Chlorofluorocarbon (CFC) banks from uses such as air conditioners or foams can be emitted after global production stops. Recent reports of unexpected emissions of CFC-11 raise the need to better ...quantify releases from these banks, and associated impacts on ozone depletion and climate change. Here we develop a Bayesian probabilistic model for CFC-11, 12, and 113 banks and their emissions, incorporating the broadest range of constraints to date. We find that bank sizes of CFC-11 and CFC-12 are larger than recent international scientific assessments suggested, and can account for much of current estimated CFC-11 and 12 emissions (with the exception of increased CFC-11 emissions after 2012). Left unrecovered, these CFC banks could delay Antarctic ozone hole recovery by about six years and contribute 9 billion metric tonnes of equivalent CO
emission. Derived CFC-113 emissions are subject to uncertainty, but are much larger than expected, raising questions about its sources.
Despite evidence that psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave ...treatment without a measured benefit. In addition, therapists appear to overestimate positive outcomes in their patients relative to measured outcomes and are particularly poor at identifying patients at risk for a negative outcome. These problems suggest the need for measuring and monitoring patient treatment response over the course of treatment while applying standardized methods of identifying at-risk cases. Computer-assisted methods for measuring, monitoring, identifying potential deteriorators, and providing feedback to clinicians are described along with a model that explains why feedback is likely to be beneficial to patients. The results of 12 clinical trials are summarized and suggest that deterioration rates can be substantially reduced in at-risk cases (from baseline rates of 21% down to 13%) and that recovery rates are substantially increased in this subgroup of cases (from a baseline of 20% up to 35%) when therapists are provided this information. When problem-solving methods are added to feedback, deterioration in at-risk cases is further reduced to 6% while recovery/improvement rates rise to about 50%. It is suggested that the feedback methods become a standard of practice. Such a change in patterns of care can be achieved through minimal modification to routine practice but may require discussions with patients about their clinical progress.
Performing exome sequencing in 14 autosomal dominant early-onset Alzheimer disease (ADEOAD) index cases without mutation on known genes (amyloid precursor protein (APP), presenilin1 (PSEN1) and ...presenilin2 (PSEN2)), we found that in five patients, the SORL1 gene harbored unknown nonsense (n=1) or missense (n=4) mutations. These mutations were not retrieved in 1500 controls of same ethnic origin. In a replication sample, including 15 ADEOAD cases, 2 unknown non-synonymous mutations (1 missense, 1 nonsense) were retrieved, thus yielding to a total of 7/29 unknown mutations in the combined sample. Using in silico predictions, we conclude that these seven private mutations are likely to have a pathogenic effect. SORL1 encodes the Sortilin-related receptor LR11/SorLA, a protein involved in the control of amyloid beta peptide production. Our results suggest that besides the involvement of the APP and PSEN genes, further genetic heterogeneity, involving another gene of the same pathway is present in ADEOAD.
In Lambda-CDM models, galaxies are thought to grow both through continuous cold gas accretion coming from the cosmic web and episodic merger events. The relative importance of these different ...mechanisms at different cosmic epochs is nevertheless not yet understood well. We aim to address questions related to galaxy mass assembly through major and minor wet merging processes in the redshift range 1 < zeta < 2, an epoch that corresponds to the peak of cosmic star formation history. A significant fraction of Milky Way-like galaxies are thought to have undergone an unstable clumpy phase at this early stage. We focus on the behavior of the young clumpy disks when galaxies are undergoing gas-rich galaxy mergers. The star formation history of isolated disks shows a stochastic star formation rate, which proceeds from the complex behavior of the giant clumps. The mass-size relation and its rate of evolution in the redshift range 1 < zeta < 2 matches observations, suggesting that the inside-out growth mechanisms of the stellar disk do not necessarily require cold accretion.
Background
Psoriasis patients carry an increased risk for associated comorbidities. Dermatologists have to be aware of the effects of systemic treatments not only on psoriasis but also on ...co‐occurring diseases. In case of other coexisting inflammatory diseases, the right psoriasis treatment may improve both disorders. For infectious and malignant disorders, some treatments have to be avoided as they may be harmful.
Objective
The primary objective of this project was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis).
Methods
Evidence‐based recommendations were formulated using a quasi‐Delphi methodology after a systematic search of the literature and a consensus procedure involving eight psoriasis experts.
Results
Recommendations are given on the use of systemic treatment in psoriatic arthritis, inflammatory bowel disease, demyelinating disorders, hepatitis B and C, HIV and cancer.
