Telemedicine of family-based treatment for adolescent anorexia nervosa: A protocol of a treatment development study.

BackgroundFamily-based treatment is an efficacious treatment available for adolescents with anorexia nervosa. Yet the implementation of this treatment, at least in the United States, is challenging due to a limited number of trained family-based treatment therapists and the concentration of these therapists in a limited number of urban centers. The use of telemedicine in the delivery of family-based treatment can increase access to this therapy for this patient population.Methods/designThis two-year treatment development study (December 2013-November 2015) follows a two-wave iterative case series design. The study is ongoing and addresses the treatment needs of families in remote, rural, or underrepresented parts of the United States by delivering family-based treatment via telemedicine (video chat). The first six months of the study was dedicated to selecting a cloud-based secure telemedicine portal for use with participants. Recruitment for the first of two consecutive case series (N = 5) began during month seven. After these five patients completed treatment, a systematic review of treatment via feedback from participants and therapists related to the delivery of this model and use of technology was completed. A second wave of recruitment is underway (N = 5). At the end of both waves (N = 10), and after a second review of treatment, we should be able to establish the feasibility and acceptability of family-based treatment delivered via telemedicine for this patient population.DiscussionThis study is the first attempt to deliver family-based treatment for adolescents with anorexia nervosa via telemedicine. If delivering family-based treatment in this format is feasible, it will provide access to an evidence-based treatment for families heretofore unable to participate in specialist treatment for their child's eating disorder

Bulimia nervosa in adolescents: treatment, eating pathology and comorbidity

Background: Bulimia nervosa (BN) is occurring with increasing frequency among adolescents. Yet, few studies have undertaken to detail the clinical presentation, or investigate different treatments for adolescents with BN. Objective: In this article, we 1) review our current knowledge of BN in adolescents, both in terms of clinical presentation and treatment possibilities, and 2) describe a cohort of adolescent bulimics in terms of eating pathology and comorbidity.Subjects: Twenty-seven consecutive referrals for adolescent BN to The University of Chicago Hospitals are presented here (mean age=16.2 yrs, sd+1.4). These patients are among the first to be evaluated for participation in an ongoing randomized controlled trial of two psychosocial treatments. Measures: Eating pathology was measured with the Eating Disorders Examination (EDE), while the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to establish comorbid psychiatric diagnoses. Results: Our findings indicate that this cohort is quite diverse in terms of ethnicity and family environment. Rates of comorbid depression are much higher in our cohort than in a comparable sample of adult BN. In most other respects, the clinical presentation of BN in our sample of adolescents appears to be similar to that in adults. Conclusion: Comorbidity and adolescent developmental status are two obvious factors that should be taken into account in the evaluation of effective treatments for adolescent BN.South African Psychiatry Review - August 200

Delivery of Family-Based Treatment for Adolescent Anorexia Nervosa in a Public Health Care Setting: Research Versus Non-Research Specialty Care.

Comparing evidence-based psychotherapy (EBP) to usual care typically demonstrates the superiority of EBPs, although this has not been studied for eating disorders EBPs such as family-based treatment (FBT). The current study set out to examine weight outcomes for adolescents with anorexia nervosa who received FBT through a randomized clinical research trial (RCT, n = 54) or non-research specialty care (n = 56) at the same specialist pediatric eating disorder service. Weight was recorded throughout outpatient treatment (up to 18 sessions over 6 months), as well as at 6- and 12-month follow-up. Survival curves were used to examine time to weight restoration [greater than 95% median body mass index (mBMI)] as predicted by type of care (RCT vs. non-research specialty care), baseline clinical and demographic characteristics, and their potential interaction. Results did not indicate a significant main effect for type of care, but there was a significant effect for baseline weight (p = .03), such that weight restoration was achieved faster across both treatment types for those with a higher initial %mBMI. These data suggest that weight restoration achieved in non-research specialty care FBT was largely similar to that achieved in a controlled research trial. Clinical Trial Registration:http://www.anzctr.org.au/, identifier ACTRN12610000216011

