The authors report on changes in cognitions related to posttraumatic stress disorder (PTSD) among 54 female survivors of sexual and nonsexual assault with chronic PTSD who completed either prolonged ...exposure alone or in combination with cognitive restructuring. Treatment included 9-12 weekly sessions, and assessment was conducted at pretreatment, posttreatment, and a modal 12-month follow-up. As hypothesized, treatment that included prolonged exposure resulted in clinically significant, reliable, and lasting reductions in negative cognitions about self, world, and self-blame as measured by the Posttraumatic Cognitions Inventory. The hypothesis that the addition of cognitive restructuring would augment cognitive changes was not supported. Reductions in these negative cognitions were significantly related to reductions in PTSD symptoms. The addition of cognitive restructuring did not significantly augment the cognitive changes. Theoretical implications of the results are discussed.
Abstract
Purpose:
Evaluation of ultrasound-guided high-intensity focused ultrasound (HIFU) used for the first time in Germany in patients with inoperable pancreatic cancer for reduction of tumor ...volume and relief of tumor-associated pain.
Materials and Methods:
15 patients with locally advanced inoperable pancreatic cancer and tumor-related pain symptoms were treated by HIFU (n = 6 UICC stage III, n = 9 UICC stage IV). 13 patients underwent simultaneous standard chemotherapy. Ablation was performed using the JC HIFU system (Chongqing, China HAIFU Company) with an ultrasonic device for real-time imaging. Imaging follow-up (US, CT, MRI) and clinical assessment using validated questionnaires (NRS, BPI) was performed before and up to 15 months after HIFU.
Results:
Despite biliary or duodenal stents (4/15) and encasement of visceral vessels (15/15), HIFU treatment was performed successfully in all patients. Treatment time and sonication time were 111 min and 1103 s, respectively. The applied total energy was 386 768 J. After HIFU ablation, contrast-enhanced imaging showed devascularization of treated tumor regions with a significant average volume reduction of 63.8 % after 3 months. Considerable pain relief was achieved in 12 patients after HIFU (complete or partial pain reduction in 6 patients).
Conclusion:
US-guided HIFU with a suitable acoustic pathway can be used for local tumor control and relief of tumor-associated pain in patients with locally advanced pancreatic cancer.
Key points:
• US-guided HIFU allows an additive treatment of unresectable pancreatic cancer.
• HIFU can be used for tumor volume reduction.
• Using HIFU, a significant reduction of cancer-related pain was achieved.
• HIFU provides clinical benefit in patients with pancreatic cancer.
Citation Format:
• Strunk HM, Henseler J, Rauch M et al. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Fortschr Röntgenstr 2016; 188: 662 – 670
Objective: Comorbidity is the rule and not the exception among veterans with posttraumatic stress disorder (PTSD). Examining comorbidities in a veteran population allows us to better understand ...veterans' symptoms and recognize when mental health treatment may need to be tailored to other co-occurring issues. This article evaluates comorbid mood and anxiety disorders and PTSD symptom severity in a large sample of veterans from multiple eras of service, including the recent wars in Iraq and Afghanistan. Method: The current study used data from veterans who sought treatment for PTSD at a VA PTSD Clinical Team from 2005 to 2013. Veterans were assessed for PTSD, mood, and anxiety disorders using a structured clinical interview and completed self-report symptom measures as part of the PTSD clinic intake procedure. A total of 2,460 veterans were evaluated, and 867 met diagnostic criteria for PTSD. Results: Veterans with PTSD were significantly more likely than those without PTSD to be diagnosed with social anxiety disorder and obsessive-compulsive disorder, but significantly less likely to be diagnosed with depression. In addition, veterans who had at least one comorbid diagnosis in addition to PTSD reported significantly higher PTSD symptom severity than veterans with PTSD alone. PTSD symptom severity also varied by era of service. Conclusion: These results suggest that among veterans seeking treatment for PTSD, comorbid mood and anxiety disorders may be associated with greater severity of PTSD symptoms. Future work is needed to determine the impact of specific comorbidities on trauma-focused treatment outcomes.
Clinical Impact Statement
Many veterans with posttraumatic stress disorder (PTSD) also have other psychological disorders, such as depression and anxiety. In this study, veterans at a PTSD clinic were evaluated for PTSD and mood and anxiety disorders. Veterans who had at least one diagnosis in addition to PTSD had more severe PTSD symptoms than veterans with PTSD alone. Veterans from different eras of service also had different symptom profiles. It is important to understand the impact of being diagnosed with a mood or anxiety disorder in addition to PTSD to tailor treatment to the individual.
Neoadjuvant systemic treatment elicits a pathologic complete response (pCR) in about 35% of women with breast cancer. In such cases, breast surgery may be considered overtreatment. We evaluated ...multivariate algorithms using patient, tumor, and vacuum-assisted biopsy (VAB) variables to identify patients with breast pCR.