Conclusion
This expert opinion is a practical guide for dermatologists when handling psoriasis patients with these specific conditions.
ABSTRACT Using three fiducial N-body+SPH simulations, we follow the merging of two disk galaxies that each have a hot gaseous halo component, and examine whether the merger remnant can be a spiral ...galaxy. The stellar progenitor disks are destroyed by violent relaxation during the merging and most of their stars form a classical bulge, while the remaining stars, as well as stars born during the merging times, form a thick disk and its bar. A new stellar disk forms subsequently and gradually in the remnant from the gas accreted mainly from the halo. It is vertically thin and well extended in its equatorial plane. A bar starts forming before the disk is fully in place, which is contrary to what is assumed in idealized simulations of isolated bar-forming galaxies, and has morphological features such as ansae and boxy/peanut bulges. Stars of different ages populate different parts of the box/peanut. A disky pseudobulge also forms, so that by the end of the simulation all three types of bulges coexist. The oldest stars are found in the classical bulge, followed by those of the thick disk, then by those in the thin disk. The youngest stars are in the spiral arms and the disky pseudobulge. The disk surface density profiles are of type II (exponential with downbending); the circular velocity curves are flat and show that the disks are submaximum in these examples: two clearly so and one near-borderline between maximum and submaximum. On average, only roughly between 10% and 20% of the stellar mass is in the classical bulge of the final models, i.e., much less than in previous simulations.
This systematic review and meta-analysis examines the impact of measuring, monitoring, and feeding back information on client progress to clinicians while they deliver psychotherapy. It considers the ...effects of the 2 most frequently studied routine outcome monitoring (ROM) practices: The Partners for Change Outcome Management System and the Outcome Questionnaire System. Like other ROM practices, they typify attempts to enhance routine care by assisting psychotherapists in recognizing problematic treatment response and increasing collaboration between therapist and client to overcome poor treatment response. A total of 24 studies were identified and considered suitable for analysis. Two-thirds of the studies found that ROM-assisted psychotherapy was superior to treatment-as-usual offered by the same practitioners. Mean standardized effect sizes indicated that the effects ranged from small to moderate. Feedback practices reduced deterioration rates and nearly doubled clinically significant/reliable change rates in clients who were predicted to have a poor outcome. Clinical examples, diversity considerations, and therapeutic advances are provided.
Clinical Impact Statement
Question: Does tracking client response to treatment improve the overall outcome? Findings: According to research, two common methods of tracking client mental health vital signs were found to improve outcomes compared with treatment without such monitoring. Meaning: These procedures help clinicians prevent treatment failure and enhance positive outcomes by becoming more responsive to the client's needs and difficulties. Next Steps: Implementation of these methods in routine care is recommended.
Outcome in Psychotherapy Lambert, Michael J
Psychotherapy (Chicago, Ill.),
03/2013, Letnik:
50, Številka:
1
Journal Article
Recenzirano
Fifty years after the 1963 debate between Strupp and Eysenck, as recorded in their articles in
Psychotherapy
, it is clear that Eysenck overstated the case against psychoanalysis and dynamic ...psychotherapy (
Bergin, 1971
), while inflating the magnitude of improvement in untreated individuals (
Lambert, 1976
). Eysenck was probably correct about the beneficial effects of behavior therapies, but did not foresee that behavior therapy would be supplanted by cognitive behavior therapies (CBT) and eclectic mixtures of CBT that incorporate elements of eastern religion, humanistic interventions, and psychodynamic constructs. Fortunately, most of the treatments that have been tested in rigorous investigations have been found to be effective, but few have distinguished themselves as uniquely superior. Many of the problems of how to measure the effects of treatment have been solved and suggest that about two thirds of treated individuals improve or recover. This leaves a sizable portion of nonresponding individuals, but emerging methods involving in tracking treatment response are being used to decrease deterioration and enhance positive outcomes.
Background
Impressive progress in new therapeutic options has been made for psoriasis. Treatments include topical steroids, phototherapy, conventional, synthetic disease‐modifying drugs and an ...expanding list of biologics.
Objective
The primary objective of this work was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis).
Methods
Evidence‐based recommendations were formulated using a quasi‐Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts.
Results
In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed.
Conclusion
Guidance on therapeutic choice in specific clinical situations in psoriasis is provided in order to facilitate the decision‐making in clinical practice.
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