Internet-based self-help for schizophrenia – risks and chances

Purpose: Schizophrenia is a severe mental disorder which is accompanied by an enormous individual and societal burden. Despite established efficacy of cognitive behavioral therapy (CBT) for schizophrenia, its dissemination into routine mental health care remains poor. Internet-based cognitive behavioral therapy in a self-help format helps to narrow the treatment gap in many mental disorders. Are Internet-based self-help programs, which are based on the principles of CBT, also feasible and viable for patients with schizophrenia? Methods: Mental health professionals (target N=50) as well as individuals with schizophrenia spectrum disorders (target N=50) reported their opinion regarding potential chances and risks of Internet-based self-help for schizophrenia in an online survey. Results: The preliminary data analysis of n=30 health professionals revealed a general acceptance of Internet-based programs for schizophrenia (53% acceptable, 47% acceptable after empirical evaluation) and specific contraindications (e.g., severe psychotic symptoms; 73%). People with schizophrenia highlighted the attractiveness of self-help interventions due to a wish for empowerment and for opportunities to strengthen self-efficacy. Conclusions: Risks, limitations and chances of Internet-based programs for patients with schizophrenia will be discussed.

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

A sorrow shared is a sorrow halved? Internet-based group therapy versus individual therapy for social anxiety disorder: A randomized controlled trial

Purpose: Social anxiety disorder is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. The present study aims at investigating the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD. Methods: A total of 150 adults with a diagnosis of SAD are randomly assigned to either a wait-list control group or one of two active treatment conditions. Participants in the two active conditions use the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of 6 individuals. In the group condition, participants communicate with each other via an integrated, protected discussion forum. The primary outcome variables are symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at 6-month follow-up. Secondary endpoints are general symptomatology, depression, quality of life and adherence to treatment. Furthermore, process variables such as group processes and the working alliance are studied. Results: Results are currently being analyzed. Results at post-treatment will be presented and discussed. Potential moderating and mediating variables of treatment success will be addressed. Conclusion: The results of this study should indicate whether therapist-guided group support could enhance the efficacy of an internet based self-help treatment for SAD. This novel treatment format, if shown efficacious, could represent a cost-effective option and could be further modified to treat other conditions.

Fibrilación auricular y terapéutica anticoagulante

La fibrilación auricular es la taquiarritmia más frecuente en la población general. La frecuencia de dicha arritmia aumenta con la edad, presentándose en un 1.5% de los 50 a 59 años a 8-10% de los 80 a 89 años. La fibrilación auricular incrementa el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico en 5 veces y causa el 15% de todos los accidentes cerebrovasculares isquémicos. El manejo de la fibrilación auricular se enfoca, principalmente, en la prevención de los fenómenos tromboembólicos y en el control de la frecuencia y ritmo cardiaco. La anticoagulación, ha demostrado ser la principal herramienta en la prevención de eventos cardioembólicos. Aunque las complicaciones hemorrágicas por el tratamiento son esperables, y aumentan con la edad, sobrepasa por mucho, el beneficio de usar anticoagulación, al riesgo de sangrados. Precisamente debido a la heterogeneidad clínica de esta arritmia y a la dificultad de establecer un tratamiento adecuado para cada caso en particular, el American College of Cardiology, la American Heart Association, la European Society of Cardiology y el American College of Chest Physicians han establecido unas guías para mejorar el manejo de los pacientes. La revisión de esta patología y de estas directrices propuestas pueden facilitar y mejorar notablemente el tratamiento de los pacientes con fibrilación auricular.

Hemodynamic performance of different stent strategies for coronary bifurcations. Evaluation with a mathematical model

Purpose: Best percutaneous treatment strategy for lesions in coronary bifurcations is an ongoing subject of debate. There is limited data that analyses the effect of the different bifurcation strategies on coronary flow. Our aim is to evaluate the influence of different bifurcation stenting strategies on hemodynamic parameters, both in the main vessel (MV) and side branch (SB).

Supplementarity measures on fuzzy sets.

In this paper, we commence the study of the so called supplementarity measures. They are introduced axiomatically and are then related to incompatibility measures by antonyms. To do this, we have to establish what we mean by antonymous measure. We then prove that, under certain conditions, supplementarity and incompatibility measuresare antonymous. Besides, with the aim of constructing antonymous measures, we introduce the concept of involution on the set made up of all the ordered pairs of fuzzy sets. Finally, we obtain some antonymous supplementarity measures from incompatibility measures by means of involutions.

A robust numerical framework for the analysis of material failure of fibre reinforced soft tissue

In this work, robustness and stability of continuum damage models applied to material failure in soft tissues are addressed. In the implicit damage models equipped with softening, the presence of negative eigenvalues in the tangent elemental matrix degrades the condition number of the global matrix, leading to a reduction of the computational performance of the numerical model. Two strategies have been adapted from literature to improve the aforementioned computational performance degradation: the IMPL-EX integration scheme [Oliver,2006], which renders the elemental matrix contribution definite positive, and arclength-type continuation methods [Carrera,1994], which allow to capture the unstable softening branch in brittle ruptures. The IMPL-EX integration scheme has as a major drawback the need to use small time steps to keep numerical error below an acceptable value. A convergence study, limiting the maximum allowed increment of internal variables in the damage model, is presented. Finally, numerical simulation of failure problems with fibre reinforced materials illustrates the performance of the adopted methodology.

Simulating improved combinations tillage-rotation under dryland conditions.

