Stepped-care approaches may offer a solution to delivering accessible, effective and efficient services for individuals with depression. In stepped care, all patients commence with a low-intensity, low-cost treatment. Treatment results are monitored systematically, and patients move to a higher-intensity treatment only if necessary. We deliver a stepped-care model targeting patients with depres...

BACKGROUND Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in the Netherlands. METHODS Alongside the QIC, an intervention study using a controlled before-and-a...

abstract stepped spillways are of most important hydraulic constructions to dissipation energy of water flow. these constructions are used in opening channel to transfer water from upper level to lower level. because of considerable effect of steps on flow dissipation energy and also the resulted developments in construction of roller competed concrete rcc, the mentioned constructions have draw...

[1] High‐speed video images of eight branches of a lightning stepped leader recorded at a frame rate of 300 kiloframes per second (kfps) (3.33 ms exposure) are analyzed, representing the fastest published frame rate measurements of stepped leader stepping by about 1 order of magnitude and the first observations of space stems/leaders associated with stepped leaders. Sixteen occurrences of space...

Numerous stepped spillways were built to date, namely on RCC gravity dams or on valley flanks besides embankment or rockfill dams, while some others are currently under design or construction. In some cases, slope changes may be required on stepped chutes, due to the topography, leading to reduced excavation and related economic benefits. A quite limited number of stepped spillways have been bu...

BACKGROUND There is limited guidance on the design of stepped wedge cluster randomised trials. Current methodological literature focuses mainly on trials with cross-sectional data collection at discrete times, yet many recent stepped wedge trials do not follow this design. In this article, we present a typology to characterise the full range of stepped wedge designs, and offer guidance on sever...

recently the stepped spillways have been used as an appropriate solution for energy dissipation. in the present study, siahbisheh dam spillway is simulated by using computational fluid dynamic (cfd), in which the mixture method and reynolds stresses model (rsm) turbulence model is used. in the first modeling series the over all steppes slope is constant. the number of the steps is increased to ...

BACKGROUND Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile. METHODS In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depress...

This paper describes the formulation and performance of a nonhydrostatic model featuring a unique variable stepped topography representation capable of capturing steep topographical slopes, while at the same time accurately representing subtle topography variations. The proposed enstrophy conserving formulation and the quasi-compressible closure cast on a multiply nested rotated spherical grid ...