The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group.</p> <p>Methods/Design</p> <p>237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization).</p> <p>Discussion</p> <p>The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual".</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN72809357</p

Two-proton small-angle correlations in central heavy-ion collisions: a beam-energy and system-size dependent study

Small-angle correlations of pairs of protons emitted in central collisions of Ca + Ca, Ru + Ru and Au + Au at beam energies from 400 to 1500 MeV per nucleon are investigated with the FOPI detector system at SIS/GSI Darmstadt. Dependences on system size and beam energy are presented which extend the experimental data basis of pp correlations in the SIS energy range substantially. The size of the proton-emitting source is estimated by comparing the experimental data with the output of a final-state interaction model which utilizes either static Gaussian sources or the one-body phase-space distribution of protons provided by the BUU transport approach. The trends in the experimental data, i.e. system-size and beam energy dependences, are well reproduced by this hybrid model. However, the pp correlation function is found rather insensitive to the stiffness of the equation of state entering the transport model calculations.Comment: 9 pages, 8 figures, accepted at Eur. Phys. Journ.

Identification of baryon resonances in central heavy-ion collisions at energies between 1 and 2 AGeV

The mass distributions of baryon resonances populated in near-central collisions of Au on Au and Ni on Ni are deduced by defolding the $p_t$ spectra of charged pions by a method which does not depend on a specific resonance shape. In addition the mass distributions of resonances are obtained from the invariant masses of $(p, \pi^{\pm})$ pairs. With both methods the deduced mass distributions are shifted by an average value of -60 MeV/c$^2$ relative to the mass distribution of the free $\Delta(1232)$ resonance, the distributions descent almost exponentially towards mass values of 2000 MeV/c^2. The observed differences between $(p, \pi^-)$ and $(p, \pi^+)$ pairs indicate a contribution of isospin $I = 1/2$ resonances. The attempt to consistently describe the deduced mass distributions and the reconstructed kinetic energy spectra of the resonances leads to new insights about the freeze out conditions, i.e. to rather low temperatures and large expansion velocities.Comment: 30 pages, 13 figures, Latex using documentstyle[12pt,a4,epsfig], to appear in Eur. Phys. J.

Stopping and Radial Flow in Central 58Ni + 58Ni Collisions between 1 and 2 AGeV

The production of charged pions, protons and deuterons has been studied in central collisions of 58Ni on 58Ni at incident beam energies of 1.06, 1.45 and 1.93 AGeV. The dependence of transverse-momentum and rapidity spectra on the beam energy and on the centrality of the collison is presented. It is shown that the scaling of the mean rapidity shift of protons established for AGS and SPS energies is valid down to 1 AGeV. The degree of nuclear stopping is discussed; the IQMD transport model reproduces the measured proton rapidity spectra for the most central events reasonably well, but does not show any sensitivity between the soft and the hard equation of state (EoS). A radial flow analysis, using the midrapidity transverse-momentum spectra, delivers freeze-out temperatures T and radial flow velocities beta_r which increase with beam energy up to 2 AGeV; in comparison to existing data of Au on Au over a large range of energies only beta_r shows a system size dependence

Direct comparison of phase-space distributions of K- and K+ mesons in heavy-ion collisions at SIS energies - evidence for in-medium modifications of kaons ?

The ratio of K- to K+ meson yields has been measured in the systems RuRu at 1.69 A GeV, Ru+Zr at 1.69 A GeV, and Ni+Ni at 1.93 A GeV incident beam kinetic energy. The yield ratio is observed to vary across the measured phase space. Relativistic transport-model calculations indicate that the data are best understood if in-medium modifications of the kaons are taken into account.Comment: 14 pages including 3 figure

Differential directed flow in Au+Au collisions

We present experimental data on directed flow in semi-central Au+Au collisions at incident energies from 90 to 400 A MeV. For the first time for this energy domain, the data are presented in a transverse momentum differential way. We study the first order Fourier coefficient v1 for different particle species and establish a gradual change of its patterns as a function of incident energy and for different regions in rapidity.Comment: 5 pages, Latex, 5 eps figures, accepted for publication in Phys. Rev. C (Rapid Communications). Data files available at http://www-linux.gsi.de/~andronic/fopi/v1.htm

Excitation function of elliptic flow in Au+Au collisions and the nuclear matter equation of state

We present measurements of the excitation function of elliptic flow at midrapidity in Au+Au collisions at beam energies from 0.09 to 1.49 GeV per nucleon. For the integral flow, we discuss the interplay between collective expansion and spectator shadowing for three centrality classes. A complete excitation function of transverse momentum dependence of elliptic flow is presented for the first time in this energy range, revealing a rapid change with incident energy below 0.4 AGeV, followed by an almost perfect scaling at the higher energies. The equation of state of compressed nuclear matter is addressed through comparisons to microscopic transport model calculations.Comment: 10 pages, 4 eps figures, submitted for publication. Data files will be available at http://www.gsi.de/~fopiwww/pub

Flow angle from intermediate mass fragment measurements

Directed sideward flow of light charged particles and intermediate mass fragments was measured in different symmetric reactions at bombarding energies from 90 to 800 AMeV. The flow parameter is found to increase with the charge of the detected fragment up to Z = 3-4 and then turns into saturation for heavier fragments. Guided by simple simulations of an anisotropic expanding thermal source, we show that the value at saturation can provide a good estimate of the flow angle, $\Theta_{flow}$, in the participant region. It is found that $\Theta_{flow}$ depends strongly on the impact parameter. The excitation function of $\Theta_{flow}$ reveals striking deviations from the ideal hydrodynamical scaling. The data exhibit a steep rise of \Theta_{\flow} to a maximum at around 250-400 AMeV, followed by a moderate decrease as the bombarding energy increases further.Comment: 28 pages Revtex, 6 figures (ps files), to appear in Nucl.Phys.

Sideward flow of K+ mesons in Ru+Ru and Ni+Ni reactions near threshold

Experimental data on K+ meson and proton sideward flow measured with the FOPI detector at SIS/GSI in the reactions Ru+Ru at 1.69 AGeV and Ni+Ni at 1.93 AGeV are presented. The K+ sideward flow is found to be anti-correlated (correlated) with the one of protons at low (high) transverse momenta. When compared to the predictions of a transport model, the data favour the existence of an in-medium repulsive K+ nucleon potential.Comment: 16 pages Revtex, 3 ps-figures, submitted to Phys. Lett.

Isospin-tracing: A probe of non-equilibrium in central heavy-ion collisions

Four different combinations of $^{96}_{44}$Ru and $^{96}_{40}$Zr nuclei, both as projectile and target, were investigated at the same bombarding energy of 400$A$ MeV using a $4 \pi$ detector. The degree of isospin mixing between projectile and target nucleons is mapped across a large portion of the phase space using two different isospin-tracer observables, the number of measured protons and the ${\rm t}/^{3}{\rm He}$ yield ratio. The experimental results show that the global equilibrium is not reached even in the most central collisions. Quantitative measures of stopping and mixing are extracted from the data. They are found to exhibit a quite strong sensitivity to the in-medium (n,n) cross section used in microscopic transport calculations.Comment: 4 pages RevTeX, 3 figures (ps files), submitted to Phys. Rev. Let