Exposure and response prevention (ERP) therapy, a form of cognitive-behavioral therapy, is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD) for adults and children. It ...is effective for the majority of those who engage in it, but treatment adherence can be challenging for some due to the stress involved in the treatment as well as different life circumstances that arise. To help improve treatment adherence, NOCD, a provider of video teletherapy ERP, identifies those at risk of non-adherence using a prediction algorithm trained on a data set of
N
= 13,809 and provides targeted peer support interventions by individuals (“Member Advocates”) who successfully completed ERP treatment for OCD. Member Advocates, using lived OCD experience as well as experience with ERP, engage at-risk patients through digital messaging to engage, educate, and encourage patients in the early stages of treatment. From June 2022 to August 2022,
N
= 815 patients deemed at risk were reached out to and
n
= 251 responded and engaged with the Member Advocates. In the at-risk patients who engaged, the intervention resulted in a significant mean 30.4% more therapy hours completed compared to those who did not engage. Additionally, engaged patients had greater reductions in OCD severity. These results have implications for how data science, digital interventions, and strategic peer-to-peer communication and support can be combined to enhance the effectiveness of treatment.
Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of ...exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging.
We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment.
The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint.
Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months.
In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Patients from opioid maintenance treatment (OMT) may taper off from opioids during rehab treatment. It is investigated whether this option improves treatment outcomes in particular for those patients ...who are affected by psychiatric or somatic comorbidity, or by social problems.
Multicenter study with 4 rehab units. Patient characteristics and treatment outcomes were collected retrospectively. There were n = 227 patients who were admitted to treatment while still receiving OMT, and n = 156 who were opioid free.
With regard to regular completion of rehab treatment, an interaction was observed between status at admission and diagnosis of affective, neurotic and anxiety disorders, and between status and previous rehab treatment experience. If admitted in an abstinent status, patients who had never entered rehab, and patients with affective or anxiety disorders showed decreased regular completion rates, while they showed increased completion rates if tapered off during treatment. There was no interaction between initial status and acute life crisis (release from prison, homelessness), somatic diagnoses, or number of stabilizing social factors.
Admission while still receiving opiate maintenance could be helpful for patients with psychiatric comorbidity and for patients who had previously been reluctant to enter rehab treatment.
Pulsatile left ventricular assist devices serving as mechanical circulatory support for patients with end-stage heart failure are associated with complications, including bleeding, thromboembolism, ...and infection. Axial-flow pumps might overcome some of these shortcomings. Here we report our experience with long-term application of the DeBakey VAD (MicroMed Technology, Inc, Houston, Tex).
Nine male transplant candidates (37 ± 14 years) with severe hemodynamic compromise (cardiac index, 1.6 ± 0.5 L · min
−1 · m
−2; pulmonary capillary wedge pressure, 27 ± 6 mm Hg) and beginning end-organ failure despite inotropic and intra-aortic balloon pump support received the DeBakey VAD. Clinical outcome was evaluated.
Cumulative support was 7.8 years, and the mean duration of support was 314 ± 75 days (range, 229-438 days). Eight patients were transplanted, and one died from intracerebral bleeding. Peripheral circulation and end-organ function recovered rapidly after implantation. Continuous flow was able to maintain adequate organ perfusion over the long term. Eight patients were discharged during support, with good quality of life. There were no early bleedings, but there were late bleedings in 3 patients caused by excessive anticoagulation and platelet inhibition. Neurologic events occurred in 4 patients. Three patients recovered completely from symptoms, and one had lethal intracerebral bleeding. Because of thrombus formation, the device was exchanged in 4 patients. With increasing experience, thrombolysis was performed in similar situations. All such patients underwent successful transplantation. Hemolysis occurred, with events indicating thrombus formation. Device-related infection was found in one patient.
The DeBakey VAD demonstrated its potential for long-term bridge to transplantation. The risk for thrombus formation needs to be addressed by improvement of pump technology and new strategies for platelet inhibition.
Continuous-time derivative control and adaptive map-based recursive feedback control techniques are used to control chaos in a variety of systems and in situations that are of practical interest. The ...theoretical part of the research includes the review of fundamental concept of control theory in the context of its applications to deterministic chaotic systems, the development of a new adaptive algorithm to identify the linear system properties necessary for control, and the extension of the recursive proportional feedback control technique, RPF, to high dimensional systems. Chaos control was applied to models of a thermal pulsed combustor, electro-chemical dissolution and the hyperchaotic Rossler system. Important implications for combustion engineering were suggested by successful control of the model of the thermal pulsed combustor. The system was automatically tracked while maintaining control into regions of parameter and state space where no stable attractors exist. In a simulation of the electrochemical dissolution system, application of derivative control to stabilize a steady state, and adaptive RPF to stabilize a period one orbit, was demonstrated. The high dimensional adaptive control algorithm was applied in a simulation using the Rossler hyperchaotic system, where a period-two orbit with two unstable directions was stabilized and tracked over a wide range of a system parameter. In the experimental part, the electrochemical system was studied in parameter space, by scanning the applied potential and the frequency of the rotating copper disk. The automated control algorithm is demonstrated to be effective when applied to stabilize a period-one orbit in the experiment. We show the necessity of small random perturbations applied to the system in order to both learn the dynamics and control the system at the same time. The simultaneous learning and control capability is shown to be an important part of the active feedback control.
