Magnitude of placebo response in clinical trials of paroxetine for vasomotor symptoms: a meta-analysis.

Introduction: Vasomotor symptoms, or hot flashes, are among the most common complaints for menopausal and postmenopausal women. As an alternative to hormone replacement therapy, paroxetine mesylate became the only non-hormonal treatment approved by the U.S. Food and Drug Administration (FDA), despite limited evidence for its efficacy. More specifically, there is uncertainty around paroxetine's unique benefit and the magnitude of the placebo response in clinical trials of paroxetine. Methods: Relevant databases were searched to identify randomized clinical trials examining the efficacy of paroxetine to treat hot flashes. The primary outcomes of interest were hot flash frequency and hot flash severity scores. Data was extracted from the published results, and risk of bias assessments were conducted. Results: Six randomized clinical trials that included a total of 1,486 women were coded and analyzed. The results demonstrated that 79% of the mean treatment response for hot flash frequency is accounted for by a placebo response, resulting in a mean true drug effect of 21% at most. Additionally, 68% of the mean treatment response for hot flash severity is accounted for by a placebo response, resulting in a maximum true drug effect of 32%. Discussion: The results herein call into question the actual efficacy of the only FDA approved, non-hormonal treatment for hot flashes by demonstrating that a placebo response accounts for the majority of treatment responses for reductions in both hot flash frequency and severity. The findings provide evidence to reevaluate the use of paroxetine to treat postmenopausal hot flashes and emphasize the importance of considering effective, alternative treatments for vasomotor symptoms.

Posttraumatic growth-oriented peer-based training among U.S. veterans: evaluation of post-intervention and long-term follow-up outcomes.

Introduction: Exposure to trauma among U.S. military veterans occurs at a high rate, often resulting in continued difficulty with emotional adjustment and a diagnosis of posttraumatic stress disorder (PTSD). The present study provides data from 184 U.S. military veterans who completed a manualized posttraumatic-growth oriented training program during an integrative seven-day retreat. Methods: Data was collected at baseline, after program completion, and at 18-month follow-up. Results: Results on primary outcomes indicated significant increases, with medium to large effect sizes, in growth related outcomes. Specifically, there was a significant increase in scores by 54% on the posttraumatic growth outcome measure (PTGI-X) from baseline (M = 50.2, SD = 31.1) to endpoint (M = 77.4, SD = 29.6), t(183) = -8.78, p < 0.001. Also, results indicate that immediately following training (Day 7), participants reported a significant decrease of 49% on the PCL-5 from baseline (M = 39.7, SD = 17.6) to endpoint (M = 20.1, SD = 13.2), t(183) = 11.75, p < 0.001. Depression subscale scores decreased by 60% from baseline (M = 8.0, SD = 5.2) to endpoint (M = 3.2, SD = 3.0), t(183) = 10.68, p < 0.001; Anxiety scores decreased by 28% from baseline (M = 5.8, SD = 4.3) to endpoint (M = 4.2, SD = 3.5), t(183) = 4.08, p < 0.001; and Stress scores decreased by 50% from baseline (M = 10.0, SD = 4.4) to endpoint (M = 5.0, SD = 3.3), t(183) = 12.21, p < 0.001. Eighteen-month follow-up data was available for 74 participants and indicated that all significant changes in growth-related outcomes were maintained. Further, all significant changes in symptomatology-related outcomes were also maintained at follow-up. Discussion: These findings demonstrate both the immediate and the long-lasting impact of an integrative posttraumatic growth-oriented training program on psychological growth and PTSD symptom reduction among U.S. military veterans.

Modeling dose rate increase from the addition of Uranium-232 for use as a tracer in uranium fuels.

The isotope 232U is being considered for additive to uranium fuel for use as a tracer. The 232U decay chain has high energy gammas that can be used for tracer purposes. However, the presence and intensity of such gammas may increase effective dose rates to workers around such materials This study examines the dose rate from different uranium materials that varying amounts of 232U has been added to. Several materials and their respective storage geometries are modeled for particle transport calculations. For each material and 232U concentration, gamma source terms were generated using SCALE 6.2 ORIGEN. These source terms were then used in MCNP for each material and geometry. Upon analysis, it was determined that the baseline dose from enriched uranium dominates until the 232U concentration reaches about 10-100 parts per trillion (ppt), after which the dose rate increases linearly.

Exploration of producing Uranium-232 for use as a tracer in uranium fuels.

This study examines the production of 232U via neutron irradiation. Uranium-232 is considered for use as a tracer in nuclear fuel. However, a source of 232U is needed. This study examines the production of 232U via neutron irradiation of targets constructed out of either 231Pa or 230Th in the High Flux Isotope Reactor. HFIR targets were modeled in MCNP to determine 232U yield in protactinium and thorium targets. Flux tallies were used inside the targets to determine the neutron flux inside each target. This flux was then used in SCALE 6.2 ORIGEN to determine the 232U yield, as well as the buildup of the byproduct 233U. Several 230Th enrichments were examined to determine how 232U yield is affected by 230Th enrichment, as well as the effects of the presence of 232Th. The buildup of 228Th and 229Th in thorium targets was also examined, as these isotopes may impact the feasibility of recycling of thorium target materials.

Changing sensitivity to cold weather in Texas power demand.

