The EVIDENT-trial: protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention

BACKGROUND: Depressive disorders are among the leading causes of worldwide disability with mild to moderate forms of depression being particularly common. Low-intensity treatments such as online psychological treatments may be an effective way to treat mild to moderate depressive symptoms and prevent the emergence or relapse of major depression. METHODS/DESIGN: This study is a currently recruiting multicentre parallel-groups pragmatic randomized-controlled single-blind trial. A total of 1000 participants with mild to moderate symptoms of depression from various settings including in- and outpatient services will be randomized to an online psychological treatment or care as usual (CAU). We hypothesize that the intervention will be superior to CAU in reducing depressive symptoms assessed with the Personal Health Questionnaire (PHQ-9, primary outcome measure) following the intervention (12 wks) and at follow-up (24 and 48 wks). Further outcome parameters include quality of life, use of health care resources and attitude towards online psychological treatments. DISCUSSION: The study will yield meaningful answers to the question of whether online psychological treatment can contribute to the effective and efficient prevention and treatment of mild to moderate depression on a population level with a low barrier to entry. TRIAL REGISTRATION: Trial Registration Number: NCT01636752.

Factors contributing to the attrition of women in the African-American Nutrition for Life study

Background. There is currently a push to increase the number of minorities in cancer clinical trials in an effort to reduce cancer health disparities. Overcoming barriers to clinical trial research for minorities is necessary if we are to achieve the goals of Healthy People 2010. To understand the unexpectedly high rate of attrition in the A NULIFE study, the research team examined the perceived barriers to participation among minority women. The purpose of this study was to determine if either personal or study-related factors influenced healthy pre-menopausal women aged 25-45 years to terminate their participation in the A NULIFE Study. We hypothesized that personal factors were the driving forces for attrition rates in the prevention trial.^ Methods. The target population consisted of eligible women who consented to the A NULIFE study but withdrew prior to being randomized (N= 46), as well as eligible women who completed the informed consent process for the A NULIFE study and withdrew after randomization (N= 42). Examination of attrition rates in this study occurred at a time point when 10 out of 12 participant groups had completed the A NULIFE study. Data involving the 2 groups that were actively engaged in study activities were not used in this analysis. A survey instrument was designed to query the personal and study-related factors that were believed to have contributed to the decision to terminate participation in the A NULIFE study.^ Results. Overall, the highest ranked personal reason that influenced withdrawal from the study was being “too busy” with other obligations. The second highest ranked factor for withdrawal was work obligations. Whereas, more than half of all participants agreed that they were well-informed about the study and considered the study personnel to be approachable, 54% of participants would have been inclined to remain in the study if it were located at a local community center.^ Conclusions. Time commitment was likely a major factor for withdrawal from the A NULIFE study. Future investigators should implement trials within participant communities where possible. Also, focus group settings may provide detailed insight into factors that contribute to the attrition of minorities in cancer clinical trials.^

Bayesian inference and its application to meta-analysis of epidemiologic data

In Part One, the foundations of Bayesian inference are reviewed, and the technicalities of the Bayesian method are illustrated. Part Two applies the Bayesian meta-analysis program, the Confidence Profile Method (CPM), to clinical trial data and evaluates the merits of using Bayesian meta-analysis for overviews of clinical trials.^ The Bayesian method of meta-analysis produced similar results to the classical results because of the large sample size, along with the input of a non-preferential prior probability distribution. These results were anticipated through explanations in Part One of the mechanics of the Bayesian approach. ^

The feasibility of self-report advance directives among elderly patients with cognitive impairment

