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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
This study aimed to deepen the understanding of the psychological mechanisms underlying the formation and maintenance of clinical high-risk symptoms for psychosis (CHR-P) in real-life contexts. Specifically, it examined whether (i) momentary feelings of stress increase the frequency of CHR-P symptoms, or conversely, (ii) CHR-P symptoms increase the intensity of stress. Additionally, potential moderators of the relationship between stress and CHR-P symptoms were explored.
Methods
Using Ecological Momentary Assessment, 79 patients (age: 11–36; 50.6% female) recruited from an early detection center for psychosis, reported their momentary stress levels and the frequency of CHR-P symptoms eight times a day for seven days. Time series data were analyzed using residual dynamic structural equation modeling in a random intercept cross-lagged panel design, comparing differently modeled contemporaneous effects.
Results
There was no evidence of a contemporaneous or temporal link between stress on CHR-P symptoms. However, a contemporaneous effect of CHR-P symptoms on stress was found, while the corresponding temporal effect was not significant. The severity of interview-assessed CHR-P symptoms, age, and type of CHR-P symptoms (i.e., basic symptoms vs. [attenuated] positive symptoms) did not affect the contemporaneous effect of CHR-P symptoms on stress. However, nonperceptive symptoms had a greater contemporaneous effect on stress than perceptive symptoms.
Conclusions
The findings suggest a greater contemporaneous impact of CHR-P symptoms on stress than vice versa. The experience of nonperceptive symptoms, in particular, may alter the appraisal of stress in daily life and represent a target for early interventions in real-time daily life (i.e., ecological momentary interventions).
The pain analgesia hypothesis suggests that reduced pain sensitivity (PS) is a specific risk factor for the engagement in non-suicidal self-injury (NSSI). Consistent with this, several studies found reduced PS in adults as well as adolescents with NSSI. Cross-sectional studies in adults with borderline personality disorder (BPD) suggest that PS may (partially) normalize after remission or reduction of BPD symptoms. The objective of the present study was to investigate the development of PS over 1 year in a sample of adolescents with NSSI and to investigate whether PS at baseline predicts longitudinal change in NSSI.
Methods
N = 66 adolescents who underwent specialized treatment for NSSI disorder participated in baseline and 1-year follow-up assessments, including heat pain stimulation for the measurement of pain threshold and tolerance. Associations between PS and NSSI as well as BPD and depressive symptoms were examined using negative binomial, logistic, and linear regression analyses.
Results
We found that a decrease in pain threshold over time was associated with reduced NSSI (incident rate ratio = 2.04, p = 0.047) and that higher pain tolerance at baseline predicted lower probability for NSSI (odds ratio = 0.42, p = 0.016) 1 year later. However, the latter effect did not survive Holm correction (p = 0.059). No associations between PS and BPD or depressive symptoms were observed.
Conclusion
Our findings suggest that pain threshold might normalize with a decrease in NSSI frequency and could thus serve as a state marker for NSSI.
The Big Exchange project investigates large-scale exchange systems in Eurasia and Africa (8000–1 BC). We concentrate on raw materials of known origin (‘sourced finds’). Network analysis of tools and artificial intelligence methods are used to analyse the combined data sets. We invite broad collaboration on bimodal exchange networks.
Social democracy in Germany emerged within the matrix of national unification and the separation conflicts between liberals of all shades and radical democrats since the mid-nineteenth century. The term ‘democracy’ in the movement’s (and then party’s) name has to be taken as seriously as the commitment to ‘socialism’ commonly associated with it.
Land-use changes and forest management decisions can profoundly alter soil organic carbon (SOC) stocks. Therefore, the objective of this study was to investigate whether existing SOC stocks in the forests of Singapore can be related to successional stages of forest vegetation following disturbances. A forest classification system was developed using information about land use history and vegetation data from 21 inventory plots collected within the framework of Singapore’s IPCC-compatible greenhouse gas reporting system. The forest successional classes obtained were related to SOC stocks (0–50 cm) determined on the same plots. The inventory plots were assigned to four classes. Primary forests (Class 1) were dominated by late succession native species. Secondary forests representing natural forest succession (Class 2) contained younger native trees and a few large trees. Secondary forests after tree plantation/fruit orchard (Class 3) and after agricultural crop cultivation (Class 4) were characterised by large proportions of exotic tree species. Maximum stocks of SOC declined from Class 1 (127.7 Mg ha−1) to Class 4 (35.2 Mg ha−1). The results of a principal component analysis confirmed our forest classification. Plant-related parameters can be successfully used to classify the forests in Singapore, which also show clear differences in SOC.
Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes.
Aims:
The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes.
Method:
Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined.
Results:
No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = –0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms.
Conclusions:
Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.
