State of the art of integrated therapy approaches in the treatment of schizophrenia: empirical evidence and clinical relevance

Objective: Integrated behavior therapy approaches are defined by the combination of behavioral and or cognitive interventions targeting neurocognition combined with other goal-oriented treatment targets such as social cognition, social skills, or educational issues. The Integrated Psychological Therapy Program (IPT) represents one of the very first behavior therapy approaches combining interventions of neurocognition, social cognition, and social competence. This comprehensive group-based bottom-up and top-down approach consists of five subprograms, each with incremental steps. IPT has been successfully implemented in several countries in Europe, America, Australia and in Asia. IPT worked as a model for some other approaches designed in the USA. IPT was undergone two further developments: based on the social competence part of IPT, the three specific therapy programs focusing residential, occupational or recreational topics were developed. Recently, the cognitive part of INT was rigorously expanded into the Integrated Neurocognitive Therapy (INT) designed exclusively for outpatient treatment: INT includes interventions targeting all neurocognitive and social cognitive domains defined by the NIMH-MATRICS initiative. These group and partially PC-based exercises are structured into four therapy modules, each starting with exercises on neurocognitive domains followed by social cognitive targets. Efficacy: The evidence of integrated therapy approaches and its advantage compared to of one-track interventions was becoming a discussion tool in therapy research as well as in mental health systems. Results of meta-analyses support superiority of integrated approaches compared to one-track interventions in more distal outcome areas such as social functioning. These results are in line with the large body of 37 independent IPT studies in 12 countries. Moreover, IPT research indicates the maintenance of therapy effects after the end of therapy and some evidence generalization effects. Additionally, the international randomized multi-center study on INT with 169 outpatients strongly supports the successful therapy of integrated therapy in proximal and distal outcome such as significant effects in cognition, functioning and negative symptoms. Clinical implication: therapy research as well as expert’s clinical experience recommends integrated therapy approaches such as IPT to be successful agents within multimodal psychiatric treatment concepts. Finally, integrated group therapy based on cognitive remediation seems to motivate and stimulate schizophrenia inpatients and outpatients to more successful and independent life also demanded by the recovery movement.

Evaluation of the diagnostic value of the ELISA tests developed by using EgHF, Em2 and EmII/3-10 antigens in the serological diagnosis of alveolar echinococcosis

Alveolar echinococcosis (AE), caused by larva stage of Echinococcus multilocularis, is one of the lethal parasitic diseases of man and a major public health problem in many countries in the northern hemisphere. When the living conditions and habits in Turkey were considered in terms of relation with the life cycle of the parasite, it was suggested that AE has been much more common than reported mainly from the Eastern Anatolia region of Turkey. Since in vitro serologic diagnosis tests with high specificity for AE have not been used in our country, most of the cases with liver lesions were misdiagnosed by radiological investigations as malignancies. The aim of this study was to evaluate the diagnostic value of the in-house ELISA methods developed by using three different antigens (EgHF, Em2, EmII/3-10) in the serological diagnosis of AE. The study samples included a total of 100 sera provided by Bern University Parasitology Institute where samples were obtained from patients with helminthiasis and all were confirmed by clinical, parasitological and/or histopathological means. Ten samples from each of the cases infected by E.multilocularis, E.granulosus, Taenia solium, Wuchereria bancrofti, Strongyloides stercolaris, Ascaris lumbricoides, Toxocara canis, Trichinella spiralis, Fasciola hepatica and Schistosoma haematobium were studied. In the study, EgHF (E.granulosus hydatid fluid) antigens were prepared in our laboratory from the liver cyst fluids of sheeps with cystic echinococcosis, however Em2 (E.multilocularis metacestode-purified laminated layer) and EmII/3-10 (E.multilocularis recombinant protoscolex tegument) antigens were provided by Bern University Parasitology Institute. Flat bottom ELISA plates were covered with EgHF, Em2 and EmII/3-10 antigens in the concentrations of 2.5 µg, 1 µg and 0.18 µg per well, respectively, and all sera were tested by EgHF-ELISA, Em2-ELISA and EmII/3-10-ELISA methods. For each tests, the samples which were reactive above the cut-off value (mean OD of negative controls+2 SD) were accepted as positive. The sensitivity of the ELISA tests performed with EgHF, Em2 and Em2II/3-10 antigens were estimated as 100%, 90% and 90%, respectively, whereas the specificity were 63%, 91% and 91%, respectively. When Em2-ELISA and EmII/3-10-ELISA tests were evaluated together, the specificity increased to 96%. Our data indicated that the highest sensitivity (100% with EgHF-ELISA) and specificity (96% with Em2-ELISA + EmII/3-10-ELISA) for the serodiagnosis of AE can be achieved by the combined use of the ELISA tests with three different antigens. It was concluded that the early and accurate diagnosis of AE in our country which is endemic for that disease, could be supported by the use of highly specific serological tests such as Em2-ELISA ve EmII/3-10-ELISA contributing radiological data.