The central objective of this dissertation was to determine the feasibility of self-completed advance directives (AD) in older persons suffering from mild and moderate stages of dementia. This was accomplished by identifying differences in ability to complete AD among elderly subjects with increasing degrees of dementia and cognitive incompetence. Secondary objectives were to describe and compare advance directives completed by elders and identified proxy decision makers. Secondary objectives were accomplished by measuring the agreement between advance directives completed by proxy and elder, and comparing that agreement across groups defined by the elder's cognitive status. This cross-sectional study employed a structured interview to elicit AD, followed by a similar interview with a proxy decision maker identified by the elder. A stratified sampling scheme recruited elders with normal cognition, mild, and moderate forms of dementia using the Mini Mental-State Exam (MMSE). The Hopkins Competency Assessment Test (HCAT) was used for evaluation of competency to make medical decisions. Analysis was conducted on "between group" (non-demented $\leftrightarrow$ mild dementia $\leftrightarrow$ moderate dementia, and competent $\leftrightarrow$ incompetent) and "within group" (elder $\leftrightarrow$ family member) variation.^ The 118 elderly subjects interviewed were generally male, Caucasian, and of low socioeconomic status. Mean age was 77. Overall, elders preferred a "trial of therapy" regarding AD rather than to "always receive the therapy". No intervention was refused outright more often than it was accepted. A test-retest of elders' AD revealed stable responses. Eleven logic checks measured appropriateness of AD responses independent of preference. No difference was found in logic error rates between elders grouped by MMSE or HCAT. Agreement between proxy and elder responses showed significant dissimilarity, indicating that proxies were not making the same medical decisions as the elders.^ Conclusions based on these data are: (1) Self reporting AD is feasible among elders showing signs of cognitive impairment and they should be given all opportunities to complete advance directives, (2) variation in preferences for advance directives in cognitively impaired elders should not be assumed to be the effects of their impairment alone, (3) proxies do not appear to forego life-prolonging interventions in the face of increasing impairment in their ward, however, their advance directives choices are frequently not those of the elder they represent. ^

Local variability of serotinous cones in a Canary Island pine (Pinus canariensis) stand

The endemic Canary Island pine (Pinus canariensis) has an effective strategy to counteract fire disturbance in the short term. It has a mixed strategy that combines the presence of serotinous cones and thick barks with the ability to re-sprout from the trunk after a fire, a rare trait in pine species. High frequency of fires in the Canary Islands is related to human action, as natural fires by lightning or vulcan activity have very low frequency; hence, the how and whys of the presence of serotinous cones in the species is still a topic of debate. Previous studies showed that the frequency of serotinous cones varies from stand to stand. Here, we analyzed the presence of serotinous cones at a local scale. We selected a Canary Island pine stand in the transition zone between dry and humid forests in the south of Tenerife. Branches were pruned from 20 trees in order to evaluate the presence of serotinous vs. non-serotinous cones by direct verticile counting on the branches. The opening temperature of serotinous cones was assessed in the laboratory. Percentages of serotinous vs. non-serotinous cones varied from 0 to 93 %, showing high variability between trees. Opening temperatures were very high (above 65 ºC) as compared to other Mediterranean pine species with serotinous cones

Principales efectos de la aplicación de una metodología destinada a inducir la muda en ponedoras comerciales sobre su producción cuantitativa y cualitativa durante el segundo ciclo de puesta