The adequate combination of reduced tillage and crop rotation could increase the viability of dry land agriculture in Mediterrenean zones. Crop simulation models can support to examine various tillage-rotation combinations and explore management scenarios. The decision support system for agrotechnology transfer (DSSAT) (Hoogenboom et al., 2010) provides a suite of crop models suitable for this task. The objective of this work was to simulate the effects of two tillage systems, conventional tillage (ConvT) and no tillage (NoT), and three crop rotations, continuous cereal (CC), fallow-cereal (FallowC) and legume-cereal (LegumeC), under dry conditions, on the cereal yield, soil organic carbon (SOC) and nitrogen (SON) in a 15-year experiment, comparing these simulations with field observations.

About t-norms on type-2 fuzzy sets.

Walker et al. defined two families of binary operations on M (set of functions of [0,1] in [0,1]), and they determined that, under certain conditions, those operations are t-norms (triangular norm) or t-conorms on L (all the normal and convex functions of M). We define binary operations on M, more general than those given by Walker et al., and we study many properties of these general operations that allow us to deduce new t-norms and t-conorms on both L, and M.

A low-mass impact sensor for high-speed firmness sensing of fruits.

A low-mass impact sensor for high-speed firmness sensing of fruits was built and tested. Results of tests with a rubber ball indicated that the impact measurement was not sensitive to the distance between the impactor and the impacting surface of the sample within the range of 8 to 23 mm, and was not sensitive to how the sample was held. Tests with kiwifruits and peaches show good correlation between firmness readings obtained with the impact sensor and those obtained with the penetrometer. The best correlation was between the slope of the impact curve (at mid-point) and the force-deformation firmness. Preliminary test showed that the sensor could sense fruit firmness at a speed of 5 fruits/s.

Sensing colour stability and mixtures of powder paprika using optical reflectance and image analysis.

The production and industry of paprika present several problems related to quality and to production costs. One of the main difficulties is to obtain an objective and quick method for predicting quality. Quality in powder paprika involves: quantity of carotenoids and the appearance and stability of colour. The method used currently for determining quality is the measurement of absorbance at 460 nm wavelength, of an acetone extract of carotenoids, but there is no information about the appearance of the paprika or the stability of its colour with time. " Another important problem is the presence of mixtures of powdered paprika produced in the Spanish region of "La Vera", which has a peculiar way of production, with a high '' quality and price, with other products of lower quality. It is necessary to obtain methods which are able to detect the fraud.

Effect of impacting radius of curvature on firmness sensing of fruits in a sorting system.

Fruits of two varieties of both apples and pear were tested to measure their response to small energy impact applied by a impact tester with two spherical tips of different radious of curvature ( RA = 2.48 cm and RB = 0.98 cm) and equal mass were used. In the four varieties studied, the size of bruise was smaller with a spherical tip RA than with tip RB . The non-destructive impact test would cause less damage with a spherical impactor with a radious bigger than 0.98 cm.

Study of packing lines for stone fruits and citrus using two instrumented spheres in some cooperatives in the region of Murcia (Spain).

Two instrumented spheres IS 100 were used to evaluate the quality of post-harvest operations. Results obtained from measurements made with both IS (8.8 cm 0 and 6.2 cm 0) show significant differences. Both IS measure the same values of the same variables for soft materials, but not for hard surfaces. Four packing lines belonging to different cooperatives of the region of Murcia (two for stone fruits and two for citrus) were tested. IS values obtained in transfers belonging to the tested lines lay well above 50 g's in most of them Much higher impact intensities are registered in citrus lines than in stone fruit packing lines. To study the incidence of a certain packing line on different products an interaction fruit-packing line test was perf01med. In all cases, more than 50% of fruits belonging to the post-handling sample showed some kind of damage. Bruises evolve after 48 hours storage at room temperature.

Objective optical classifier for tobacco leaves.

The main objective of the current research was to search the optimum method to segregate the most frequent color commercial quality classes of tobacco leaves (c.v. "Virginia"). These color classes cover the whole continuous color scale, between "Pale Lemon" and "Oxidated Brown". With the usual expert classification there exists a significant level of uncertainty . Within this research, several methods for data discrimination were tested, in order to solve uncertainty. Classification errors below 5% were obtained with this proposed classifier along two different seasons (1994&1995).

Identification procedure of mealy apples by instrumental means. Extraction of storage features.

Mealiness is a negative attribute of sensory texture that combines the sensation of a disaggregated tissue with the sensation of lack of juiciness. Since January 1996, a wide EC Project entitled : "Mealiness in fruits. Consumers perception and means for detection'" is being carried out. Within it, three sensory panels have been trained at : the Institute of Food Research (IFR, United Kingdom), the Instituto de Agroquímica y Tecnología de los Alimentos (IATA, Spain) and the Institut voor Agrotechnologisch Onderzoek (ATO-DLO, Netherlands) to assess mealiness in apples. In all three cases, mealiness has been described as a multidimensional sensory descriptor capable of gathering the loss of consistency (of crispness and of hardness) and of juiciness. Also within the EC Project several instrumental procedures have been tested for mealiness assessment. In this sense the Physical Properties Laboratory (ETS1A-UPM) has focused its aims in a first stage on performing instrumental tests for assessing some textural descriptors as crispiness, hardness and juiciness. The results obtained within these tests have shown to correlate well with the sensory measurements (Barreiro et Ruiz-Altisent, 1997) in apples, but also have succeed when trying to generate several texture degradation levels on peaches from which mealiness appears to be the last stage (Ortiz et al. 1997).