We developed and tested four multivariate algorithms: a logistic regression with elastic net penalty, an Extreme Gradient Boosting (XGBoost) tree, Support Vector Machines (SVM), and neural network. We used data from 457 women, randomly partitioned into training and test set (2:1), enrolled in three trials with stage 1–3 breast cancer, undergoing VAB before surgery. False-negative rate (FNR) and specificity were the main outcome measures. The best performing algorithm was validated in an independent fourth trial.
In the test set (n = 152), the logistic regression with elastic net penalty, XGboost tree, SVM, and neural network revealed an FNR of 1.2% (1 of 85 patients with missed residual cancer). Specificity of the logistic regression with elastic net penalty was 52.2% (35 of 67 women with surgically confirmed breast pCR identified), of the XGBoost tree 55.2% (37 of 67), of SVM 62.7% (42 of 67), and of the neural network 67.2% (45 of 67). External validation (n = 50) of the neural network showed an FNR of 0% (0 of 27) and a specificity of 65.2% (15 of 23). Area under the ROC curve for the neural network was 0.97 (95% CI, 0.94–1.00).
A multivariate algorithm can accurately select breast cancer patients without residual cancer after neoadjuvant treatment.
•Identify women with a complete response in the breast after neoadjuvant treatment.•We compared the diagnostic performance of multivariate algorithms to breast surgery.•An international cohort of 457 women was used for the algorithm development.•Upon validation (n = 50) the neural network missed 0% cancer compared to surgery.•Omitting breast cancer surgery for these women may be evaluated in future trials.
We present a computation of the O(αs) QCD corrections to W±Zγ production at the Large Hadron Collider. The photon is considered as real, and we include full leptonic decays for the W- and Z-bosons. ...Based on the structure of the VBFNLO program package, we obtain numerical results via a Monte Carlo program, which allows to implement general cuts and distributions of the final-state particles. The NLO QCD corrections are sizable and strongly exceed the theory error obtained by a scale variation of the leading-order result. Also, the shapes of relevant observables are significantly altered.
Many patients evince significant post-traumatic stress disorder (PTSD) symptoms after a dose of an evidence-based treatment (EBT) for PTSD. Little research systematically addresses if individual PTSD ...symptoms are more or less resistant to change through an EBT for PTSD or have greater or lesser post-treatment severity levels. Two studies within VA medical centers provided data. Study 1 (n = 81) was drawn from a randomized clinical trial of Prolonged Exposure (PE), an EBT for PTSD. Study 2 (n = 225) was drawn from two PTSD specialty clinics employing PE. Symptoms were assessed pre- and post-treatments via semi-structured clinician interview (Study 1) and patient self-report (Studies 1 and 2). Most individual symptoms reduced about the same amount through the course of treatment except for avoidance, which showed greater reductions. High heterogeneity in post-treatment symptom severity was found with troubled sleep and hypervigilance displaying above average levels, and traumatic amnesia, foreshortened future, and flashbacks displaying below average levels. Method of symptom measurement had a modest impact on results, as semi-structured clinical interview results were moderately more differentiated than self-report measures. Results were generally consistent between an efficacy (i.e., extremely high, potentially artificial methodological control) and effectiveness (i.e., relatively more real world) context. Primary limitation is analysis of single items on semi-structured clinician interview and patient self-report scale when psychometric validation studies did not interpret measures this way. Moreover, DSM-IV criteria for PTSD were assessed. EBT augmentation and new treatment development should focus on further reducing both PTSD symptoms in general and on the specific symptoms of troubled sleep and hypervigilance, which persist to a greater degree.
Impact Statement
Even with the best treatments for PTSD, some individual PTSD symptoms do not reduce enough during treatment and so remain after treatment. Through PE, an evidenced-based treatment, most individual PTSD symptoms reduced about the same amount with avoidance patterns reducing the most. Post-treatment, disturbed sleep, and hypervigilance had the highest levels. Patients and clinicians can use this information in planning treatment, and researchers can use it in developing second-generation PTSD treatments.