En la presente Tesis Doctoral se ha estudiado el efecto de una metodología para inducir la muda en dos estirpes de gallinas ponedoras comerciales, una ligera y otra semipesada, mediante el suministro de tres alimentos: salvado de trigo, cebada en grano y un pienso comercial de ponedoras aportado en cantidad restringida. Se realizaron dos pruebas en dos lotes diferentes de gallinas. En la primera de ellas se utilizaron 472 animales (236 de cada estirpe) alojados en jaulas con cuatro o seis gallinas por jaula, con una estructura factorial 2 x 3 x 2 (2 estirpes, 3 alimentos, 2 densidades) y una duración total de 32 semanas (4 de muda y 28 de producción posmuda). En la segunda prueba fueron 432 animales los utilizados (216 de cada estirpe), alojados en grupos de cuatro aves por jaula, con una estructura factorial 2 x 3 (2 estirpes, 3 alimentos) y una duración de 27 semanas (4 de muda y 23 de producción postmuda). En los dos experimentos realizados se estudió el efecto del uso de los alimentos citados para inducir de la muda sobre los resultados cuantitativos: pérdida de peso vivo durante la muda e intensidad de puesta, peso medio del huevo y masa de huevo diaria, durante y después de la muda, así como la distribución de la puesta en clases comerciales durante el segundo ciclo de puesta. Así como sobre los resultados cualitativos después de la muda: color de la cáscara de los huevos morenos, espesor de la cáscara, peso específico del huevo, altura del albumen, unidades Haugh y color de la yema. En la primera prueba se estudió, además, el efecto que la inducción de la muda mediante los tres alimentos considerados tuvo sobre la regresión del aparato reproductor de las gallinas durante este período de muda. En el primer experimento se observaron diferencias entre estirpes. Las gallinas ligeras tuvieron una más rápida regresión del aparato reproductor (ovario+oviducto) (P=0,003) que las semipesadas, aunque la regresión total no presentó diferencias significativas. Las gallinas semipesadas tuvieron mejores resultados después de la muda en intensidad de puesta (P<0,0001), en peso medio del huevo (P<0,0001) y en masa de huevo diaria (P=0,0002). También hubo diferencias significativas para las variables cualitativas espesor de la cáscara (mayor en huevos de gallinas semipesadas) mientras que los huevos procedentes de gallinas ligeras presentaron mejores valores de altura del albumen, de unidades Haugh y de color de yema; todas estas variables tuvieron un nivel de significación P<0,0001. El suministro restringido de pienso dio lugar a un mayor porcentaje de pérdida de peso vivo (P<0,0001) aunque la regresión de los órganos del aparato reproductor fue la más baja (P<0,003), no habiéndose encontrado diferencias entre los otros dos alimentos utilizados. Con este alimento también fue más lenta (P<0,0001) la disminución de la puesta durante la muda, aunque fue mayor la producción durante el segundo ciclo (P<0,0001). La única variable cualitativa afectada fue el espesor de cáscara (P<0,0001), con valores más altos en los huevos producidos por las gallinas mudadas con cebada. Los grupos de seis gallinas por jaula produjeron más huevos durante la muda (P<0,0001) aunque después de ésta la densidad de animales no tuvo efecto significativo, como tampoco lo hubo sobre los parámetros de calidad del huevo. En la segunda prueba las gallinas semipesadas experimentaron un menor porcentaje de pérdida de peso corporal (P<0,01) pero tuvieron mayores índices de puesta (P<0,001) y de huevos clasificables (P<0,001) durante la muda. En cambio, durante el segundo ciclo de producción las gallinas ligeras produjeron más huevos (P=0,0041), de menor peso (P<0,02) y con menor consumo de pienso (P<0,001). Los huevos puestos por las gallinas semipesadas tuvieron mayor espesor de cáscara y mayor color de yema, pero peor calidad de albumen (P<0,0001). La mayor pérdida de peso la experimentaron las gallinas mudadas con salvado (P<0,02). La producción durante la muda fue mayor (P<0,001) en las gallinas que consumieron pienso en cantidad restringida y también fueron las que tuvieron menor intensidad de puesta (P<0,006) y masa de huevo diaria (P<0,042) durante el segundo ciclo. El tratamiento de muda no tuvo efecto significativo sobre la calidad del huevo en esta segunda prueba. La principal conclusión que merece destacarse es que es posible