Online computer or therapist-guided cognitive behavioral therapy in university students with anxiety and/or depression: study protocol of a randomised controlled trial

IntroductionEmerging adulthood is a phase in life that is associated with an increased risk to develop a variety of mental health disorders including anxiety and depression. However, less than 25% of university students receive professional help for their mental health reports. Internet-based cognitive behavioural therapy (iCBT) may entail useful interventions in a format that is attractive for university students. The aim of this study protocol is to test the effectiveness of a therapist-guided versus a computer-guided transdiagnostic iCBT programme with a main focus on anxiety and depression.Methods and analysisUniversity students with anxiety and/or depressive symptoms will be randomised to a (1) 7-week iCBT programme (excluding booster session) with therapist feedback, (2) the identical iCBT programme with computer feedback only or (3) care as usual. Participants in the care as usual condition are informed and referred to conventional care services and encouraged to seek the help they need. Primary outcome variables are self-reported levels of anxiety as measured with the General Anxiety Disorder-7 and self-reported levels of depression as measured with the Patient Health Questionnaire-9. Secondary outcomes include treatment adherence, client satisfaction, medical service use, substance use, quality of life and academic achievement. Assessments will take place at baseline (t1), midtreatment (t2), post-treatment (t3), at 6 months (t4) and 12 months (t5) postbaseline. Social anxiety and perfectionism are included as potentially important predictors of treatment outcome. Power calculations are based on a 3 (group) × 3 (measurement: pretreatment, midtreatment and post-treatment) interaction, resulting in an aimed sample of 276 participants. Data will be analysed based on intention-to-treat and per protocol samples using mixed linear models.Ethics and disseminationThe current study was approved by the Medical Ethics Review Committee (METC) of the Academic Medical Centre, Amsterdam, The Netherlands (number: NL64929.018.18). Results of this trial will be published in peer-reviewed journals.Trial registration numberNL7328.

Local Shape of the Vapor–Liquid Critical Point on the Thermodynamic Surface and the van der Waals Equation of State

Differential geometry is a powerful tool to analyze the vapor–liquid critical point on the surface of the thermodynamic equation of state. The existence of usual condition of the critical point (∂p/∂V)T=0 requires the isothermal process, but the universality of the critical point is its independence of whatever process is taken, and so we can assume (∂p/∂T)V=0. The distinction between the critical point and other points on the surface leads us to further assume that the critical point is geometrically represented by zero Gaussian curvature. A slight extension of the van der Waals equation of state is to letting the two parameters a and b in it vary with temperature, which then satisfies both assumptions and reproduces its usual form when the temperature is approximately the critical one.

The Efficacy of Two Models of Professional Development Mediated by Fidelity on Fourth Grade Student Reading Outcomes

This study addressed the effects of Strategies for Teaching Reading, Information, and Vocabulary Effectively (STRIVE), a distributed professional development (PD) model designed to help teachers implement reading comprehension and vocabulary practices in fourth grade social studies classes. Schools (n = 81 schools, n = 235 teachers, n = 4,757 students) were randomly assigned to one of three conditions: researcher-supported PD, school-supported PD, or business as usual (typical instruction). Findings revealed significant effects for both treatment conditions when compared to the business-as-usual condition for content knowledge (g = 0.51 to 0.55), vocabulary learning (g = 0.49) and reading comprehension in content (g = 0.16 to 0.26). Statistically significant effects were not observed for the Gates MacGinitie Reading Comprehension (g = 0.04 to 0.06), however, the effect size for the Gates MacGinitie Vocabulary test was statistically significant for the school-supported PD group (g = 0.03 to 0.07). Findings establish the efficacy of the STRIVE PD model on student reading outcomes and supports the efficacy of using more sustainable methods of PD that feature school supported follow up PD. Fidelity did not mediate any outcomes.

Recovery Following Peer and Text Messaging Support after Discharge from Acute Psychiatric Care: A Randomized Controlled Pilot Trial (Preprint)

BACKGROUND Peer support (PS) is emotional, social, and practical help that is provided by non-professionals to assist others in sustaining health behaviours. PS is valued in recovery-oriented models of mental health and is becoming implemented increasingly at the organizational level. Text messaging is a relatively low cost, high impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE This study aims to evaluate the effect of an innovative peer support system plus supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS This is a prospective, rater-blinded, pilot randomized controlled trial, including 180 patients discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages, peer-support only, or peer-support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale; RAS) was completed at baseline, six weeks, three months, and six months. Descriptive analysis, One-Way ANOVA, and repeated measures MANCOVA were deployed to examine the changes in RAS among the study groups and over the follow-up time points. RESULTS Sixty-five patients completed assessments at each time-point. For the overall sample, higher scores were found for the peer-support plus text message condition compared to the text message only and treatment as usual condition on several scales (i.e., Willingness to ask for help and Personal Confidence and Hope) and total score on the RAS. CONCLUSIONS Peer support plus supportive text messaging results in improved recovery compared to other interventions. It is advisable to incorporate the two interventions as a part of routine practice for patients with psychiatric disorders upon their hospital discharge. CLINICALTRIAL The study received ethical approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from the Alberta Health Services regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

A prospective study of clinical pattern of febrile thrombocytopenia in government general hospital, Nalgonda

