Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

Background: Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. Methods/design: This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants’ motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs. Discussion: This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified

Superposition of external and internal stress components in γ/γ'-microstructures and their effect on γ-channel dislocations

Glide and climb forces on γ-channel dislocations in γ/γ'-microstructures are calculated considering a simplified scenario involving discrete dislocations. The influence of (i) misfit stresses, (ii) volume fraction of γ'-particles, (iii) the density of channel dislocations and (iv) the external stress is considered. In the approach taken in this study we superimpose misfit stresses from thermo-elastic FEM-calculations with applied stresses and with stresses caused by discrete channel dislocations. The calculations are based on previous mechanical and microstructural results where a number of dislocation reactions were observed using TEM and identified as relevant microstructural elements of the overall mechanism of high temperature and low stress creep. Preliminary results show that in a realistic microstructural scenario there is a limit to the number of dislocations which can enter a γ-channel by glide (in the absence of recovery processes). This number depends on γ'-volume fraction and on γ/γ'-misfit. Moreover it was found that glide and climb forces depend on the position of the dislocation segment in the channel and that there is a general tendency to push dislocations out of the channels

Web-based treatment program using intensive therapeutic contact for patients with eating disorders: Before-after study

Contains fulltext : 116776.pdf (publisher's version ) (Open Access)Background: Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. Objective: This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients with an eating disorder. Methods: In a pre-post design with 6-week and 6-month follow-ups, eating disorder psychopathology, body dissatisfaction, Body Mass Index, physical and mental health, and quality of life were measured. The participant's satisfaction with the web-based treatment program was also studied. Attrition data were collected, and participants were classified as noncompleters if they did not complete all 10 assignments of the web-based treatment program. Differences in baseline characteristics between completers and noncompleters were studied, as well as reasons for noncompletion. Furthermore, differences in treatment effectiveness, treatment adherence, and baseline characteristics between participants of the three major eating disorder diagnostic groups EDNOS (n=115), BN purging (n=24), and BN nonpurging (n=24) were measured. Results: Of the 165 participants who started the web-based treatment program, 89 participants (54%) completed all of the program assignments (completers) and 76 participants (46%) ended the program prematurely (noncompleters). Severe body dissatisfaction and physical and mental health problems seemed to have a negative impact on the completion of the web-based treatment program. Among the participants who completed the treatment program, significant improvements were found in eating disorder psychopathology (F=54.6, df=68, P<.001, d=1.14). Body dissatisfaction, quality of life, and physical and mental health also significantly improved, and almost all of these positive effects were sustained up to 6 months after the participants had completed the web-based treatment program. Body Mass Index improved only within the group of participants suffering from obesity. The improvement in eating disorder psychopathology occurred in all three eating disorder diagnostic groups, and the percentage of completers did not differ significantly between these groups. Participants' satisfaction with the treatment program, as well as with their therapist, was high, and participants indicated that they would recommend the program to other patients with eating disorders. Conclusions: The results of this study suggest that the web-based treatment program has the potential to improve eating disorder psychopathology in patients with different types of eating disorders.15 p

Artificial intelligence for decision support in surgical oncology - a systematic review

Aim: We systematically review current clinical applications of artificial intelligence (AI) that use machine learning (ML) methods for decision support in surgical oncology with an emphasis on clinical translation.Methods: MEDLINE, Web of Science, and CENTRAL were searched on 19 January 2021 for a combination of AI and ML-related terms, decision support, and surgical procedures for abdominal malignancies. Data extraction included study characteristics, description of algorithms and their respective purpose, and description of key steps for scientific validation and clinical translation.Results: Out of 8302 articles, 107 studies were included for full-text analysis. Most of the studies were conducted in a retrospective setting (n = 105, 98%), with 45 studies (42%) using data from multiple centers. The most common tumor entities were colorectal cancer (n = 35, 33%), liver cancer (n = 21, 20%), and gastric cancer (n = 17, 16%). The most common prediction task was survival (n = 36, 34%), with artificial neural networks being the most common class of ML algorithms (n = 52, 49%). Key reporting and validation steps included, among others, a complete listing of patient features (n = 95, 89%), training of multiple algorithms (n = 73, 68%), external validation (n = 13, 12%), prospective validation (n = 2, 2%), robustness in terms of cross-validation or resampling (n = 89, 83%), treatment recommendations by ML algorithms (n = 9, 8%), and development of an interface (n = 12, 11%).Conclusion: ML for decision support in surgical oncology is receiving increasing attention with promising results, but robust and prospective clinical validation is mostly lacking. Furthermore, the integration of ML into AI applications is necessary to foster clinical translation

Modification by N-acetyltransferase 1 genotype on the association between dietary heterocyclic amines and colon cancer in a multiethnic study

OBJECTIVE: Colorectal cancer incidence is greater among African Americans, compared to whites in the U.S., and may be due in part to differences in diet, genetic variation at metabolic loci, and/or the joint effect of diet and genetic susceptibility. We examined whether our previously reported associations between meat-derived heterocyclic amine (HCA) intake and colon cancer were modified by N-acetyltransferase 1 (NAT1) or 2 (NAT2) genotypes and whether there were differences by race. METHODS: In a population-based, case-control study of colon cancer, exposure to HCAs was assessed using a food-frequency questionnaire with a meat-cooking and doneness module, among African Americans (217 cases and 315 controls) and whites (290 cases and 534 controls). RESULTS: There was no association with NAT1*10 versus NAT1-non*10 genotypes for colon cancer. Among whites, there was a positive association for NAT2-“rapid/intermediate” genotype [odds ratio (OR)= 1.4; 95% confidence interval (CI)=1.0, 1.8], compared to the NAT2-“slow” that was not observed among African Americans. Colon cancer associations with HCA intake were modified by NAT1, but not NAT2, regardless of race. However, the “at-risk” NAT1 genotype differed by race. For example, among African Americans, the positive association with 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) was confined to those with NAT1*10 genotype (OR=1.8; 95% CI=1.0, 3.3; P for interaction=0.02, comparing highest to lowest intake), but among whites, an association with 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) was confined to those with NAT1-non*10 genotype (OR=1.9; 95% CI=1.1, 3.1; P for interaction=0.03). CONCLUSIONS: Our data indicate modification by NAT1 for HCA and colon cancer associations, regardless of race. Although the at-risk NAT1 genotype differs by race, the magnitude of the individual HCA-related associations in both race groups are similar. Therefore, our data do not support the hypothesis that NAT1 by HCA interactions contribute to differences in colorectal cancer incidence between African Americans and whites