Cognitive Remediation in early psychosis and in at-risk mental states – Approaches and efficacy

Cognitive Remediation approaches have proven to be effective in enhancing cognitive functions and psychosocial outcomes in multi-episode schizophrenia patients. However, there is a paucity of studies evaluating Cognitive Remediation in first-episode psychosis patients and in those symptomatically at-risk for psychosis. This is despite the growing evidence that impairments in neuro- and social-cognitive functions are already present in early psychosis and even in at-risk mental states and are important predictors of poor outcome, including transition to psychosis. Moreover, Cognitive Remediation applied at younger ages and at earlier stages of schizophrenia yielded greater cognitive and functional gains. Therefore, Cognitive Remediation may be especially appropriate for early intervention. Against this background, we will review and discuss the efficacy of current Cognitive Remediation approaches in early psychosis and in at-risk mental states. Furthermore, we will present novel interventions that are tailored to the specific needs and developmental tasks of patients at-risk for psychosis and aim at improving social and self-referential cognitions as well as interpersonal skills

Significance of social cognitive remediation therapy within a comprehensive treatment concept

Objectives: The final goal in the successful treatment of schizophrenia patients is defined in improved functional recovery. Thus the integration of social cognitive tasks within a comprehensive treatment concept should offer significant advantages in generalization and transfer of therapy effects. Recent therapy outcome research supports these advantages. Empirical modeling identified social cognition as a mediating factor between neurocognition and functional recovery. Regarding this, we first developed the Integrated Psychological Therapy Program (IPT). It consists of 5 subprograms and combines interventions on neurocognition, social cognition, and social competence. As a further development of the cognitive part of IPT we developed the Integrated Neurocognitive Therapy (INT), which focuses on all social and neurocognitive domains defined by MATRICS. Methods: The aim was to investigate whether the application of the complete IPT is superior in comparison to the use of single IPT subprograms. Data were based on 37 independent IPT studies including a total sample of 1692 schizophrenia patients. Additionally, the proximal outcome in cognitive domains as well as in more distal outcome areas was investigated in an international RCT on INT including 169 schizophrenia outpatients. Results: All IPT subprogram variations obtained significant effects in proximal outcome. Each subprogram domain reached the largest effects in the targeted area. With regard to distal outcomes, combinations of subprograms showed a significant reduction of negative symptoms and an improvement in not targeted areas of functioning. This strongly supports vertical generalization effects to other functional domains. Regarding INT, results support efficacy compared to TAU in various cognitive domains, in psychosocial functioning and symptoms after therapy and at 1-year-follow-up. Conclusion: Results support evidence for the efficacy of longer lasting integrated therapy. The success of these treatment concepts is strongly based on successful therapy of social cognitive functions.

"Two hundred ninety-four": Remediation and multimodal performance in tourist placemaking

We offer here a multimodal discourse analysis of a range of verbal (writing and speech), nonverbal (movement and gesture) and technological (photography and video) resources used by tourists at the Leaning Tower of Pisa. In doing so, we pin-point the recycling and layering of mediatized representations (e.g. guidebooks and official brochures), mediated actions (e.g. climbing the Tower or posing in front of it), and remediated practices (e.g. posting a YouTube video of oneself climbing the 294 steps to the top of the Tower). Through this kind of empirically-based examination of tourists’ discursive and embodied performances – their ways of talking about and behaving in spaces – we witness how people never simply visit places but are always actively shaping and making these places. The Leaning Tower of Pisa is, therefore, as much an emergent production of the tourist imagination as it is a pre-existing, lop-sided construction of stone.

Cognitive remediation therapy: Does it generalize to significant outcome areas?

Objective: Cognitive remediation therapy (CRT) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia. However, there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome and negative symptoms. Method: This 8-site randomized controlled trial evaluated the efficacy of a novel cognitive-behavioral group therapy approach called integrated neurocognitive therapy (INT). INT includes manual-based exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative by compensation and restitution. One hundred and fifty-six outpatients with a diagnosis of schizophrenia or schizoaffective disorder accord- ing to DSM-IV-TR were randomly assigned to receive 15 weeks of INT or treatment as usual (TAU). INT patients received 30 bi-weekly therapy sessions. Each session lasted 90min. Mixed models were applied to assess changes in neurocognition, social cognition, symptoms, and functional outcome at post-treatment and at 9-month follow-up. Results: Compared to TAU, INT patients showed significant improvements on multiple neuro- and social-cognitive domains, negative symptoms, and functional outcome after therapy and at 9-month follow-up. Number-needed-to-treat analyses indicate that only five INT patients are necessary to produce durable and meaningful improvements in functional outcome. Conclusions: Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome and negative symptoms. These findings are important as treatment guidelines for schizophrenia have criticized CRT for their poor generalization effects.