Drilling into debris-rich basal ice at the bottom of the NEEM (Greenland) borehole

After the NEEM (Greenland) deep ice-core drilling was declared terminated with respect to developing stratigraphic climate reconstructions, efforts were turned toward collecting basal ice-sheet debris and, if possible, drilling into the bedrock itself. In 2010, several meters of banded debris-rich ice were obtained under normal ice-drilling operations with the NEEM version of the Hans Tausen (HT) drill, but further penetration was obstructed by a rock in the path of the drill head at 2537.36 m. During short campaigns in 2011 and 2012, attempts were made to penetrate further using various reinforced ice cutters mounted on the HT drill head, tailored to cut through rock. These had some success in penetrating coarse material, but produced severely damaged cutters. Additionally a 51 mm diameter diamond cutting tipped rock drill was adapted to fit the NEEM drill. With this device, several additional meters of core containing subglacial sediments, rocks and rock fragments were collected. With these tools 1.39 m of additional material were obtained during the 2011 field season, and 7.1 m during 2012. Subglacial water refreezing into the newly formed borehole hindered further penetration, and the bedrock interface was not reached before final closure of the NEEM Camp.

The bottom-quark mass from non-relativistic sum rules at NNNLO

We determine the mass of the bottom quark from high moments of the bbproduction cross section in e+e−annihilation, which are dominated by the threshold region. On the theory side next-to-next-to-next-to-leading order (NNNLO) calculations both for the resonances and the continuum cross section are used for the first time. We find mPSb(2GeV) =4.532+0.013−0.039GeVfor the potential-subtracted mass and mMSb(mMSb) =4.193+0.022−0.035GeVfor the MSbottom-quark mass.

Complementary passive hydrotherapy WATSU (WaterShiatsu) in the rehabilitation of a severely traumatized accident survivor – A prospective case report

Introduction: The implementation of complementary and alternative therapies into conventional treatment schemes is gaining popularity. However, their use is widely depending on patients’ drive. This case-report focuses on a patient’s experience of the integration of WATSU (WaterShiatsu) in rehabilitative care. Methods: Patient: A 52 year old woman survived a severe motorcycle-accident in which she sustained several fractures on the right side of her body, including ribs, pelvis, and femur. After discharge from stationary care, she independently added WATSU to her rehabilitative regimen. Treatment approach: WATSU is a passive form of hydrotherapy in warm water that aims at relaxation, pain relief, and a sense of secureness. In the reported case, an experienced WATSU-therapist who is also trained in physiotherapy and psychosomatics delivered weekly sessions of one hour duration. Measures used: Qualitative data were collected by patient’s diary. Also the therapist’s notes including The Patient Specific Functional Scale (PSFS) were considered. Results: The patient associated WATSU with trunk mobilization (followed by ameliorated breath), reconciliation with her body, and emotional discharge. She ascribed WATSU lasting effects on her body-image. The therapist employed WATSU for careful mobilization and to equalize awareness throughout the body. The PSFS displayed continuous improvement in all categories except usage of public transportation. Due to complications (elevated inflammation markers) only 6 of 8 scheduled sessions were administered. Conclusions: WATSU was experienced helpful in approaching conditions that are difficult to address by conventional physiotherapy. In early rehabilitation, additional medical/physiotherapeutic skills of contributing complementary therapists are advocated.