Metals that are exposed to high pressure hydrogen gas may undergo detrimental failure by embrittlement. Understanding the mechanisms and driving forces of hydrogen absorption on the surface of metals ...is crucial for avoiding hydrogen embrittlement. In this study, the effect of stress-enhanced gaseous hydrogen uptake in bulk metals is investigated in detail. For that purpose, a generalized form of Sievert's law is derived from thermodynamic potentials considering the effect of microstructural trapping sites and multiaxial stresses. This new equation is parametrized and verified using experimental data for carbon steels, which were charged under gaseous hydrogen atmosphere at pressures up to 1000 bar. The role of microstructural trapping sites on the parameter identification is critically discussed. Finally, the parametrized equation is applied to calculate the stress-enhanced hydrogen solubility of thin-walled pipelines and thick-walled pressure vessels during service.
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•Improvement of Sievert's law to consider trapping sites and stress states.•Calculation and validation of gaseous hydrogen solubility under extreme conditions.•Hydrogen uptake measured for L450 steel at 200 and 1000 bar.•Calculation of the hydrogen solubility in pipes and pressure vessels.•Comprehensive literature survey of gaseous hydrogen solubility.
High- and medium-entropy alloys (HEAs) are a quite new class of materials. They have a high potential for applications from low to high temperatures due to the excellent combination of their ...structural properties. Concerning their application as components; processing properties, such as machinability, have hardly been investigated so far. Hence, machinability analyses with a focus on the influence of the milling process and its basic parameters (cutting speed, feed per cutting edge) on the resulting surface integrity of specimens from an equiatomic high- (CoCrFeMnNi) and a medium- (CoCrNi) entropy alloy have been carried out. A highly innovative milling process with ultrasonic assistance (USAM) was compared to conventional milling processes. Recent studies have shown that USAM has a high potential to significantly reduce the mechanical load on the tool and workpiece surface during milling. In this study, the basic machining and ultrasonic parameters were systematically varied. After machining, the surface integrity of the alloys was analyzed in terms of topography, defects, subsurface damage, and residual stresses. It was observed that USAM reduces the cutting forces and increases the surface integrity in terms of lower tensile residual stresses and defect density near the surfaces for the CoCrFeMnNi alloy. It was shown that the cutting forces and the metallurgical influence in the sub surface region are reduced by increasing the cutting speed and reducing the feed rate per cutting edge. With the CoCrNi alloy, the tool revealed severe wear. As a result, for this alloy no influence of the parameters on the machinability could be determined.
•CoCrFeMnNi HEA can be reliable machined.•Ultrasonic assistance is beneficial as it improves the surface integrity of CoCrFeMnNi HEA.•The cutting force increase significant with raising tool wear with milling of CoCrNi MEA.•Toll condition is the main factor according surface integrity on milling CoCrNi MEA.
The new multi-element alloying concept of systems with defined entropy (HEA — high-entropy alloy or MEA — medium-entropy alloy) is increasing in material research interest. Improved properties or ...combinations of properties are shown by several systems. Thus, the resulting microstructures and production of HEA/MEA as well as properties have been primarily investigated so far. Furthermore, processing is a key issue to transfer HEA/MEA systems to real components. Since welding is the most important joining process for metals, it is crucial to investigate the influence of welding to guarantee component integrity. Since most HEA are made of expensive alloying elements such as Co or Ni, they will not be used entirely as structural materials. Thus, it can be advantageous to weld conventional alloys such as austenitic stainless steels with the HEA and MEA to produce components that are both application-oriented and economically viable. Therefore, in this paper, first results of dissimilar metal welding, by tungsten inert gas (TIG) and friction stir welding (FSW), of a CoCrFeMnNi HEA as well as a CoCrNi MEA with a conventional AISI 304 austenitic stainless steel are presented. The focus is on the microstructure formation due to the two welding processes. The results of TIG welding show a dendritic microstructure, whereas in FSW both materials are stirred but still coexist.
The hydrogen solubility in ferritic and martensitic steels is affected by hydrostatic stress, pressure, and temperature. In general, compressive stresses decrease but tensile stresses increase the ...hydrogen solubility. This important aspect must be considered when qualifying materials for high‐pressure hydrogen applications (e.g., for pipelines or tanks) by using autoclave systems. In this work, a pressure equivalent for compensating the effect of compressive stresses on the hydrogen solubility inside of closed autoclaves is proposed to achieve solubilities that are equivalent to those in pipelines and tanks subjected to tensile stresses. Moreover, it is shown that the temperature effect becomes critical at low temperatures (e.g., under cryogenic conditions for storing liquid hydrogen). Trapping of hydrogen in the microstructure can increase the hydrogen solubility with decreasing temperature, having a solubility minimum at about room temperature. To demonstrate this effect, the generalized law of the hydrogen solubility is parameterized for different steels using measured contents of gaseous hydrogen. The constant parameter sets are verified and critically discussed with respect to the high‐pressure hydrogen experiments.
The hydrogen solubility in ferritic and martensitic steels is affected by hydrostatic stress, pressure, and temperature. In general, compressive stresses decrease but tensile stresses increase the hydrogen solubility. This important aspect must be considered when qualifying materials for high‐pressure hydrogen applications (e.g., for pipelines or tanks) by using autoclave systems.
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