inducir la muda a las gallinas ponedoras utilizando alimentos bajos en energía o en proteína, o altos en fibra, con un porcentaje de pérdida de peso vivo no tan alta como las recomendaciones tradicionales, y alcanzar buenos resultados productivos, tanto cuantitativos como cualitativos, durante el segundo ciclo de puesta. ABSTRACT Present Doctoral Thesis has studied the effect of a methodology to induce molting in two strains of commercial laying hens, one light and another semi-heavy one, through the provision of three feed: wheat bran, barley grain and a commercial laying hens feed provided in limited quantity. Two tests were performed in two different lots of layers. In the first 472 animals were used (236 of each strain) housed in cages with four or six hens per cage, with a structure 2 x 3 x 2 factorial (2 strains, 3 meals, 2 densities) and a total duration of 32 weeks (4 of molt and 28 of postmolting). In the second test 432 animals were used (216 each strain), housed in groups of four birds per cage, with a structure factorial 2 x 3 (2 strain, 3 meals) along 27 weeks (4 of molt and 23 of postmolting). In both experiments, we studied the effect of the use of above mentioned foods to induce molting on the quantitative results: body weight lost during the molt and laying index, average egg weight and egg mass daily during and after the molt, as well as on grading in commercial classes during the second laying cycle. As well as on qualitative outcomes after the molt: colour of Brown eggsshell, shell thickness, specific density, albumen height, Haugh units and yolk colour. In the first test was studied, in addition, the effect of induction of molting through the three feed considered on the regression of the reproductive tract of hens during molting period. In the first experiment, differences between strains were observed. Light hens had a faster regression of the reproductive tract (ovary+oviduct) (P=0,003) than semi-heavy hens, although the total regression did not present significant differences. Semi-heavy hens had better outcomes after the molt in laying index (P<0.0001), in average egg weight (P<0.0001) and daily egg mass (P=0, 0002). There were also significant differences for the qualitative variables (higher in semi-heavy hen eggs) as shell thickness while light chicken eggs showed better values of albumen height, Haugh units and yolk color; all these variables had the same level of significance (P<0.0001). Restricted supply of layer feed resulted in a greater percentage of live weight loss (P<0.0001) although the regression of the reproductive organs was the lowest (P<0.003), having not found differences between the other two feed used. With this food decreasing of laying during molting period was also slower (P<0.0001), although production was higher during the second cycle (P < 0.0001). The only qualitative variable affected was shell thickness (P<0.0001), with higher values in the eggs produced by hens molted with barley. Groups of six hens per cage produced more eggs during the moult (P<0.0001) but after this animal density had no significant effect, as neither had it on egg quality parameters. In the second trial hens semi-heavy experienced a lower percentage of body weight loss (P<0.01) but had higher rates of egg production (P<0.001) and of grading eggs (P<0.001) during the moult. On the other hand, during the second production cycle light hens produced more eggs (P=0,0041), of lower weight (P < 0.02) and with less feed intake (P<0.001). Eggs from semi-heavy hens had thicker shell and greater color yolk, but poorer quality of albumen (P<0.0001). The greater weight loss was experimented by the hens molted with wheat bran (P=0.02). Production during molting period was greater (P<0.001) in hens which consumed feed in restricted quantities and were also less the laying index (P=0.006) and daily egg mass (P=0.042) during the second cycle. The molting treatment had no significative effect on the quality of the egg in this second test. The main conclusion that deserves to stand out is that it is possible to induce molting hens using foods low in energy or in protein or high in fiber, with a percentage of live weight loss not as high as the traditional recommendations, and achieve good productive, both quantitative and qualitative results during the second implementation cycle.