We estimate the effect of heightened temperature sensitivity on electricity demand in Texas during the February 2021 blackout event. Using 20 years of hourly data, we estimate the relationship between temperature and electricity demand; finding demand has become more responsive to cold temperatures over time. This is consistent with the fact electric heating has similarly increased over the past 20 years in Texas. We find during the February 2021 event, average electricity demand was 8% higher, and approximately 10,000 MW higher during the peak hour, than it would have been had temperature sensitivity remained unchanged at early 2000s levels. Our results highlight that Texas's increased sensitivity to cold weather extremes is not limited to the supply side, but the demand side as well. These findings have implications to other regions that are seeking to reduce carbon emissions through the electrification of heating.

Willingness and Accessibility of a Hypnosis Intervention for Anxiety Among a Low Socioeconomic Status Population.

Objective: This survey study aimed to investigate the willingness and accessibility of a hypnosis intervention for anxiety among low socioeconomic status patients in a primary care setting. Methods: Participants were asked to complete a one-page survey during a scheduled office visit with their primary care provider. Survey questions included participants' interest in hypnosis as a treatment for anxiety, how many sessions they would be willing/able to attend, how they would prefer access to a recorded hypnosis intervention, and items relating to anxiety, including the Generalized Anxiety Disorder-7 measure. Results: Two hundred participants (71.5% female) completed the survey with a mean age of 43.16 (standard deviation = 15.78). Over half (54.6%) of the survey participants reported that they experience anxiety, and 74% of the participants indicated that they would be interested in hypnosis if it were recommended by their provider for anxiety. Discussion: Given the high prevalence of anxiety among survey participants, there exists a clear need for effective and accessible treatment options. These results demonstrate the willingness of individuals to use hypnosis for anxiety and to engage in remote hypnosis interventions.

Effect of Hypnosis on Anxiety: Results from a Randomized Controlled Trial with Women in Postmenopause.

Anxiety is common, yet often under-treated, among women in postmenopause. This study examined the effect of a hypnotic intervention designed to reduce hot flashes, on anxiety levels of postmenopausal women. Anxiety was assessed using the State-Trait Anxiety Inventory, the Hospital Anxiety and Depression Scale-Anxiety subscale, and a visual analog scale. Additionally, hypnotizability was tested as a moderator of anxiety reductions. Significant reductions in anxiety were found from baseline to endpoint and follow-up and hypnosis was superior to the control condition. Additionally, ratings of Current Anxiety decreased from pre-session to post-session at each weekly visit and the pre-session scores reduced continuously. Hypnotizability was found to moderate anxiety reductions, but regardless of hypnotizability level participants, on average, experienced significant symptom improvement from baseline scores. These data provide initial support for the use of hypnosis to reduce symptoms of anxiety among postmenopausal women.Trial registration: This study was registered at ClinicalTrials.gov on February 11, 2011 under Identifier number NCT01293695 ( https://clinicaltrials.gov/ct2/show/NCT01293695?term=Elkins&cond=hot+flashes&draw=2&rank=2 ).

Feasibility of Attention Restoration Theory-Driven Hypnotherapy for Fatigue in Cancer Survivors.

This study aimed to assess the feasibility of Attention Restoration Theory (ART)-driven hypnotherapy to address cancer-related fatigue (CRF). Six participants with CRF completed the study. Participants completed measures of fatigue and pain pre- and posttreatment of 5 sessions of ART-driven hypnotherapy, each of which followed a treatment manual. Results indicate that participants experienced reductions in fatigue, fatigue bothersomeness, and pain following the intervention. Additionally, participants reported high levels of treatment satisfaction. This innovative intervention of ART-driven hypnotherapy appears to be feasible and warrants further study in a controlled trial with a larger sample.

Mindful Hypnotherapy to Reduce Stress and Increase Mindfulness: A Randomized Controlled Pilot Study.

The feasibility of mindful hypnotherapy (MH) intervention for stress reduction was investigated in a randomized trial. Forty-two college-age participants with elevated stress were randomized into MH intervention or wait-list control condition. MH participants completed an 8-week intervention with 1-hour individual sessions and self-hypnosis audio recordings for daily mindfulness. Results indicated excellent feasibility, determined by participant satisfaction, treatment adherence (84% compliance rate), and low rate of adverse events (4.5%). There were significant differences between the MH and control groups postintervention, with the mindful hypnotherapy intervention resulting in significant and large decrease in perceived distress, p < .001, 15.35 (1.54), Hedge's g = - 1.14, and increase in mindfulness, p < .001, 50.07 (2.04), Hedge's g = 1.36. This study indicates that MH is a feasible intervention for stress reduction and increasing mindfulness.

PSYCHOLOGICAL MINDEDNESS, ATTITUDES TOWARD HYPNOSIS, AND EXPECTANCY AS CORRELATES OF HYPNOTIZABILITY.

This study aimed to understand how psychological mindedness, attitudes toward hypnosis, and expectancy of hypnotizability are related to hypnotizability. Ninety-one undergraduate students were given measures pertaining to attitudes toward hypnosis, psychological mindedness, and self-ratings of expectancy of hypnotizability. The subjects were then administered the Elkins Hypnotizability Scale (EHS). Results demonstrated a significant correlation between participant scores on the EHS and the Attitudes Toward Hypnosis Scale (r = .401, p < .01) and self-ratings of expectancy of hypnotizability (r = .391, p < .01). The results of this study did not reveal any statistically significant correlations between psychological mindedness and hypnotizability (r = .113, p > .29) or expectancy of hypnotizability (r = .175, p > .10). Additional research is needed to fully understand the relationship between psychological mindedness and hypnotizability.