Background: Chronic pain has a large individual and societal burden. Previous reviews have shown that internetbased cognitive-behavioral therapy (iCBT) can support patients' pain coping. However,... Show moreBackground: Chronic pain has a large individual and societal burden. Previous reviews have shown that internetbased cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized. Objective: The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery. Methods: Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes. Results: The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills. Conclusions: Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice. Show less
Background:The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting a lesser severity of illness. The clinical importance of patients with... Show moreBackground:The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting a lesser severity of illness. The clinical importance of patients with pulmonary embolism isolated to the subsegmental vessels is unknown.Objective:To determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation.Design:Multicenter prospective cohort study. (ClinicalTrials.gov: NCT01455818)Setting:Eighteen sites between February 2011 and February 2021.Patients:Patients with isolated subsegmental pulmonary embolism.Intervention:At diagnosis, patients underwent bilateral lower-extremity venous ultrasonography, which was repeated 1 week later if results were negative. Patients without deep venous thrombosis did not receive anticoagulant therapy.Measurements:The primary outcome was recurrent venous thromboembolism during the 90-day follow-up period.Results:Recruitment was stopped prematurely because the predefined stopping rule was met after 292 of a projected 300 patients were enrolled. Of the 266 patients included in the primary analysis, the primary outcome occurred in 8 patients, for a cumulative incidence of 3.1% (95% CI, 1.6% to 6.1%) over the 90-day follow-up. The incidence of recurrent venous thromboembolism was 2.1% (CI, 0.8% to 5.5%) and 5.7% (CI, 2.2% to 14.4%) over the 90-day follow-up in patients with single and multiple isolated subsegmental pulmonary embolism, respectively. No patients had a fatal recurrent pulmonary embolism.Limitation:The study was restricted to patients with low-risk subsegmental pulmonary embolism.Conclusion:Overall, patients with subsegmental pulmonary embolism who did not have proximal deep venous thrombosis had a higher-than-expected rate of recurrent venous thromboembolism. Show less
Terpstra, J.A.; Vaart, R. van der; Beugen, S. van; Eersel, R.A. van; Gkika, I.; Erdős, D.; ... ; Evers, A.W.M. 2022
Background: The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, sug-gesting a lesser severity of illness. The clinical importance of patients with... Show moreBackground: The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, sug-gesting a lesser severity of illness. The clinical importance of patients with pulmonary embolism isolated to the subseg-mental vessels is unknown.Objective: To determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation.Design: Multicenter prospective cohort study. (ClinicalTrials. gov: NCT01455818)Setting: Eighteen sites between February 2011 and February 2021.Patients: Patients with isolated subsegmental pulmonary embolism.Intervention: At diagnosis, patients underwent bilateral lower-extremity venous ultrasonography, which was repeated 1 week later if results were negative. Patients without deep venous thrombosis did not receive anticoagulant therapy.Measurements: The primary outcome was recurrent venous thromboembolism during the 90-day follow-up period.Results: Recruitment was stopped prematurely because the predefined stopping rule was met after 292 of a projected 300 patients were enrolled. Of the 266 patients included in the pri-mary analysis, the primary outcome occurred in 8 patients, for a cumulative incidence of 3.1% (95% CI, 1.6% to 6.1%) over the 90-day follow-up. The incidence of recurrent venous throm-boembolism was 2.1% (CI, 0.8% to 5.5%) and 5.7% (CI, 2.2% to 14.4%) over the 90-day follow-up in patients with single and multiple isolated subsegmental pulmonary embolism, respec-tively. No patients had a fatal recurrent pulmonary embolism.Limitation: The study was restricted to patients with low-risk subsegmental pulmonary embolism.Conclusion: Overall, patients with subsegmental pulmonary em-bolism who did not have proximal deep venous thrombosis had a higher-than-expected rate of recurrent venous thromboembolism. Show less
Aims The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment... Show moreAims The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment.Methods and results Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm.Conclusions For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.[GRAPHICS]. Show less
