Case complexity as a guide for psychological treatment selection

Objective: Some cases are thought to be more complex and difficult to treat, although there is little consensus on how to define complexity in psychological care. This study proposes an actuarial, data-driven method of identifying complex cases based on their individual characteristics. Method: Clinical records for 1512 patients accessing low and high intensity psychological treatments were partitioned in 2 random subsamples. Prognostic indices (PI) predicting post-treatment reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated in one subsample using penalized (Lasso) regressions with optimal scaling. A PI-based algorithm was used to classify patients as standard (St) or complex (Cx) cases in the second (cross-validation) subsample. RCSI rates were compared between Cx cases that accessed treatments of different intensities using logistic regression. Results: St cases had significantly higher RCSI rates compared to Cx cases (OR = 1.81 to 2.81). Cx cases tended to attain better depression outcomes if they were initially assigned to high intensity (vs. low intensity) interventions (OR = 2.23); a similar pattern was observed for anxiety but the odds ratio (1.74) was not statistically significant. Conclusions: Complex cases could be detected early and matched to high intensity interventions to improve outcomes

A renormalization procedure for tensor models and scalar-tensor theories of gravity

Tensor models are more-index generalizations of the so-called matrix models, and provide models of quantum gravity with the idea that spaces and general relativity are emergent phenomena. In this paper, a renormalization procedure for the tensor models whose dynamical variable is a totally symmetric real three-tensor is discussed. It is proven that configurations with certain Gaussian forms are the attractors of the three-tensor under the renormalization procedure. Since these Gaussian configurations are parameterized by a scalar and a symmetric two-tensor, it is argued that, in general situations, the infrared dynamics of the tensor models should be described by scalar-tensor theories of gravity.Comment: 20 pages, 3 figures, references added, minor correction

Matrix geometries and Matrix Models

We study a two parameter single trace 3-matrix model with SO(3) global symmetry. The model has two phases, a fuzzy sphere phase and a matrix phase. Configurations in the matrix phase are consistent with fluctuations around a background of commuting matrices whose eigenvalues are confined to the interior of a ball of radius R=2.0. We study the co-existence curve of the model and find evidence that it has two distinct portions one with a discontinuous internal energy yet critical fluctuations of the specific heat but only on the low temperature side of the transition and the other portion has a continuous internal energy with a discontinuous specific heat of finite jump. We study in detail the eigenvalue distributions of different observables.Comment: 20 page

Transdermal Delivery of Cytochrome C—A 12.4kDa Protein—Across Intact Skin by Constant-Current Iontophoresis

Purpose: To demonstrate the transdermal iontophoretic delivery of a small (12.4kDa) protein across intact skin. Materials and Methods: The iontophoretic transport of Cytochrome c (Cyt c) across porcine ear skin in vitro was investigated and quantified by HPLC. The effect of protein concentration (0.35 and 0.7mM), current density (0.15, 0.3 or 0.5mA.cm−2 applied for 8h) and competing ions was evaluated. Co-iontophoresis of acetaminophen was employed to quantify the respective contributions of electromigration (EM) and electroosmosis (EO). Results: The data confirmed the transdermal iontophoretic delivery of intact Cyt c. Electromigration was the principal transport mechanism, accounting for ∼90% of delivery; correlation between EM flux and electrophoretic mobility was consistent with earlier results using small molecules. Modest EO inhibition was observed at 0.5mA.cm−2. Cumulative permeation at 0.3 and 0.5mA.cm−2 was significantly greater than that at 0.15mA.cm−2; fluxes using 0.35 and 0.7mM Cyt c in the absence of competing ions (J tot  = 182.8 ± 56.8 and 265.2 ± 149.1μg.cm−2.h−1, respectively) were statistically equivalent. Formulation in PBS (pH8.2) confirmed the impact of competing charge carriers; inclusion of ∼170mM Na+ resulted in a 3.9-fold decrease in total flux. Conclusions: Significant amounts (∼0.9mg.cm−2 over 8h) of Cyt c were delivered non-invasively across intact skin by transdermal electrotranspor

High pressure and thermal pasteurization effects on sweet cherry juice microbiological stability and physicochemical properties

This study evaluated high pressure processing (P1 – 400 MPa/5 min; P2 – 550 MPa/2 min) and thermal pasteurization (TP – 70°C/30 s) effects on sweet cherry juice’s microbiological and physicochemical parameters, during four weeks of refrigerated storage. All treatments reduced the microbiological load to undetectable levels not affecting total soluble solids and titratable acidity. The pH increased with all treatments, however, it decreased during storage. Phenols were differently affected: TP increased them by 6%, P1 had no effect while P2 decreased them by 11%. During storage, phenols in control and TP samples decreased by 26% and 20%, P1 samples decreased them by 11% whereas P2 showed no variation. TP had no effect on anthocyanins, while pressure treatments increased them by 8%. Anthocyanins decreased during storage, particularly in the control and P1 (decreasing 41%). All treatments had no effect on antioxidant activity until the 14th day, thereafter high pressure processing samples showed the highest antioxidant activity

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Objectives: Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design: A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods: A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions: Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points: IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development

Heterogeneity in patient-reported outcomes following low-intensity mental health interventions: a multilevel analysis.

