplasia and 3717 subcohort members were analysed in a case–cohort design using Cox proportional hazards models while adjusting for potential confounders. Men exhibited a lower risk of Barrett's oesophagus in the highest v. the lowest quintile of total (multivariable-adjusted hazard ratio (HR): 0·66, 95 % CI 0·43, 1·01), raw (HR 0·63, 95 % CI 0·40, 0·99), raw leafy (HR 0·55, 95 % CI 0·36, 0·86) and Brassica (HR 0·64, 95 % CI 0·41, 1·00) vegetable intake. No association was found for other vegetable groups and fruits. No significant associations were found between vegetable and fruit intake and Barrett's oesophagus risk among women. Total nitrate intake was inversely associated with Barrett's disease risk in men (HR 0·50, 95 % CI 0·25, 0·99) and positively associated with it in women (HR 3·77, 95 % CI 1·68, 8·45) (P for interaction = 0·04). These results suggest that vegetable intake may contribute to the prevention of Barrett's oesophagus. The possible differential effect in men and women should be evaluated further.
To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness.
Methods.
The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A Markov-type cost-effectiveness model (health care perspective, 5-year time horizon) was used to compare CNCM with care as usual (CAU). Two studies were used to determine model parameters: a before–after study (n = 2155) and a matched-control study (n = 937).
Results.
The CNCM may lead to a gain in psychiatric functioning according to the models. CNCM patients remain in (outpatient) care, while CAU patients drop out more frequently. There is only a small difference in inpatient care. As a result, average costs per patient in the CNCM group are between €2809 (before–after model) and €5251 (matched-control model) higher. The iCER was between €45 127 and €57 839 per life year without psychiatric dysfunction gained.
Conclusions.
CNCM may be only cost-effective when willingness to pay for a life year without psychiatric dysfunction is higher than €45 000. However, this result is highly sensitive to the level of psychiatric dysfunctioning in patients who do not receive care.
Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU).
Methods.
South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis.
Results.
FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess.
Conclusion.
Implementation of FACT results in measurable changes in mental health care use.
In this work, we present a continuous observer and continuous controller for a multiple degree of freedom robot manipulator with hysteretic joint friction. The fictitious hysteresis state is of course unknown to the controller and must be estimated. The joint velocities are assumed measured here. For this considered plant, we propose and present a continuous observer/controller that estimates or observes the hysteresis state and drives the position tracking error to zero. We prove that the combined tracking error and observer error converges to zero globally exponentially.