OBJECTIVES/SPECIFIC AIMS: The objective of this project is to determine whether HRV, collected peri-operatively, is predictive of cognitive decline among older adults who undergo elective surgery/anesthesia. METHODS/STUDY POPULATION: This project is a part of the ongoing INTUIT/PRIME study, which is collecting pre- and post-operative cognitive testing, fMRI imaging, CSF samples, and EEG recordings from 200 older adults (age ≥ 60) undergoing elective non-cardiac/non-neurologic surgery scheduled to last > 2 hours at Duke University Medical Center and Duke Regional Hospital. This project utilizes data from the first 60 INTUIT participants who contributed continuous heart rate data before and during surgery. Participants undergo cognitive testing prior to surgery (baseline) and at 6 weeks after surgery. Our primary dependent variable is the change in the composite score from baseline to 6-weeks. Delirium is assessed in the hospital with the twice daily 3D-CAM tool, so we will report the proportion of individuals with 6-week cognitive decline who exhibited delirium in the days following surgery. Participants’ echocardiogram (ECG) recordings are extracted pre- and intraoperatively from B650/B850 patient monitors with VSCapture software. HRV is defined as the variability between successive R-spikes or inter-beat-intervals on ECG. RESULTS/ANTICIPATED RESULTS: We anticipate that lower intraoperative HRV is associated with worse cognitive decline at 6 weeks after surgery. As secondary objectives, we will determine whether pre-operative HRV or change in HRV (from pre-operative to intra-operative measures) are predictive of cognitive decline after surgery. We expect that in-hospital delirium will be detected in a higher proportion of those with 6-week cognitive decline, compared to those with stable or improved cognition at 6 weeks. DISCUSSION/SIGNIFICANCE OF IMPACT: HRV may address the present need for pre- and intra-operative cognitive risk stratification in the elderly. Physiological indices like HRV have the potential to dramatically change our understanding of CI in older adults undergoing surgery, as they offer an accessible, cost-effective, and non-invasive means whereby clinicians, particularly those unfamiliar with the nuances of geriatric and CI/dementia-related care, can monitor patients and refer those at high-risk of CI after surgery for early intervention.
Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.
Methods
Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.
Results
Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.
Conclusions
Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
A modern catheter laboratory for the treatment of children with CHD should be in close proximity to the paediatric ICU, operating theatres, and imaging facilities. Space requirements and equipment for an up-to-date catheter laboratory are discussed. The document was endorsed by the council of the Association of European Paediatric and Congenital Cardiologists.
Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease.
Patients and methods
The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers.
Results
Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart–lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child’s health-related quality of life.
Conclusions
Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.
How can Japan put its past behind? Scholars, journalists, and activists frequently argue that Japan cannot solve its “history problem” unless it follows West Germany's lead in offering contrition for World War II violence. Into this debate, Jennifer Lind's Sorry States: Apologies in International Politics offers an original and provocative contribution. Lind argues that while countries should acknowledge past atrocities, frequent public apologies can be domestically polarizing and diplomatically counterproductive. Sorry States outlines a theory of remembrance and threat perception and tests it in a comparative study of Japanese-South Korean and Franco-German relations after World War II. Its methods, data, and findings will interest not only East Asianists, but also scholars of international reconciliation and security studies more broadly. This roundtable presents three critical essays in addition to a response by the author. They discuss the mechanisms through which historical memory influences perceptions of threat, the relative weight of ideational versus material factors in threat perception, and whether changes in international norms and economic interdependence may increasingly pressure countries to confront past violence.
The paratexts in early modern English playbooks – the materials to be found primarily in their preliminary pages and end matter – provide a rich source of information for scholars interested in Shakespeare, Renaissance drama and the history of the book. In addition, these materials offer valuable insights into the rise of dramatic authorship in print, early modern attitudes towards theatre, notorious literary wrangles and the production of drama both on the stage and in the printing house. This unique two-volume reference is the first to include all paratextual materials in early modern English playbooks, from the emergence of print drama to the closure of the theatres in 1642. The texts have been transcribed from their original versions and presented in old-spelling. With an introduction, user's guide, multiple indices and a finding list, the editors provide a comprehensive overview of seminal texts which have never before been fully transcribed, annotated and cross-referenced.
In the frame of the EXPOSE-R mission outside the Russian Zvezda Module of the International Space Station (ISS) passive thermoluminescence dosimeters were applied to measure the radiation exposure of biological samples. The detectors were located beneath the sample carriers to determine the dose levels for maximum shielding. The dose measured beneath the sample carriers varied between 317 ± 10 and 230 ± 2 mGy, which amount to an average dose rate of 381 ± 12 and 276 ± 2 μGy d−1. These values are close to those assessed for the interior of the ISS and reflect the high shielding of the biological experiments within the EXPOSE-R facility. As a consequence of the high shielding (several g cm−2), the biological samples were predominantly exposed to galactic cosmic heavy ions and trapped protons in the Earth's radiation belts, whereas the trapped electrons did not reach the samples.