Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders

<p>Abstract</p> <p>Background</p> <p>Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD.</p> <p>Methods/Design</p> <p>In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST.</p> <p>Discussion</p> <p>This trial is the first to compare ST and COP head-to-head with TAU for people with a cluster C, paranoid, histrionic and/or narcissistic PD. By combining clinical effectiveness data with an economic evaluation and with direct information from primary stakeholders, this trial offers a complete and thorough view on ST as a contribution to the improvement of treatment for this PD patient group.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=566">NTR566</a></p

Albumen Freshness Assessment by Combining Visible Near-Infrared Transmission and Low-Resolution Proton Nuclear Magnetic Resonance Spectroscopy

Objetivos: Desarrollar un sistema de seguimiento solar adaptativo para paneles solares fotovoltaicos que no necesitan una configuración inicial. Métodos: Se utilizó el método estructuralista, en el cual se observa la realidad, se construye modelos y se analiza la estructura. Se utilizaron bloques de programación del controlador lógico programable (PLC) y de modelos de mecanismos para construir el modelo del seguidor solar; además se aplicó teorías de ingeniería de control como la estabilidad de sistemas dinámicos y control adaptativo. La prueba de estabilidad y el funcionamiento correcto se analiza utilizando todo el sistema en conjunto, luego, se validan estos análisis con las simulaciones y experimentaciones. Resultados: Se presentan resultados de simulación y experimentación, en los cuales se hace evidente que el controlador adaptativo mantiene el error de control de seguimiento muy bajo a pesar de las condiciones nubladas. En las simulaciones y experimentaciones no se requirió una configuración inicial; este hecho es uno de los requisitos que se busca alcanzar en los objetivos. La ventaja de la adaptación es que el seguidor solar seguirá la trayectoria del sol aun cuando este se encuentre oculto por las nubes. Conclusiones: El aporte fue brindar un diseño novedoso de un seguidor solar cronológico adaptativo. El algoritmo de control adaptativo evita la configuración inicial del seguidor solar cronológico.Objectives: Develop an adaptive solar tracker system for photovoltaic solar panels which does not require an initial configuration. Methods: A structuralist method was used, where the reality is observed, models are developed, and the structure is analyzed. Blocks programming of the programmable logic controller (PLC) and mechanisms models were used to develop the solar tracker model. And also control engineering theories were used like the dynamic systems stability and the adaptive control. The stability testing and the correct operation are analyzed using the whole system, then, these analyzes are validated with simulations and experimentations. Results: Simulation and experimental results are presented, these make evident that the adaptive controller keeps very low the tracking control error although the cloudy conditions. An initial configuration was not required in simulations and experimentations; this fact is one of the requirements that is needed to reach in the objectives. The advantage of the adaptation is that the solar tracker will follow the sun path; even though the sun could be hidden by the clouds. Conclusions: The contribution was to provide a novel design of an adaptive chronological solar tracker. The adaptive control algorithm avoids the initial configuration of the chronological solar tracker

Effects of storage time on incubating egg gas pressure, thyroid hormones, and corticosterone levels in embryos and on their hatching parameters

Incubating eggs (1,800 total) produced by a commercial flock of Cobb broiler breeders were used to determine the effects of storage duration (3 and 18 d) on gas partial pressure, thyroid hormones, and hatching parameters. Partial pressure of oxygen (pO2) and carbon dioxide (pCO2) were measured on d 18 and at internal pipping (IP) during incubation. Blood samples were collected for determination of triiodothyronine (T3), thyroxine (T4), and corticosterone concentrations in the embryos at IP and in newly hatched chicks. From 464 to 510 h of incubation, eggs were checked individually every 2 h to determine the timing and duration of IP, external pipping (EP), and total hatching time. At 18 d of incubation and at IP, pCO2 was greater in air cell of eggs stored for 3 d compared to those stored for 18 d (P < 0.05), but pO2 was greater in eggs stored for 18 d. At IP, T3 and corticosterone levels were higher in plasma of the embryos of eggs stored for 3 d compared to those stored for 18 d, but it was the reverse in newly hatched chicks (P < 0.05). Embryos from eggs stored for 18 d required more time to complete IP compared to embryos of eggs stored for only 3 d (P < 0.05), whereas the duration of EP was not affected by storage. The overall longer incubation was, however, not only due to prolonged IP but also to later occurrence of IP. It was concluded that prolonged IP as a result of long storage may be related to the late increase in corticosterone level, which may be a necessary stimulus for higher T 3/T4 ratio, late increase in pCO2 level, and decrease in pO2. The effect of long storage was a delay in hatching and a continuous increase in T3 due to higher corticosterone levels between IP and hatching, which may be an indication of the more stressful event of hatching of embryos from eggs stored longer. Differences in pCO2, pO2, T3, T4, and corticosterone levels in the incubating eggs may be manifestations of these changes culminating in altered hatching parameters and consequently differences in chick quality and growth potentials

Ring test within EU on methods for evaluation of egg albumen functional properties : foaming and gelation

vokBEL/PR