RESUMO
BACKGROUND: Social anxiety disorder (SAD) is characterized by a marked fear of negative evaluation in social situations and significant impairments. Even with the most effective treatments, remission rates are around 50%. An important reason for the limited effectiveness of treatments is the lack of evidence-based explanation of how treatments work and what their active ingredients might be. An approach to unpack the active ingredients and mechanisms of treatment is the factorial design. OBJECTIVES: The study is a factorial trial aiming (1) to examine the main effects and interactions for the four main treatment components of internet-based cognitive-behavioral therapy (ICBT) for SAD (i.e., psychoeducation, cognitive restructuring, attentional training, and exposure) and (2) to examine whether and which change mechanisms mediate the relationship between treatment components and symptom reduction. METHODS: A total of 464 adults diagnosed with SAD will be randomized to one of 16 conditions containing combinations of the treatment components. The primary endpoint is SAD symptomatology at eight weeks. Secondary endpoints include symptoms of depression and anxiety, quality of life, and negative effects. Hypothesized change mechanisms are the increase of knowledge about SAD, the decrease of dysfunctional cognitions, the decrease of self-focused attention, and the decrease of avoidance and safety behaviors. DISCUSSION: A better understanding of the differential efficacy of treatment components and mechanisms of treatment underlying ICBT for SAD might inform clinicians and researchers to plan more potent and scalable treatments. TRIAL REGISTRATION: clinicaltrials.gov (NCT04879641) on June, 11th 2021. https://clinicaltrials.gov/ct2/show/NCT04879641.
RESUMO
The objective of this study was to determine the effect of soybean hulls (SBH) and/or calcium oxide (CaO) on rumen pH, digestibility, and performance of steers fed diets containing dried distillers grains with solubles (DDGS). In experiment 1, Angus × Simmental steers (n = 112, body weight [BW] = 364 ± 7.8 kg) were allotted to 1 of 4 diets arranged as a 2 × 2 factorial and placed in 16 pens (7 steers/pen, 4 pens/treatment, and 28 steers/treatment). Factors were SBH (0% or 30% of diet dry matter [DM]) and CaO (0% or 1%) inclusion. Basal diets contained 20% corn stover, 30% DDGS, and 4% supplement. Diets with SBH contained 14.1% or 15.0% corn and diets without SBH contained 43.9% or 44.8% corn. In experiment two, four steers (BW = 510 ± 9.8 kg) were allotted to a 4 × 4 Latin square (21 d periods) to determine the effects of CaO and SBH on ruminal pH, volatile fatty acid (VFA), nutrient digestibility, and digestion kinetics. Statistical analyses were conducted using the MIXED procedure of SAS. In experiment 1, BW did not differ among treatments (P ≥ 0.46). Overall carcass-adjusted gain did not differ due to SBH or CaO inclusion (P ≥ 0.13); however, there was an interaction (P = 0.01) where CaO improved gain in steers fed no SBH, but not in steers fed SBH. Steers fed SBH consumed more DM than steers not fed SBH (P = 0.02) and an interaction tended to occur (P = 0.06) where CaO increased dry matter intake in steers fed no SBH, but not in steers fed SBH. Calcium oxide increased hot carcass weight and yield grade (interaction; P ≤ 0.04) and tended to increase fat thickness (interaction; P = 0.08) in steers fed no SBH, but not in steers fed SBH. Dressing percentage, longissimus muscle area, % kidney, pelvic, heart fat, and marbling score did not differ among treatments (P ≥ 0.14). Total VFA concentrations were greater with SBH inclusion and with CaO addition (P < 0.01). Digestibility of DM, neutral detergent fiber (NDF), and acid detergent fiber (ADF) was greater with CaO addition (P ≤ 0.04) and NDF and ADF digestibility were greater with SBH inclusion (P < 0.001). Inclusion of SBH did not affect (P ≥ 0.26) rate of digestion (k d) or passage (k p). Addition of CaO tended to increase mean retention time (P = 0.09). An interaction between SBH inclusion and CaO addition occurred for k d (P = 0.01), where CaO increased k d in steers fed SBH, but decreased k d when steers were fed no SBH. Total N excretion tended to be lower with SBH inclusion and CaO addition (P = 0.07). In conclusion, CaO enhances performance of cattle fed corn, DDGS, and corn stover diets, but not when corn is partially replaced by a fiber-based energy feed.