Differential effectiveness of integrated cognitive remediation therapy for schizophrenbia outpatients: The impact oft he duration of illness

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation (CR). To date, only limited evidence is available about the impact of the duration of illness on CR effects. The Integrated Neurocognitive Therapy (INT) represents a new developed CR approach. It is a manualized group therapy targeting all 11 NIMH-MATRICS domains. Methods In an international multicenter study, 166 schizophrenia outpatients (DSM-IV-TR) were randomly assigned either to INT or to Treatment-As-Usual (TAU). 60 patients were defined as Early Course group (EC) characterized by less than 5 years of illness, 40 patients were in the Long-Term group (LT) characterized by more than 15 years of illness, and 76 patients were in the Medium-Long-Term group (MLT) characterized by an illness of 5-15 years. Treatment comprised of 15 biweekly sessions. Assessments were conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) examined our hypothesis, whether EC, LT, and MLT groups differ under INT and TAU from each other in outcome. Results First of all, the attendance rate of 65% was significantly lower and the drop out rate of 18.5% during therapy was higher in the EC group compared to the other groups. Interaction effects regarding proximal outcome showed that the duration of illness has a strong impact on neurocognitive functioning in speed of processing (F>2.4) and attention (F>2.8). But INT intervention compared to TAU only had a significant effect in more chronically ill patients of MLT and LT, but not in younger patients in EC. In social cognitive domains, only the EC group showed a significant change in attribution (hostility; F>2.5), LT and MLT groups did not. However, no differences between the 3 groups were evident in memory, problem solving, and emotion perception. Regarding more distal outcome, LT patients had more symptoms compared to EC (F>4.4). Finally, EC patients showed higher improvements in psychosocial functioning compared to LT and MLT (F=1.8). Conclusions Against common expectations, long-term, more chronically ill patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). On the other hand, early-course patients had a greater potential to change in attribution, symptoms and psychosocial functioning. Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

Minding the 3 R's: Response, Remediation and Restoration

Working with CT DEP, the NOAA Office of Damage Assessment, Remediation and Restoration uses funds recovered from polluters to conduct restoration projects. Here in Connecticut, projects include the Jordan Brook Fishway in Waterford, the Remington Gun Club site at Lordship Point in Stratford, and more.

Perchlorate remediation technologies: A systematic review of solely biodegradation versus a combination of ion-exchange and biodegradation technologies

A systematic review was performed in order to evaluate perchlorate remediation technologies. The two included technologies were ion-exchange concerted with biodegradation and solely biodegradation. A meta-analysis was completed and subsequently, a regression model was formed to conduct a degradation rate analysis and to depict the association between rate and various dependent variables (salinity/sali, nitrate concentration/nitc and carbon source concentration/csou). The outcome of the model analysis suggested that salt concentration did have an effect on the degradation rate in the ion-exchange process and that with a salt concentration greater than or equal to 18.6 g/L, the biodegradation process will produce a greater reduction of perchlorate than ion-exchange concerted with biodegradation. However, when a t-test examined the difference in perchlorate degradation rate between the two cleanup methods, there was no significant difference seen (p=0.7351, α = 0.05).^

Remediation of feedlot effluents using aquatic plants

Feedlots have increased in several regions of Argentina, particularly in the Pampas. The absence of adequate treatments of the effluents produced in these establishments creates serious problems to the society. Phytoremediation can be defined as inexpensive and environmentally sustainable strategy used to remove pollutants by plants. The aim of this study was to evaluate the remediation potential of two macrophyte species (Eichhornia crassipes and Hydrocotyle ranunculoides) on a feedlot effluent. This effluent was treated with these species for 31 days. Control and macrophyte treatments decreased dissolved inorganic nitrogen (DIN), Kjeldahl nitrogen (Kj N), biological oxygen demand (BOD), chemical oxygen demand (COD), total dissolved salts (TDS), total phosphorus (TP), Pb, Zn and Cr levels. At macrophyte treatments, relatively constant pH levels were kept and decreased EC and TDS values were obtained compared to control, mitigating the release of contaminants and potential greenhouse gases to the atmosphere. Moreover, significant increases in biomass were obtained, being higher in E. crassipes. The results allow concluding that the presence of aquatic plants increases the removal rates of nutrients, organic matter and heavy metals from wastewater in approximately 10-17 days for a feedlot effluent with high organic load.