Development of a sensorimotor algorithm able to deal with unforeseen pushes and its implementation based on VHDL

Development of a Sensorimotor Algorithm Able to Deal with Unforeseen Pushes and Its Implementation Based on VHDL is the title of my thesis which concludes my Bachelor Degree in the Escuela Técnica Superior de Ingeniería y Sistemas de Telecomunicación of the Universidad Politécnica de Madrid. It encloses the overall work I did in the Neurorobotics Research Laboratory from the Beuth Hochschule für Technik Berlin during my ERASMUS year in 2015. This thesis is focused on the field of robotics, specifically an electronic circuit called Cognitive Sensorimotor Loop (CSL) and its control algorithm based on VHDL hardware description language. The reason that makes the CSL special resides in its ability to operate a motor both as a sensor and an actuator. This way, it is possible to achieve a balanced position in any of the robot joints (e.g. the robot manages to stand) without needing any conventional sensor. In other words, the back electromotive force (EMF) induced by the motor coils is measured and the control algorithm responds depending on its magnitude. The CSL circuit contains mainly an analog-to-digital converter (ADC) and a driver. The ADC consists on a delta-sigma modulation which generates a series of bits with a certain percentage of 1's and 0's, proportional to the back EMF. The control algorithm, running in a FPGA, processes the bit frame and outputs a signal for the driver. This driver, which has an H bridge topology, gives the motor the ability to rotate in both directions while it's supplied with the power needed. The objective of this thesis is to document the experiments and overall work done on push ignoring contractive sensorimotor algorithms, meaning sensorimotor algorithms that ignore large magnitude forces (compared to gravity) applied in a short time interval on a pendulum system. This main objective is divided in two sub-objectives: (1) developing a system based on parameterized thresholds and (2) developing a system based on a push bypassing filter. System (1) contains a module that outputs a signal which blocks the main Sensorimotor algorithm when a push is detected. This module has several different parameters as inputs e.g. the back EMF increment to consider a force as a push or the time interval between samples. System (2) consists on a low-pass Infinite Impulse Response digital filter. It cuts any frequency considered faster than a certain push oscillation. This filter required an intensive study on how to implement some functions and data types (fixed or floating point data) not supported by standard VHDL packages. Once this was achieved, the next challenge was to simplify the solution as much as possible, without using non-official user made packages. Both systems behaved with a series of interesting advantages and disadvantages for the elaboration of the document. Stability, reaction time, simplicity or computational load are one of the many factors to be studied in the designed systems. RESUMEN. Development of a Sensorimotor Algorithm Able to Deal with Unforeseen Pushes and Its Implementation Based on VHDL es un Proyecto de Fin de Grado (PFG) que concluye mis estudios en la Escuela Técnica Superior de Ingeniería y Sistemas de Telecomunicación de la Universidad Politécnica de Madrid. En él se documenta el trabajo de investigación que realicé en el Neurorobotics Research Laboratory de la Beuth Hochschule für Technik Berlin durante el año 2015 mediante el programa de intercambio ERASMUS. Este PFG se centra en el campo de la robótica y en concreto en un circuito electrónico llamado Cognitive Sensorimotor Loop (CSL) y su algoritmo de control basado en lenguaje de modelado hardware VHDL. La particularidad del CSL reside en que se consigue que un motor haga las veces tanto de sensor como de actuador. De esta manera es posible que las articulaciones de un robot alcancen una posición de equilibrio (p.ej. el robot se coloca erguido) sin la necesidad de sensores en el sentido estricto de la palabra. Es decir, se mide la propia fuerza electromotriz (FEM) inducida sobre el motor y el algoritmo responde de acuerdo a su magnitud. El circuito CSL se compone de un convertidor analógico-digital (ADC) y un driver. El ADC consiste en un modulador sigma-delta, que genera una serie de bits con un porcentaje de 1's y 0's determinado, en proporción a la magnitud de la FEM inducida. El algoritmo de control, que se ejecuta en una FPGA, procesa esta cadena de bits y genera una señal para el driver. El driver, que posee una topología en puente H, provee al motor de la potencia necesaria y le otorga la capacidad de rotar en cualquiera de las dos direcciones. El objetivo de este PFG es documentar los experimentos y en general el trabajo realizado en algoritmos Sensorimotor que puedan ignorar fuerzas de gran magnitud (en comparación con la gravedad) y aplicadas en una corta ventana de tiempo. En otras palabras, ignorar empujones conservando el comportamiento original frente a la gravedad. Para ello se han desarrollado dos sistemas: uno basado en umbrales parametrizados (1) y otro basado en un filtro de corte ajustable (2). El sistema (1) contiene un módulo que, en el caso de detectar un empujón, genera una señal que bloquea el algoritmo Sensorimotor. Este módulo recibe diferentes parámetros como el incremento necesario de la FEM para que se considere un empujón o la ventana de tiempo para que se considere la existencia de un empujón. El sistema (2) consiste en un filtro digital paso-bajo de respuesta infinita que corta cualquier variación que considere un empujón. Para crear este filtro se requirió un estudio sobre como implementar ciertas funciones y tipos de datos (coma fija o flotante) no soportados por las librerías básicas de VHDL. Tras esto, el objetivo fue simplificar al máximo la solución del problema, sin utilizar paquetes de librerías añadidos. En ambos sistemas aparecen una serie de ventajas e inconvenientes de interés para el documento. La estabilidad, el tiempo de reacción, la simplicidad o la carga computacional son algunas de las muchos factores a estudiar en los sistemas diseñados. Para concluir, también han sido documentadas algunas incorporaciones a los sistemas: una interfaz visual en VGA, un módulo que compensa el offset del ADC o la implementación de una batería de faders MIDI entre otras.

Random allocation or allocation at random? Patients’ perspectives of participation in a randomised controlled trial

Objectives To explore trial participants’ understandings of randomisation.

A companion to Palgrave's Golden treasury,

"First printed 1917. Reprinted."