Famine responses in the world food crisis 1972–5 and the World Food Conference of 1974

In the early 1970s, there was scarcity in the world grain market, soaring prices and famines in several countries of Asia and Africa. The commercial grain trade was expanded at the expense of food aid. After a brief look at policies addressing the situation in terms of modernised methods of agricultural production for small producers, the article sketches how such policies also affected relief efforts, from the low availability for food aid, the provision of food that was not useful and late deliveries through efforts to tie food aid to local changes in agricultural production and settlement patterns. In part, food aid thus reinforced processes of social differentiation that had contributed to causing the famines in the first place.

Sedimentological and biostratigraphical analyses of short sediment cores from Hagelseewli (2339 m a.s.l.) in the Swiss Alps

Several short sediment cores of between 35 and 40 cm from Hagelseewli, a small, remote lake in the Swiss Alps at an elevation of 2339 m a.s.l. were correlated according to their organic matter content. The sediments are characterized by organic silts and show in their uppermost part a surprisingly high amount of organic matter (30-35%). Synchronous changes, occurring in pollen from snow-bed vegetation, the alga Pediastrum, chironomids, and grain-size composition, point to a climatic change interpreted as cooler or shorter summers that led to prolonged ice-cover on the lake. According to palynological results the sediments date back to at least the early 15th century A.D., with the cooling phase encompassing the period between late 16th and the mid-19th century thus coinciding with the Little Ice Age. Low concentrations of both chironomid head capsules and cladoceran remains in combination with results from fossil pigment analyses point to longer periods of bottom-water anoxia as a result of long-lasting ice-cover that prevented mixing of the water column. According to our results aquatic biota in Hagelseewli are mainly indirectly influenced by climate change. The duration of ice-cover on the lake controls the mixing of the water column as well as light-availability for phytoplankton blooms.

Prevalence and Risk Factors for Therapy Escalation in Ulcerative Colitis in the Swiss IBD Cohort Study.

BACKGROUND Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors. METHODS Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy. RESULTS Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery. CONCLUSIONS The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.

Securing one's livelihood. Philanthropy in a mixed economy of welfare in the early 20th century

Since the late 19th century different social actors have played an important role in providing social security in Switzerland. Cooperatives, philanthropic organisations, social insurances, and the poor relief of the communes were all part of a "mixed economy of welfare". This article examines how the different actors in this "mixed economy" worked together, and asks what forms of help they supplied. It raises the question of whether a dichotomy between public and private forms of relief can be traced in the Swiss case. Did democratically legitimised processes of redistribution shape the social security system? Or was social security rather funded by private relief programs? The author argues that in the early 20th century, a complex public-private mix structured the Swiss welfare state and the poor often depended on both public and private funding. In this system, financially potent philanthropic organisations successfully contested the legal power of public actors.

Patterns of landscape form in the upper Rhône basin, Central Swiss Alps, predominantly show lithologic controls despite multiple glaciations and variations in rock uplift rates

The development of topography depends mainly on the interplay between uplift and erosion. These processes are controlled by various factors including climate, glaciers, lithology, seismic activity and short-term variables, such as anthropogenic impact. Many studies in orogens all over the world have shown how these controlling variables may affect the landscape's topography. In particular, it has been hypothesized that lithology exerts a dominant control on erosion rates and landscape morphology. However, clear demonstrations of this influence are rare and difficult to disentangle from the overprint of other signals such as climate or tectonics. In this study we focus on the upper Rhône Basin situated in the Central Swiss Alps in order to explore the relation between topography, possible controlling variables and lithology in particular. The Rhône Basin has been affected by spatially variable uplift, high orographically driven rainfalls and multiple glaciations. Furthermore, lithology and erodibility vary substantially within the basin. Thanks to high-resolution geological, climatic and topographic data, the Rhône Basin is a suitable laboratory to explore these complexities. Elevation, relief, slope and hypsometric data as well as river profile information from digital elevation models are used to characterize the landscape's topography of around 50 tributary basins. Additionally, uplift over different timescales, glacial inheritance, precipitation patterns and erodibility of the underlying bedrock are quantified for each basin. Results show that the chosen topographic and controlling variables vary remarkably between different tributary basins. We investigate the link between observed topographic differences and the possible controlling variables through statistical analyses. Variations of elevation, slope and relief seem to be linked to differences in long-term uplift rate, whereas elevation distributions (hypsometry) and river profile shapes may be related to glacial imprint. This confirms that the landscape of the Rhône Basin has been highly preconditioned by (past) uplift and glaciation. Linear discriminant analyses (LDAs), however, suggest a stronger link between observed topographic variations and differences in erodibility. We therefore conclude that despite evident glacial and tectonic conditioning, a lithologic control is still preserved and measurable in the landscape of the Rhône tributary basins.