Remediation of crude oil contaminated soils by means of bitumen emulsions

Effective remediation of contaminated sites with oils, heavy metals and other chemical agents is one of the most important environmental problems all over the world. Contaminated soils by petroleum from different sites and origins, might contaminate groundwater aquifers and then be spread by rain. Many years and the requirement of remedial techniques may be needed to remediate them. However, previous experiences show the uselessness of these methods for the solution of all problems. As any case of soil contamination is different, specific studies with relevant factors at financial aspects, legal limits and waste and soil characteristics are needed. In this work, a study of the use of bitumen asphalt emulsion to remediate contaminated soils by crude oils is exposed. By means of the soil stabilization technology, using the contaminated soils as aggregates and the tailor made emulsion as binder, the feasibility of the mix application to produce stable and resistant pavements is demonstrated

A fuzzy MCDA framework for safety assessment in the remediation of a uranium mill tailings site in Ukraine

The Pridneprovsky Chemical Plant was one of the largest uranium processing enterprises in the former USSR, producing a huge amount of uranium residues. The Zapadnoe tailings site contains most of these residues. We propose a theoretical framework based on multicriteria decision analysis and fuzzy logic to analyze different remediation alternatives for the Zapadnoe tailings, which simultaneously accounts for potentially conflicting economic, social and environmental objectives. We build an objective hierarchy that includes all the relevant aspects. Fuzzy rather than precise values are proposed for use to evaluate remediation alternatives against the different criteria and to quantify preferences, such as the weights representing the relative importance of criteria identified in the objective hierarchy. Finally, we suggest that remediation alternatives should be evaluated by means of a fuzzy additive multi-attribute utility function and ranked on the basis of the respective trapezoidal fuzzy number representing their overall utility.

Fuzzy MCDA for remediation of a uranium tailing

The Pridneprovsky Chemical Plant was a largest uranium processing enterprises, producing a huge amount of uranium residues. The Zapadnoe tailings site contains the majority of these residues. We propose a theoretical framework based on Multi-Criteria Decision Analysis and fuzzy logic to analyse different remediation alternatives for the Zapadnoe tailings, in which potentially conflicting economic, radiological, social and environmental objectives are simultaneously taken into account. An objective hierarchy is built that includes all the relevant aspects. Fuzzy rather than precise values are proposed for use to evaluate remediation alternatives against the different criteria and to quantify preferences, such as the weights representing the relative importance of criteria identified in the objective hierarchy. Finally, it is proposed that remediation alternatives should be evaluated by means of a fuzzy additive multi-attribute utility function and ranked on the basis of the respective trapezoidal fuzzy number representing their overall utility.

Characterization of complex mineral assemblages: Implications for contaminant transport and environmental remediation

Surface reactive phases of soils and aquifers, comprised of phyllosilicate and metal oxohydroxide minerals along with humic substances, play a critical role in the regulation of contaminant fate and transport. Much of our knowledge concerning contaminant-mineral interactions at the molecular level, however, is derived from extensive experimentation on model mineral systems. Although these investigations have provided a foundation for understanding reactive surface functional groups on individual mineral phases, the information cannot be readily extrapolated to complex mineral assemblages in natural systems. Recent studies have elucidated the role of less abundant mineral and organic substrates as important surface chemical modifiers and have demonstrated complex coupling of reactivity between permanent-charge phyllosilicates and variable-charge Fe-oxohydroxide phases. Surface chemical modifiers were observed to control colloid generation and transport processes in surface and subsurface environments as well as the transport of solutes and ionic tracers. The surface charging mechanisms operative in the complex mineral assemblages cannot be predicted based on bulk mineralogy or by considering surface reactivity of less abundant mineral phases based on results from model systems. The fragile nature of mineral assemblages isolated from natural systems requires novel techniques and experimental approaches for investigating their surface chemistry and reactivity free of artifacts. A complete understanding of the surface chemistry of complex mineral assemblages is prerequisite to accurately assessing environmental and human health risks of contaminants or in designing environmentally sound, cost-effective chemical and biological remediation strategies.

Radon gas. Environmental concentration measures and remediation actions in exposed buildings

The main contribution to the radiological impact from natural radiation received by general population is due to the emission of radon (222Rn). The objective of this project is the study of radon gas as a radioactive element in our buildings (existing and future constructions) to avoid its influence in interior rooms. The proposed methodology reflects different aspects of natural radioactivity in buildings, their sources, their control criteria and regulatory framework; aspects related to the presence of radon in our constructions, entryways, measurement methodology for indoor environmental concentration are studied; other protection solutions and remediation measures in both existing buildings and new construction projects are analyzed. In conclusion, the paper presents previous evaluation tools, the analysis of existing concentration and the choice of the most appropriate mitigation / remediation measures depending on each case, through the establishment of different architectural proposals to plan actions against radon where necessary.

Basics of pump-and-treat ground-water remediation technology /

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