Evaluating the effect of splitting cylindrical power on improving patient tolerance to toric lens misalignment

Purpose: Evaluating the impact of splitting toric power on patient tolerance to misorientation such as with intraocular lens rotation. Setting: University vision clinic. Methods: Healthy, non astigmats had +1.50D astigmatism induced with spectacle lenses at 90°, 135°, 180° and +3.00D at 90°. Two correcting cylindrical lenses of the opposite sign and half the power each were subsequently added to the trial frame misaligned by 0°, 5° or 10° in a random order and misorientated from the initial axis in a clockwise direction by up to 15° in 5° steps. A second group of adapted astigmats with between 1.00 and 3.00DC had their astigmatism corrected with two toric spectacle lenses of half the power separated by 0°, 5° or 10° and misorientated from the initial axis in both directions by up to 15° in 5° steps. Distance, high contrast visual acuity was measured using a computerised test chart at each lens misalignment and misorientation. Results: Misorientation of the split toric lenses caused a statistically significant drop in visual acuity (F= 70.341; p< 0.001). Comparatively better acuities were observed around 180°, as anticipated (F= 3.775; p= 0.035). Misaligning the split toric power produced no benefit in visual acuity retention with axis misorientation when subjects had astigmatism induced with a low (F= 2.190, p= 0.129) or high cylinder (F= 0.491, p= 0.617) or in the adapted astigmats (F= 0.120, p= 0.887). Conclusion: Misalignment of toric lens power split across the front and back lens surfaces had no beneficial effect on distance visual acuity, but also no negative effect. © 2013 British Contact Lens Association.

How to Transfer a Coupon-Based Event into a Hedonic Shopping Experience? Retail Branding Implications Based on the Glamour Shopping Days

The paper examines the motivational drivers behind the participation of Hungarian consumers on a special shopping event, also known as Glamour Days. The study encompasses a variety of related conceptualizations such as hedonic/utilitarian shopping values, self-gifting as well as impulsive buying practices. After the introduction of relevant consumer behaviour concepts and theoretical frameworks, the paper presents a qualitative research on adult and adolescent female consumers’ shopping experiences during Glamour Days. By building on phenomenological methodology, this study also portrays the ways this shopping event has changed consumer society within an originally strongly utilitarian attitude driven Hungarian culture. The phenomenological interview results highlight differences within the motivational drivers of pleasure-oriented shopping for the two age groups. For teenagers, the main motivation was related to the utilitarian aspect due to their financial dependence and the special opportunity to stand out of their peer group by joining an event that is exclusively held for adult women. On the other hand, adult women are motivated by combined hedonic and utilitarian values manifested in self gifting and impulse buying within an effectively planned and managed shopping trip. Based on the results, retail specific strategies are provided along with future research directions.

Problem solving competency and the mathematical kangaroo

The goal of the study was to investigate differences in how two groups of students activated mathematical competencies in the mathematical kangaroo (MK). The two groups, group 1 and 2, were identified from a sample of 264 students (grade 7, age 13) through high achievement (top 20 %) in only one of the tests: the MK or a curriculum bounded test (CT). Analysis of mathematical competencies showed that the high achievers in the MK, activated the problem solving competency to a greater extent than the high achievers in the CT, when doing the MK. The results indicate the importance of using non-traditional tests in the assessment process of students to be able to find students that might possess good mathematical competencies although they do not show it on curriculum bounded tests.

Determinação da difusividade efetiva de raiz de chicória

Inulin is a fructooligosacharide found in diverse agricultural products, amongst them garlic, banana, Jerusalem artichoke and chicory root. Inulin generally is used in developed countries, as a substitute of sugar and/or fat due to its characteristics of fitting as functional and dietary food. Chicory root is usually used as source and raw material for commercial extration of inulin. The experiments consisted on drying sliced chicory roots based on a factorial experimental design in a convective dryer whose alows the air to pass perpendicularly through the tray. Effective diffusivity (dependent variable) has been determined for each experimental combination of independent variables (air temperature and velocity). The data curves have been fitted by the solution of the second Fick law and Page's model. Effective difusivity varied from 3.51 x 10-10 m² s-1 to 1.036 x 10-10 m² s-1. It is concluded that, for the range of studied values, air temperature is the only statistically significant variable. So, a first order mathematical model was obtained, representing effective diffusivity behavior as function of air temperature. The best drying condition was correspondent to the trial using the highest drying air temperature.

Educação fisica na educação infantil : concepções e praticas de professores

Universidade Estadual de Campinas. Faculdade de Educação Física

Etno Desporto indigena : contribuições da antropologia social a partir da experiencia entre os Kaingang

Universidade Estadual de Campinas . Faculdade de Educação Física