Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression

BackgroundInnovative moments (IMs), defined as moments in psychotherapy when patients’ problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement.MethodsThe therapy transcripts of n = 10 patients with mild to moderate depression (range: 7–11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models.ResultsThe rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R$^{2}$ = 0.05, p = 0.01).DiscussionThe results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments

Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression.

BACKGROUND Innovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement. METHODS The therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models. RESULTS The rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R2 = 0.05, p = 0.01). DISCUSSION The results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments

Entwicklung von Rückbau- und Recyclingstandards für Rotorblätter : Abschlussbericht [Kurztitel: Aufbereitung von Rotorblättern]

Als Ergebnis der breiten politischen Befürwortung für die Energiewende und des stetig wachsenden Bestands an Windenergieanlagen (WEA) in Deutschland und Europa gewinnen Fragen der Wartung, Laufzeitverlängerung sowie des Anlagenrückbaus und Recyclings an Bedeutung. Eine besondere Herausforderung stellt dabei das Rotorblattrecycling mit ihren glasfaserverstärkten (GFK) und carbonfaserverstärkten (CFK) Anlagenteilen dar. Die für diese Materialien existierenden Recyclingprozesse haben sich noch nicht durchgesetzt und der Wiedereinsatz der recyclierten Materialien ist in der Breite nicht etabliert. Weiterhin mangelt es an Standards für die Demontage und werkstoffliche Aufbereitung dieser Materialien. Zentraler Forschungsgegenstand war die Entwicklung von Standards für eine möglichst hochwertige und gleichzeitig wirtschaftlich zumutbare Aufbereitungs- und Behandlungsstrategie für Rotorblätter. Ausgehend von den zu erwartenden Abfallmengen und - arten und des speziellen Aufbaus und der Zusammensetzung der verschiedenen Rotorblätter wurde ein vollständiges und schlüssiges Konzept für deren Wartungen, Reparatur, Demontage, Vorzerkleinerung und Aufbereitung erarbeitet. Darauf basierend wurde die Organisationsverantwortung aus rechtlicher Sicht geprüft und mögliche erforderlicher, ergänzender materiell-rechtlicher Vorgaben vorgeschlagen. Auch Elemente der abfallwirtschaftlichen Produktverantwortung wurden auf Zweckmäßigkeit geprüft und bewertet. Die Studie beschreibt damit ein erstes umfassendes technisches, rechtliches und organisatorisches Recyclingkonzept für Rotorblätter

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Mikrowellenpyrolyse von carbonfaserhaltigen Kunststoffen als Recyclingoption

Challenges in establishing a circular economy of carbon-fiber-reinforced plastics (CFRP) arise in particular from the necessary but problematic separation of the fiber from the matrix. The pyrolysis process is a possible technology for composite separation that has already been industrially implemented. A further development is microwave-assisted pyrolysis, in which the CFRP material is heated by the microwaves to expose the fiber. Process fundamentals and influences on fiber-matrix separation are considered in this article

A holistic approach to use multi-scale fractions of dry carbon fibre production waste in filled Bulk Moulding Compounds (BMC)

The increasing demand for composites leads to a growing amount of end-of-life materialand production waste. The latter consists of a large fraction of unimpregnated fibre waste which is notsufficiently reprocessed using conventional textile processing procedures as they are either too expensiveor their mechanical performance is too low. Using pieces of dry non-crimp fabrics (patches) ina Bulk Moulding Compound process (BMC) displays a straightforward approach of fabric recycling.Adding fillers to the mixture not only offers the opportunity to modify mechanical and electrical propertiesas well as the costs but also a chance for a more holistic approach of dry fibre recycling, whenconventional fillers like chalk are replaced by ground recycled carbon fibres. In this way, all kindof dry fibre wastes can be reused in one process: Larger offcuts are chopped to smaller rectangularpatches whereas waste fractions of small offcuts are processed to carbon fibre powder as filler andprocessed together with resin to produce BMC materials. Mechanical investigations reveal that thepresented approach shows higher specific properties than the conventional filler without compromisingthe process and material quality.</jats:p

3D-printed LEGO®-inspired titanium scaffolds for patient-specific regenerative medicine

Despite the recent advances in 3D-printing, it is often difficult to fabricate implants that optimally fit a defect size or shape. There are some approaches to resolve this issue, such as patient-specific implant/scaffold designs based on CT images of the patients, however, this process is labor-intensive and costly. Especially in developing countries, affordable treatment options are required, while still not excluding these patient groups from potential material and manufacturing advances. Here, a selective laser melting (SLM) 3D-printing strategy was used to fabricate a hierarchical, LEGO®-inspired Assemblable Titanium Scaffold (ATS) system, which can be manually assembled in any shape or size with ease. A surgeon can quickly create a scaffold that would fit to the defect right before the implantation during the surgery. Additionally, the direct inclusion of micro- and macroporous structures via 3D-printing, as well as a double acid-etched surface treatment (ST) in the ATS, ensure biocompatibility, sufficient nutrient flow, cell migration and enhanced osteogenesis. Three different structures were designed (non-porous:NP, semi-porous:SP, ultra-porous:UP), 3D-printed with the SLM technique and then surface treated for the ST groups. After analyzing characteristics of the ATS such as printing quality, surface roughness and interconnected porosity, mechanical testing and finite element analysis (FEA) demonstrated that individual and stacked ATS have sufficient mechanical properties to withstand loading in a physiological system. All ATS showed high cell viability, and the SP and UP groups demonstrated enhanced cell proliferation rates compared to the NP group. Furthermore, we also verified that cells were well-attached and spread on the porous structures and successful cell migration between the ATS units was seen in the case of assemblies. The UP and SP groups exhibited higher calcium deposition and RT-qPCR proved higher osteogenic gene expression compared to NP group. Finally, we demonstrate a number of possible medical applications that reveal the potential of the ATS through assembly.ISSN:2772-9508ISSN:2772-951

Effect of evening postexercise cold water immersion on subsequent sleep

PURPOSE: This study investigated the effect of cold water immersion after evening exercise on subsequent sleep quality and quantity in trained cyclists. METHODS: In the evenings (~1900 h) on three separate occasions, male cyclists (n = 11) underwent either no exercise (control, CON), exercise only (EX), or exercise followed by cold water immersion (CWI). EX comprised cycling for 15 min at 75% peak power, then a 15-min maximal time trial. After each condition, a full laboratory-based sleep study (polysomnography) was performed. Core and skin temperature, heart rate, salivary melatonin, ratings of perceived fatigue, and recovery were measured in each trial. RESULTS: No differences were observed between conditions for any whole night sleep measures, including total sleep time, sleep efficiency, sleep onset latency, rapid eye movement onset latency, wake after sleep onset, or proportion of the night spent in different sleep stages. Core temperature in EX and CWI trials was higher than CON, until it decreased below that of EX and CON until bedtime in CWI. After bedtime, core temperature was similar for all conditions throughout the night, except for a 90-min period where it was lower for CWI than EX and CON (3.5-4.5 h postexercise). Heart rates for EX and CWI were both significantly higher than CON postexercise until bedtime, whereas skin temperature after CWI was significantly lower than EX and CON, remaining lower than EX until 3 h postexercise. Melatonin levels and recovery ratings were similar between conditions. Fatigue ratings were significantly elevated after exercise in both CWI and EX conditions, with EX still being elevated compared with CON at bedtime. CONCLUSION: Whole night sleep architecture is not affected by evening exercise alone or when followed by CWI. Copyright © 2013 by the American College of Sports Medicine