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Sökning: WFRF:(Strunk DR)

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1.
  • Furukawa, Toshi A, et al. (författare)
  • Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual participant data
  • 2021
  • Ingår i: Lancet psychiatry. - London, United Kingdom : The Lancet Publishing Group. - 2215-0374 .- 2215-0366. ; 8:6, s. 500-511
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom.METHODS: We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683.FINDINGS: We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components.INTERPRETATION: The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package.FUNDING: Japan Society for the Promotion of Science.
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2.
  • Strunk, Peter, 1972- (författare)
  • Characterization of cellulose pulps and the influence of their properties on the process and production of viscose and cellulose ethers
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Today’s market offers an ever-increasing range of cellulose pulps (derivative pulps) made fromvarious wood types through different delignification processes. Each pulp segment has its uniquecharacteristics, which makes it difficult for the producer of cellulose derivatives to choose the mostsuitable pulp for optimum processability and product quality. The objective of this study was toimprove knowledge of cellulose pulps and to describe how different pulp properties affectprocessability and quality in the production of viscose dope and cellulose ethers.Ten pulp samples were investigated, originating from both sulfite and sulfate processes, with highand low viscosities and with softwood and hardwood as raw material. The pulps were analyzed fortheir properties and then processed to viscose dope and a cellulose ether in two separate pilotfacilities. The intermediates in the viscose process as well as the quality of the viscose dope andcellulose ether were analyzed and the results correlated to pulp properties.Multivariate regression methods were applied to investigate the dominating physical and chemicalproperties of each pulp and pulp segment, and to study the use of spectroscopic analyses inpredicting pulp origin, concentration and composition of hemicelluloses as well as the content ofreducing end groups in cellulose. For the production of viscose dope, the models presented showedthe most important pulp properties for good cellulose reactivity and viscose filterability. In addition,the properties affecting gel formation, flocculation, degree of substitution and clarity in theproduction of cellulose ether were highlighted. The study also emphasized the need to supplementthe use of conventional analyses on pulps and viscose intermediates with other analytical methods,such as molecular weight distribution and carbohydrate analysis, to better predict the quality ofboth viscose dope and viscose fiber.The results of the present study could be useful to predict the origin and properties of new pulps, toreplace or supplement otherwise expensive pulp analyses, and to assess the impact of pulpproperties on the production of cellulose derivatives without extensive pilot-scale trials.
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