Environmental input–output analyses can be a useful decision support tool at the subnational level, because of its ability to capture economic and environmental impacts at other geographical levels... Show moreEnvironmental input–output analyses can be a useful decision support tool at the subnational level, because of its ability to capture economic and environmental impacts at other geographical levels. Yet, such analyses are hindered by the lack of subnational IO tables. Furthermore, the lack of physical product and waste flows in what is known as a “hybrid” table prevents a range of consumption‐based and circular‐economy‐type analyses. We demonstrate the development of a multiregional hybrid IOT (MRHIOT) along with environmental extensions at the subnational level and exemplify it for the case of Belgium. The development procedure discloses a novel approach of combining national hybrid tables, subnational monetary tables, and physical survey‐based data. Such a combination builds upon a partial‐survey approach that includes a range of techniques for initial estimation and reconciliation within a balancing procedure. For the validation of the approaches, we assessed the magnitude of deviations between the initial and final estimates and analyzed the uncertainties inherent to each initial estimation procedure. Subsequently, we conducted a consumption‐based analysis where we assessed the carbon footprint (CF) at the subnational level and highlighted the CF inherent to the interregional linkages. This study provides methodological and application‐based contributions to the discussion on the relevance of hybrid subnational tables and analyses compared to national ones. The proposed approach could be replicable to some extent for further developing subnational MRHIOT. The study is expected to foster more research toward the development of further subnational MRHIOT as well as its associated wide‐ranging applications. Show less
Lagrange, A.M.; Rubini, P.; Nowak, M.; Lacour, S.; Grandjean, A.; Boccaletti, A.; ... ; Woillez, J. 2020
Context. The nearby and young β Pictoris system hosts a well resolved disk, a directly imaged massive giant planet orbiting at '9 au, as well as an inner planet orbiting at '2.7 au, which was... Show moreContext. The nearby and young β Pictoris system hosts a well resolved disk, a directly imaged massive giant planet orbiting at '9 au, as well as an inner planet orbiting at '2.7 au, which was recently detected through radial velocity (RV). As such, it offers several unique opportunities for detailed studies of planetary system formation and early evolution. Aims. We aim to further constrain the orbital and physical properties of β Pictoris b and c using a combination of high contrast imaging, long base-line interferometry, and RV data. We also predict the closest approaches or the transit times of both planets, and we constrain the presence of additional planets in the system. Methods. We obtained six additional epochs of SPHERE data, six additional epochs of GRAVITY data, and five additional epochs of RV data. We combined these various types of data in a single Markov-chain Monte Carlo analysis to constrain the orbital parameters and masses of the two planets simultaneously. The analysis takes into account the gravitational influence of both planets on the star and hence their relative astrometry. Secondly, we used the RV and high contrast imaging data to derive the probabilities of presence of additional planets throughout the disk, and we tested the impact of absolute astrometry. Results. The orbital properties of both planets are constrained with a semi-major axis of 9.8 ± 0.4 au and 2.7 ± 0.02 au for b and c, respectively, and eccentricities of 0.09 ± 0.1 and 0.27 ± 0.07, assuming the HIPPARCOS distance. We note that despite these low fitting error bars, the eccentricity of β Pictoris c might still be over-estimated. If no prior is provided on the mass of β Pictoris b, we obtain a very low value that is inconsistent with what is derived from brightness-mass models. When we set an evolutionary model motivated prior to the mass of β Pictoris b, we find a solution in the 10–11 MJup range. Conversely, β Pictoris c’s mass is well constrained, at 7.8 ± 0.4 MJup, assuming both planets are on coplanar orbits. These values depend on the assumptions on the distance of the β Pictoris system. The absolute astrometry HIPPARCOS-Gaia data are consistent with the solutions presented here at the 2σ level, but these solutions are fully driven by the relative astrometry plus RV data. Finally, we derive unprecedented limits on the presence of additional planets in the disk. We can now exclude the presence of planets that are more massive than about 2.5 MJup closer than 3 au, and more massive than 3.5 MJup between 3 and 7.5 au. Beyond 7.5 au, we exclude the presence of planets that are more massive than 1–2 MJup. Conclusions. Combining relative astrometry and RVs allows one to precisely constrain the orbital parameters of both planets and to give lower limits to potential additional planets throughout the disk. The mass of β Pictoris c is also well constrained, while additional RV data with appropriate observing strategies are required to properly constrain the mass of β Pictoris b. Show less