Background: Febrile thrombocytopenia is a usual condition caused by infections such as dengue, malaria, typhoid, septicimea and certain viral infections. The present study is aimed to study the aetiology of fever with thrombocytopenia and the clinical presentation in the patients admitted in Government General Hospital.Methods: This prospective observational study was done from August 2019 to September 2019 in Government General Hospital Nalgonda. A total of 100 cases male and female admitted with febrile thrombocytopenia were studied based on inclusion and exclusion criteria. All patients were done routine investigations and ELISA test for dengue done in susceptible patients. Patients below 12 years, pregnant women and patients with previous bleeding manifestations were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 100 patients 60 females and 40 males presented during the study period. Most of the fevers with low platelet count were viral 30 (30%), dengue 25 (25%), typhoid 20(20%), malaria 15 (15%), hepatitis 10 (10%). The patients presented with fever 25 (25%), nausea 20 (20%), headache 20 (20%) abdominal ain 15 (15%), diarrhea 10 (10%), bleeding manifestations 5 (5%), myalgia 5 (5%).Conclusions: It was observed from the study that the viral infections were predominant cause for the fevers with thrombocytopenia followed by dengue, typhoid and malaria, furthur it was observed that apart from fever nausea and headache were predominant symptoms in patients presenting with febrile thrombocytopenia. Major complications were avoided by timely admission and proper care of the patients.

Is Postoperative Non-Weight-bearing Necessary? (INWN) Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Background:Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing may lead to poorer clinical outcomes. Traditional non-weight bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.Methods:A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 hours versus non-weight-bearing (NWB) and immobilisation in a cast for six weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes included wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance.Discussion:Traditional management of operatively treated ankle fractures includes an extended period of non-weight bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but with higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual condition of care. It is hoped that these results will contribute to the modern management of ankle fractures.Trial registration:The trial is retrospectively registered on the 30th of June 2019, ISRCTN - ISRCTN76410775.http://www.isrctn.com/ISRCTN76410775

Is Postoperative Non-Weight-bearing Necessary? (INWN) Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Background:Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing may lead to poorer clinical outcomes. Traditional non-weight bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.Methods:A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 hours versus non-weight-bearing (NWB) and immobilisation in a cast for six weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes included wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance.Discussion:Traditional management of operatively treated ankle fractures includes an extended period of non-weight bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but with higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual condition of care. It is hoped that these results will contribute to the modern management of ankle fractures.Trial registration:The trial is retrospectively registered on the 30th of June 2019, ISRCTN - ISRCTN76410775.http://www.isrctn.com/ISRCTN76410775

Is post-operative non-weight-bearing necessary? Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Background:Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing may lead to poorer clinical outcomes. Traditional non-weight bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates.Methods:A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 hours versus non-weight-bearing (NWB) and immobilisation in a cast for six weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes included wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance.Discussion:Traditional management of operatively treated ankle fractures includes an extended period of non-weight bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but with higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual condition of care. It is hoped that these results will contribute to the modern management of ankle fractures.Trial registration:The trial is retrospectively registered on the 30th of June 2019, ISRCTN - ISRCTN76410775.http://www.isrctn.com/ISRCTN76410775

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

Background Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder. Methods Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity. Results The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001). Conclusion The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.

A Comprehensive Modeling of Centrifugal Compressor Vibrations for Early Fault Detection

In the last decade, the development of machine connectivity has made possible early fault detection with remote analysis of operating data. Solutions aiming to reduce maintenance costs and production losses due to unplanned downtimes were brought to market. These solutions provide with a model of the equipment in healthy conditions using machine learning techniques applied on historical data. During operation a warning is issued when expected and actual measurements do not match. Although these solutions have proven their value to detect abnormal behaviors, they generate a large number of alarms that require resource to be analyzed. Moreover, these solutions rely on a large number of sensors that need to work correctly both for the learning and the monitoring phase. This generates additional maintenance even though these sensors are often not essential to operate the machine. Lastly the solutions are expensive: their application is usually limited to critical machines with risks of production loss. Indeed, they are not economic for a Transmission System Operator that has ensured the availability of its network with redundancy. The objective of the authors was to focus on the monitoring of radial vibrations of centrifugal compressors. Experience proves this is one of the most critical data for early fault detection. The goal was to develop a smart modelling based on historical data using essential parameters influencing rotor-dynamics. As a result, a clear correlation was found between the operating point and the vibration level. That can be easily shown on a centrifugal compressor map. A second-degree polynomial equation was successfully tested. The model equation relies only on two compressor physics parameters: flow coefficient and speed. We discuss in the paper the impact of other essential parameters. The method has been applied on different type of centrifugal compressors, with different bearing technology (magnetic...) or shaft driving equipment (gas turbine, electric motor drive). A fault detection case study using this method is described, eg: vibration variation due to abnormal opening of an anti-surge control valve. In conclusion this method is a simple alternative to usual condition monitoring solutions. Similarly to what was described in the GT2014-25242 for a Predictive Emission Monitoring System [1], equations based on physical parameters prove to be an efficient modelling technique. Moreover, it helps monitoring teams to better understand the underlying relation between parameters. Indeed, to achieve a complete monitoring of a centrifugal compressor health, this method can be combined with first-principle performance models that use the same physical parameters.