Several issues concerning stepped care are discussed: the constraints of using Diagnostic and Statistical Manual of Mental Disorders diagnoses in randomized clinical trials (RCTs), the importance of basic and process research, the unintended negative effects of exaggerated claims of effectiveness and efficiency, the limits of RCTs in evaluating improvement and deterioration, the self-correcting...

BACKGROUND The cost effectiveness of various treatment strategies for bulimia nervosa (BN) is unknown. AIMS To examine the cost effectiveness of stepped care treatment for BN. METHOD Randomized trial conducted at four clinical centers with intensive measurement of direct medical costs and repeated measurement of subject quality of life and family/significant other time involvement. Two hund...

in this paper we investigate the mechanism of internal erosion caused in the right abutment of the shahghasem dam’s spillway. shahghasem dam is an earthen dam located in yasouj, in southwest of iran. a significant hole and pipe have been observed in the corner of the right abutment from upstream view. the foundation is marlstone, which has low cohesion and susceptible for internal erosion and p...

This paper describes the design and analysis of planar dualband bandpass filters using stepped impedance resonators. In the proposed filter configurations, dual-band bandpass filters are designed, and realized by using inverted stepped impedance (SIR) resonators. The conventional half wavelength open circuited stub single frequency resonators are replaced with dual band simple two section stepp...

BACKGROUND Stepped care is recommended and implemented as a means to organise depression treatment. Compared with alternative systems, it is assumed to achieve equivalent clinical effects and greater efficiency. However, no trials have examined these assumptions. A fully powered trial of stepped care compared with intensive psychological therapy is required but a number of methodological and pr...

BACKGROUND Stepped wedge cluster randomised trials frequently involve a relatively small number of clusters. The most common frameworks used to analyse data from these types of trials are generalised estimating equations and generalised linear mixed models. A topic of much research into these methods has been their application to cluster randomised trial data and, in particular, the number of c...

Excess mortality in persons of lower socioeconomic status is a finding confirmed in many population studies. Among the nearly 11,000 hypertensive trial participants in the population-based Hypertension Detection and Follow-up Program, lower educational level (an indicator of low socioeconomic status) was associated with a 5-year death rate significantly above that found in those with higher edu...

ABSTRACT During voluntary or involuntary spills, the total dissolved gas (TDG) may increase with potential of causing bubble disease (GBD) in affected fish. Bubbles entrained during spill events Colider are transported by plunging jets to deep, high pressure, regions tailrace where dissolution is enhanced increasing TDG concentrations. The most common alternative minimize supersaturation downst...

We propose an optimization technique for reducing global synchronizations in traditional time-stepped simulations. Time-stepped simulations are known to be efficient when events are frequent or dense. However, when events are less frequent (when compared to the size of time-steps) the performance of time-stepped simulations drop noticeably. This paper aims at improving the performance of tradit...

In the last three decades the design of stepped spillways regained some interest because of their suitability with new construction methods including gabion placement. In this study, the hydraulic performances of gabion stepped weirs were investigated experimentally in terms of the air-water flow properties and energy dissipation rate. A physical study was performed in a relatively large size f...