Human–climate interactions in the central Mediterranean region during the last millennia: The laminated record of Lake Butrint (Albania)

Lake Butrint (39°47 N, 20°1 E) is a ca. 21 m deep, coastal lagoon located in SW Albania where finely-laminated sediments have been continuously deposited during the last millennia. The multi-proxy analysis (sedimentology, high-resolution elemental geochemistry and pollen) of a 12 m long sediment core, supported by seven AMS radiocarbon dates and 137Cs dating, enable a precise reconstruction of the environmental change that occurred in the central Mediterranean region during the last ∼4.5 cal kyrs BP. Sediments consist of triplets of authigenic carbonates, organic matter and clayey laminae. Fluctuations in the thickness and/or presence of these different types of seasonal laminae indicate variations in water salinity, organic productivity and runoff in the lake's catchment, as a result of the complex interplay of tectonics, anthropogenic forcing and climate variability. The progradation of the Pavllo river delta, favoured by variable human activity from the nearby ancient city of Butrint, led to the progressive isolation of this hydrological system from the Ionian Sea. The system evolved from an open bay to a restricted lagoon, which is consistent with archaeological data. An abrupt increase in mass-wasting activity between 1515 and 1450 BC, likely caused by nearby seismic activity, led to the accumulation of 24 homogenites, up to 17 cm thick. They have been deposited during the onset of finely laminated sedimentation, which indicates restricted, anoxic bottom water conditions and higher salinity. Periods of maximum water salinity, biological productivity, and carbonate precipitation coincide with warmer intervals, such as the early Roman Warm Period (RWP) (500 BC–0 AD), the Medieval Climate Anomaly (MCA) (800–1400 AD) and recent times (after 1800 AD). Conversely, lower salinity and more oxic conditions, with higher clastic input were recorded during 1400–500 BC, the Late Roman and the Early Medieval periods (0–800 AD) and during the Little Ice Age (1400–1800 AD). Hydrological fluctuations recorded in Butrint are in phase with most central and western Mediterranean records and correlate with NAO variability. In contrast, opposite hydrological patterns have been recorded in the Eastern Balkans and the Levant during the last millennium, emphasizing a complex spatial variability in the region. Phases of maximum settlement intensity in Butrint (Roman-Late Antique) coincide with warmer and/or stable climate periods (0–800 AD and MCA, respectively), indicating a long-term influence of climatic conditions on human activities. The Late Holocene sedimentary record of Lake Butrint demonstrates the complex interplay of climate variability, tectonics and human impact in the recent evolution of coastal Mediterranean regions.

Biological and physical controls in the Southern Ocean on past millennial-scale atmospheric CO2 changes

Millennial-scale climate changes during the last glacial period and deglaciation were accompanied by rapid changes in atmospheric CO2 that remain unexplained. While the role of the Southern Ocean as a ’control valve’ on ocean–atmosphere CO2 exchange has been emphasized, the exact nature of this role, in particular the relative contributions of physical (for example, ocean dynamics and air–sea gas exchange) versus biological processes (for example, export productivity), remains poorly constrained. Here we combine reconstructions of bottom-water [O2], export production and 14C ventilation ages in the sub-Antarctic Atlantic, and show that atmospheric CO2 pulses during the last glacial- and deglacial periods were consistently accompanied by decreases in the biological export of carbon and increases in deep-ocean ventilation via southern-sourced water masses. These findings demonstrate how the Southern Ocean’s ’organic carbon pump’ has exerted a tight control on atmospheric CO2, and thus global climate, specifically via a synergy of both physical and biological processes.