BACKGROUND: Variability in patient-reported outcomes of psychological treatments has been partly attributed to therapists--a phenomenon commonly known as therapist effects. Meta-analytic reviews reveal wide variation in therapist-attributable variability in psychotherapy outcomes, with most studies reporting therapist effects in the region of 5% to 10% and some finding minimal to no therapist effects. However, all except one study to date have been conducted in high-intensity or mixed intervention groups; therefore, there is scarcity of evidence on therapist effects in brief low-intensity psychological interventions. OBJECTIVE: To examine therapist effects in low-intensity interventions for depression and anxiety in a naturalistic setting. DATA AND ANALYSIS: Session-by-session data on patient-reported outcome measures were available for a cohort of 1,376 primary care psychotherapy patients treated by 38 therapists. Outcome measures included PHQ-9 (sensitive to depression) and GAD-7 (sensitive to general anxiety disorder) measures. Three-level hierarchical linear modelling was employed to estimate therapist-attributable proportion of variance in clinical outcomes. Therapist effects were evaluated using the intra-cluster correlation coefficient (ICC) and Bayesian empirical predictions of therapist random effects. Three sensitivity analyses were conducted: 1) using both treatment completers and non-completers; 2) a sub-sample of cases with baseline scores above the conventional clinical thresholds for PHQ-9 and GAD-7; and 3) a two-level model (using patient-level pre- and post-treatment scores nested within therapists). RESULTS: The ICC estimates for all outcome measures were very small, ranging between 0% and 1.3%, although most were statistically significant. The Bayesian empirical predictions showed that therapist random effects were not statistically significantly different from each other. Between patient variability explained most of the variance in outcomes. CONCLUSION: Consistent with the only other study to date in low intensity interventions, evidence was found to suggest minimal to no therapist effects in patient-reported outcomes. This draws attention to the more prominent source of variability which is found at the between-patient level

Enhanced control of Bacillus subtilis endospores development by hyperbaric storage at variable/uncontrolled room temperature compared to refrigeration

The effect of hyperbaric storage on Bacillus subtilis endospores, as a new food preservation methodology with potential to replace the conventional refrigeration processes, was assessed and compared to refrigeration. To do so, three different matrices (McIlvaine buffer, carrot juice and brain-heart infusion broth, BHI-broth) were inoculated with B. subtilis endospores and stored at 25, 50 and 100 MPa at variable/uncontrolled room temperature (18-23 °C), under refrigeration (4 °C), and room temperature at atmospheric pressure (0.1 MPa), up to 60 days. Two different quantification procedures were performed to assay both vegetative and endospores (unheated samples) and endospores (heated samples), to assess germination under pressure. The results showed that hyperbaric storage yielded pronounced endospore loads reductions in carrot juice and BHI-broth at 50 and 100 MPa, while in McIlvaine buffer, lower endospore loads reductions were observed. At 25 MPa, the endospores germinated and outgrew in carrot juice. Under refrigeration conditions, both carrot juice and BHI-broth underwent endospore germination and outgrowth after 60 and 9 days of storage, respectively, while in McIlvaine buffer there were no endospore outgrowth. These results suggest that hyperbaric storage at room temperature might not only be a feasible preservation procedure regarding endospores, but also that the food product (matrix characteristics) seems to influence the microbial inactivation that occurs during hyperbaric storage.publishe

Highly precocious activation of reproductive function in autumn-born goats (Capra hircus) by exposure to sexually active bucks

Goats are seasonal breeders with the main cue controlling the timing of breeding season being photoperiod. Hence, the season of birth impacts puberty onset: spring-born goats reach puberty in autumn, at 7 mo of age, whereas autumn-born goats reach puberty at 1 yr during the next reproductive season. The aim of this study was to determine whether exposure of autumn-born young females to sexually active males could counteract the delay in puberty onset observed in autumn-born goats. Females exposed to sexually active males (n = 8) reached puberty earlier than isolated females (n = 8), with exposed females ovulating at a mean age of 3.5 mo. To our knowledge, such precocious puberty onset obtained through social stimulation has never been described in the literature. Moreover, those exposed females exhibited estrus behavior for most ovulations. Our results indicate that in goats born out of season, exposure to sexually active bucks is a really efficient approach to induce early puberty, suggesting that social interactions could have a crucial impact on the regulation of pubertal transition

Variation in Magnetic Fabrics at Low Shock Pressure Due to Experimental Impact Cratering

Magnetic fabrics provide important clues for understanding impact cratering processes. However, only a few magnetic fabric studies for experimentally shocked material have been reported so far. In the framework of MEMIN (Multidisciplinary Experimental and Modeling Impact Research Network), we conducted two impact experiments on blocks of Maggia gneiss with the foliation oriented perpendicular (A38) and parallel (A37) to the target surface. Maggia gneiss has plenty of biotite bands forming a strong rock foliation. The bulk magnetic susceptibility varies from 0.376 × 10$^{−3}$ to 1.298 × 10$^{−3}$ SI in unshocked and from 0.443 × 10$^{−3}$ to 3.940 × 10$^{−3}$ SI in shocked gneiss. The thermomagnetic curves reveal a Verwey transition at −147 °C and a Curie temperature between 576 and 579 °C in unshocked and shocked samples, indicating nearly pure magnetite, which carries the magnetic fabrics. In A37 and A38 kinking is prominent from the point source down to a depth of 2 and 4.2 d$_{p}$ (projectile diameter) or 1 and 2.1 cm, respectively. Kinking, folding, and fracturing changed the position of magnetite grains with respect to each other to reorient the magnetic fabrics. Reorientation of magnetic fabrics is conspicuous down to 20 d$_{p}$ (10 cm) in A38, where no other impact‐related deformation is visible. The reorientation of magnetic fabrics may, therefore, aid in identifying impact processes at very low pressures, starting at 0.1 GPa, when other common indicators are absent