Aguilar-Hernandez, G.A.; Siguenza-Sanchez, C.P.; Donati, F.; Merciai, S.; Schmidt, J.; Dias Rodrigues, J.F.; Tukker, A. 2020
Due to increased policy attention on circular economy strategies, many studies have quantified material use and recovery at national and global scales. However, there has been no quantitative... Show moreDue to increased policy attention on circular economy strategies, many studies have quantified material use and recovery at national and global scales. However, there has been no quantitative analysis of the unrecovered waste that can be potentially reintegrated into the economy as materials or products. This can be interpreted as the gap of material circularity. In this paper we define the circularity gap of a country as the generated waste, plus old materials removed from stocks and durable products disposed (i.e. stock depletion), minus recovered waste. We estimated the circularity gap of 43 nations and 5 rest of the world regions in 2011, using the global, multiregional hybrid-units input-output database EXIOBASE v3.3. Our results show the trends of circularity gap in accordance to each region. For example, the circularity gaps of Europe and North America were between 1.6–2.2 tonnes per capita (t/cap), which are more than twice the global average gap (0.8 t/cap). Although these regions presented the major amount of material recovery, their circularity gaps were mostly related to the levels of stock depletion. In Africa and Asia-Pacific regions, the circularity gap was characterized by a low degree of recovery and stock depletion, with high levels of generated waste. Moreover, we discuss which intervention types can be implemented to minimize the circularity gap of nations. Show less
Background Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with... Show moreBackground Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonary embolism undergo computed tomographic (CT) pulmonary angiography or ventilation-perfusion scanning, both of which involve radiation exposure to the mother and fetus. Whether a pregnancy-adapted algorithm could be used to safely avoid diagnostic imaging in pregnant women with suspected pulmonary embolism is unknown. Methods In a prospective study involving pregnant women with suspected pulmonary embolism, we assessed three criteria from the YEARS algorithm (clinical signs of deep-vein thrombosis, hemoptysis, and pulmonary embolism as the most likely diagnosis) and measured the d-dimer level. Pulmonary embolism was ruled out if none of the three criteria were met and the d-dimer level was less than 1000 ng per milliliter or if one or more of the three criteria were met and the d-dimer level was less than 500 ng per milliliter. Adaptation of the YEARS algorithm for pregnant women involved compression ultrasonography for women with symptoms of deep-vein thrombosis; if the results were positive (i.e., a clot was present), CT pulmonary angiography was not performed. All patients in whom pulmonary embolism had not been ruled out underwent CT pulmonary angiography. The primary outcome was the incidence of venous thromboembolism at 3 months. The secondary outcome was the proportion of patients in whom CT pulmonary angiography was not indicated to safely rule out pulmonary embolism. Results A total of 510 women were screened, of whom 12 (2.4%) were excluded. Pulmonary embolism was diagnosed in 20 patients (4.0%) at baseline. During follow-up, popliteal deep-vein thrombosis was diagnosed in 1 patient (0.21%; 95% confidence interval [CI], 0.04 to 1.2); no patient had pulmonary embolism. CT pulmonary angiography was not indicated, and thus was avoided, in 195 patients (39%; 95% CI, 35 to 44). The efficiency of the algorithm was highest during the first trimester of pregnancy and lowest during the third trimester; CT pulmonary angiography was avoided in 65% of patients who began the study in the first trimester and in 32% who began the study in the third trimester. Conclusions Pulmonary embolism was safely ruled out by the pregnancy-adapted YEARS diagnostic algorithm across all trimesters of pregnancy. CT pulmonary angiography was avoided in 32 to 65% of patients. Show less
Motivation: The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity... Show moreMotivation: The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community-led open-source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene.Main types of variables included: The database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record.Spatial location and grain: BioTIME is a global database of 547,161 unique sampling locations spanning the marine, freshwater and terrestrial realms. Grain size varies across datasets from 0.0000000158 km(2) (158 cm(2)) to 100 km(2) (1,000,000,000,000 cm(2)).Time period and grainBio: TIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year.Major taxa and level of measurement: BioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates. Show less