Distributed Nonlinear Filtering using Triangular Transport Maps

The distributed filtering problem sequentially estimates a global state variable using observations from a network of local sensors with different measurement models. In this work, we introduce a novel methodology for distributed nonlinear filtering by combining techniques from transportation of measures, dimensionality reduction, and consensus algorithms. We illustrate our methodology on a satellite pose estimation problem from a network of direct and indirect observers. The numerical results serve as a proof of concept, offering new venues for theoretical and applied research in the domain of distributed filtering.Comment: 7 pages, 2 figure

Patterns of expressed emotion in adolescent eating disorders

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135121/1/jcpp12594.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135121/2/jcpp12594_am.pd

Developing Organisms for Consolidated Bioprocessing of Biomass to Ethanol

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Prognostic factors of liver metastases from uveal melanoma

Objectives: This study was designed to assess survival and identify prognostic factors for liver metastases diagnosed by systematic screening in uveal melanoma patients. Methods: Among 602 consecutive patients treated over 10 years for uveal melanoma and followed by systematic semi-annual hepatic screening (abdominal ultrasonography), 63 (10.5%) developed liver metastases; these patients form the basis of this study. Factors including patient demographics, characteristics of the uveal tumor, metastasis-free interval, severity of liver metastatic involvement, and treatments of metastases were studied retrospectively regarding their prognostic value, using univariate (Kaplan-Meier method) and multivariate (Cox model) analyses. Results: Thirty-five patients (55.6% of the metastatic population) received systemic chemotherapy or best supportive care only; 14 patients (22.2% of the metastatic population) diagnosed with diffuse liver involvement had cytoreductive surgery and intra-arterial chemotherapy; 14 (22.2% of the metastatic population) had complete surgical removal of liver metastases followed by postoperative intra-arterial chemotherapy. No significant surgical complications were experienced. The median overall survival after diagnosis of liver metastases was 15 months. It reached 25 months for selected patients with complete resection (P=0.0002). In this cohort of 63 patients, ten or fewer preoperatively diagnosed metastases and primary uveal melanoma not involving the ciliary body were independently associated with better prognosis. Conclusions: This study suggests that selected patients with screened liver metastases from uveal melanoma may benefit from aggressive treatment, including surgery. The two independent favorable prognostic factors are fewer than ten metastases at screening and the absence of ciliary body involvemen

Bilateral rhegmatogenous retinal detachment after external-beam radiotherapy: just a coincidence?

Purpose: To report an unusual case of almost simultaneous bilateral rhegmatogenous retinal detachment in the context of external-beam radiotherapy for a tumor at a non-ocular target site and in the absence of pre-existing ocular pathology. Methods: Observational case report with review of corresponding literature. Results: A 63-year-old man was referred for bilateral retinal detachment which was associated with many horseshoe tears and proliferative vitreoretinopathy. He had undergone surgery for a carcinoma of the left maxillary sinus 4 months prior to the presentation and had then received external-beam radiotherapy for 3 months. There was no familial history of retinal detachment and/or eye trauma in this hyperopic patient with clear native lenses. No chorioretinal pathology was apparent that could have predisposed the retinas to tearing. Conclusions: Simultaneous bilateral retinal detachment is exceptional, especially in a patient with no risk factors. The effect of radiotherapy on the vitreoretinal interface is discussed in the light of existing data and may have been responsible for our patient's retinal detachmen

Computational Optimal Transport and Filtering on Riemannian manifolds

In this paper we extend recent developments in computational optimal transport to the setting of Riemannian manifolds. In particular, we show how to learn optimal transport maps from samples that relate probability distributions defined on manifolds. Specializing these maps for sampling conditional probability distributions provides an ensemble approach for solving nonlinear filtering problems defined on such geometries. The proposed computational methodology is illustrated with examples of transport and nonlinear filtering on Lie groups, including the circle $S^1$, the special Euclidean group $SE(2)$, and the special orthogonal group $SO(3)$.Comment: 6 pages, 7 figure