High rates of drop-out from treatment of PTSD have challenged implementation. Care models that integrate PTSD focused psychotherapy and complementary interventions may provide benefit in retention ...and outcome. The first 80 veterans with chronic PTSD enrolled in a 2-week intensive outpatient program combining Prolonged Exposure (PE) and complementary interventions completed symptom and biological measures at baseline and posttreatment. We examined trajectories of symptom change, mediating and moderating effects of a range of patient characteristics. Of the 80 veterans, 77 completed (96.3%) treatment and pre- and posttreatment measures. Self-reported PTSD (p < .001), depression (p < .001) and neurological symptoms (p < .001) showed large reductions with treatment. For PTSD, 77% (n = 59) showed clinically significant reductions. Satisfaction with social function (p < .001) significantly increased. Black veterans and those with a primary military sexual trauma (MST) reported higher baseline severity than white or primary combat trauma veterans respectively but did not differ in their trajectories of treatment change. Greater cortisol response to the trauma potentiated startle paradigm at baseline predicted smaller reductions in PTSD over treatment while greater reductions in this response from baseline to post were associated with better outcomes. Intensive outpatient prolonged exposure combined with complementary interventions shows excellent retention and large, clinically significant reduction in PTSD and related symptoms in two weeks. This model of care is robust to complex presentations of patients with varying demographics and symptom presentations at baseline.
Impact Statement
Intensive and integrative models of exposure-based treatment of PTSD show large reductions in PTSD and related mental health issues while greatly increasing retention over weekly PTSD standard models of care. Such models provide new options for PTSD care to improve outcomes, retention, and access through specialty PTSD care centers.
► The basic fitted allometric equation (biomass
=
β
×
(
d
2
h)
γ
) allowed to work with biologically meaningful parameters. ► Allometric parameters were found to vary with stand age (decreasing for ...the crown and increasing for the bole), and introducing these parameters to the equations significantly improved their performance. ► Introducing stand age into the predictive parameters is the key for the accuracy of our equations, management options and stand fertility standing in the low residual variations. ► As a confirmation, we were able to homogenize most of the published biomass equations by accounting for the stand age given in each original paper. ► We noticed that our results were consistent with and matched the patterns that were observed for Eucalyptus (
Eucalyptus). This could mean that species with similar wood properties and crown architecture may exhibit similar to identical biomass equation structures.
A set of robust biomass equations was developed for European beech (
Fagus sylvatica), using a large database made of trees from three different European countries. Models were calibrated on the French control dataset, including a broad range of tree size, age and geographical conditions. Their independent validation on Belgian, German unfertilized, German and French fertilized stands gave very promising unbiased results for all of the main tree compartments. The basic fitted allometric equation (biomass
=
β
×
(
d
2
h)
γ
) allowed us to work with biologically meaningful parameters, where
β encompasses both the form of the tree and the wood density, and
γ is the allometric exponent that indicates the proportionality between the biomass and volume relative increments. The allometric parameters were found to vary with stand age (decreasing for the crown and increasing for the bole), and introducing these parameters to the equations significantly improved the performance of all aboveground biomass equations. This age effect was related to changes in both stem form and wood density for the trunk and to changes in hydraulic conductance for the crown. We argue that introducing stand age into the predictive parameters is the key for the accuracy of our equations. Management options and stand fertility stand for the low residual variations around this relationship. To confirm this result, we were able to homogenize most of the published biomass equations by accounting for the stand age given in each original paper. We noticed that our results were consistent with and matched the patterns that were observed for Eucalyptus (
Eucalyptus). This could mean that species with similar wood properties and crown architecture may exhibit similar biomass equation structures.
Introduction: Despite high cost and wide prevalence of posttraumatic stress disorder (PTSD) in veteran populations, and Veterans Health Administration (VA)-wide mental health provider training in ...evidence-based treatments for PTSD, most veterans with PTSD do not receive best practices interventions. This may be because virtually all evidence-based PTSD treatment is offered through specialty clinics, which require multiple steps and referrals to access. One solution is to offer PTSD treatment in VA primary care settings, which are often the first and only contact point for veterans. Method: The present study, Improving Function Through Primary Care Treatment of PTSD (IMPACT), used a randomized controlled design to compare an adaptation of prolonged exposure for PTSD to primary care (PE-PC) versus best practices Primary Care Mental Health Integration (PCMHI) clinic treatment as usual (TAU) in terms of both functioning and psychological symptoms in 120 veterans recruited between April 2019 and September 2021. Results: Participants were mostly males (81.7%) with a mean age of 43.6 years (SD = 12.8), and more than half were non-White veterans (50.8%). Both conditions evinced significant improvement over baseline across functioning, PTSD, and depression measures, with no differences observed between groups. As observed in prior studies, PTSD symptoms continued to improve over time in both conditions, as measured by structured clinical interview. Discussion: Both PE-PC and best-practices TAU are effective in improving function and reducing PTSD severity and depression severity. Although we did not observe differences between the two treatments, note that this study site and two PCMHI clinics employ primarily cognitive behavioral therapies (e.g., exposure and behavioral activation).
Public Significance StatementVeterans with posttraumatic stress disorder (PTSD) can be effectively treated in the primary care setting. Specifically, veterans who received either prolonged exposure for primary care or usual Veterans Health Administration-integrated primary care showed reductions in PTSD and improvement in PTSD function.
PDF
