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Cognitive remediation (CR) preceding cognitive–behavioural therapy for psychosis (CBTp) was trialled within routine clinical services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological performance.
Method
A total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12 weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12 weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a group × time interaction term. Measures of CBTp progress and some neuropsychological measures were modelled by regression.
Results
There was no significant difference between the CR and SC groups in PSYRATS (group × time coefficient 0.3, 95% confidence interval −0.4 to 1.1, p = 0.39). However, after CR CBTp was shorter [median 7 sessions, interquartile range (IQR) 2–12 after CR; median 13, IQR 4–18 after SC; model p = 0.011] and linked to better insight (p = 0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012).
Conclusions
CBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp considerably.
We develop and analyze an adaptive hybridized Interior Penalty Discontinuous Galerkin (IPDG-H) method for H(curl)-elliptic boundary value problems in 2D or 3D arising from a semi-discretization of the eddy currents equations. The method can be derived from a mixed formulation of the given boundary value problem and involves a Lagrange multiplier that is an approximation of the tangential traces of the primal variable on the interfaces of the underlying triangulation of the computational domain. It is shown that the IPDG-H technique can be equivalently formulated and thus implemented as a mortar method. The mesh adaptation is based on a residual-type a posteriori error estimator consisting of element and face residuals. Within a unified framework for adaptive finite element methods, we prove the reliability of the estimator up to a consistency error. The performance of the adaptive symmetric IPDG-H method is documented by numerical results for representative test examples in 2D.
We present a novel, cell-local shock detector for use with discontinuous Galerkin (DG)methods. The output of this detector is a reliably scaled, element-wise smoothnessestimate which is suited as a control input to a shock capture mechanism. Using anartificial viscosity in the latter role, we obtain a DG scheme for the numerical solutionof nonlinear systems of conservation laws. Building on work by Persson and Peraire, wethoroughly justify the detector’s design and analyze its performance on a number ofbenchmark problems. We further explain the scaling and smoothing steps necessary to turnthe output of the detector into a local, artificial viscosity. We close by providing anextensive array of numerical tests of the detector in use.
An outbreak of hepatitis A involved more than 50 residents of a group of villages in the late spring and summer of 1989. The only food that was common to all the laboratory-confirmed cases was bread, purchased either unwrapped or as rolls, sandwiches or filled rolls, and supplied either directly from one shop or indirectly through its subsidiary outlets. It was concluded that this bread was the most likely vehicle of transmission of the hepatitis A virus and that the bread was contaminated by soiled hands which were inadequately washed because of painful skin lesions. Comprehensive control measures were successful in limiting further spread of the infection. This outbreak highlights the transmissibility of hepatitis A virus on food. The use of disposable gloves when handling food which is to be consumed without further cooking would prevent transmission of this or other infectious agents by this route.
The large number of constituent elements and high symmetry of the ordered Fe–Co−V alloys make a complete solution of its structure impossible from a single diffraction experiment. We have carried out a Rietveld refinement of the site occupancies for a partially ordered Fe–Co–V alloy using both neutron and anomalous dispersion x-ray powder diffraction data in order to obtain a complete crystallographic solution to its structure. Contrary to previous assumptions that V occupies both sites randomly or magnetic and Mössbauer studies that suggest that V has a site preference for the Fe sublattice, we find that the V dopant preferentially occupies the Co sites.
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