Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial

Background: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. Methods/design: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Alava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. Discussion: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients.

Growth and survival of sockeye salmon (Oncorhynchus nerka) from Karluk Lake and River, Alaska, in relation to climatic and oceanic regimes and indices, 1922–2000

We examined whether the relationship between climate and salmon production was linked through the effect of climate on the growth of sockeye salmon (Oncorhynchus nerka) at sea. Smolt length and juvenile, immature, and maturing growth rates were estimated from increments on scales of adult sockeye salmon that returned to the Karluk River and Lake system on Kodiak Island, Alaska, over 77 years, 1924–2000. Survival was higher during the warm climate regimes and lower during the cool regime. Growth was not correlated with survival, as estimated from the residuals of the Ricker stock-recruitment model. Juvenile growth was correlated with an atmospheric forcing index and immature growth was correlated with the amount of coastal precipitation, but the magnitude of winter and spring coastal downwelling in the Gulf of Alaska and the Pacific Northwest atmospheric patterns that influence the directional bifurcation of the Pacific Current were not related to the growth of Karluk sockeye salmon. However, indices of sea surface temperature, coastal precipitation, and atmospheric circulation in the eastern North Pacific were correlated with the survival of Karluk sockeye salmon. Winter and spring precipitation and atmospheric circulation are possible processes linking survival to climate variation in Karluk sockeye salmon.

Subclinical Depressive Symptoms and Continued Cannabis Use: Predictors of Negative Outcomes in First Episode Psychosis

Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (beta=4.45; 95% confidence interval [CI]: 1.78 to 11.17; P=.001) and with worse functioning (beta=-5.50; 95% CI: -9.02 to -0.33; P=.009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

The impacts of El Nino on Philippine fisheries

The El Nino phenomenon is an "anomalous climatic condition in the tropical Pacific region which occurs every two to seven years and affects the global climate". There is a greater increase in the water surface temperature of the eastern tropical and central tropical Pacific during an El Nino episode relative to that of the western tropical Pacific. The phenomenon causes fluctuations in rainfall, resulting in drought in some areas and heavy rainfall in others. During the El Nino of 1990-1992, the damage caused by the drought in the Philippines was estimated to be P4.1 billion (PhP24 = US$1). While the damage to agriculture is well documented, the impact on fisheries has not been considered. The impacts of the El Nino episode of 1997-1998 were assessed in the Philippines by the filed personnel of the Department of Agriculture and representatives of the private sector in the 15 regions of the country. Data on the losses caused by the phenomenon were obtained from interviews, surveys and reports of local government units and provincial agricultural offices for the period October 1997-June 1998. The effects of El Nino on aquaculture, marine fisheries and inland fisheries were determined.

Climatic factors associated with phytoplankton community succession during and after the 1977 drought for the San Francisco Bay-Delta Estuary [abstract]

Principal coordinates analysis and multiple regression analysis were used to determine the environmental factors associated with the decline in phytoplankton production during and after the 1977 drought for the San Francisco Bay-Delta Estuary. Physical, chemical and biological data were collected semimonthly or monthly during the spring-summer between 1973 and 1982 from 15 sampling sites located throughout the Bay-Delta. A decline in phytoplankton community diversity and density during the 1977 drought and subsequent years (1978 through 1981) was described using principal coordinates analysis. The best multiple regression which described the changes in phytoplankton community succession contained the variables water temperature, wind velocity and ortho-phosphate concentration. Together these variables accounted for 61 percent of the variation in the phytoplankton community among years described by principal coordinates analysis. An increase in water temperature, wind velocity and ortho-phosphate concentration within the Bay-Delta, beginning in June 1976 and continuing through 1981, was demonstrated using weighted moving averages. From the strong association between phytoplankton community succession and climatic variables it was hypothesized that the decline in phytoplankton production during and after the 1977 drought was associated with climatic changes within the northeast Pacific.

An overview of 1000 years of tropical climatic variability from ice cores from the Andes of southern Peru [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): Each summer between 1976 and 1984 research was conducted on the Quelccaya Ice Cap with one central objective, to recover an ice core to bedrock from which an approximate 1000 year climatic history for tropical South America could be reconstructed. In 1983 that central objective was accomplished by recovering one core 155 meters in length containing 1350 years and a second core of 163.6 meters containing more than 1500 years of climatic history. ... The most significant climatic event in tropical South America over the last 1500 years was the "Little Ice Age" which is recorded between 1490 to 1880 A.D. in these ice core records. Records from the summit of the Quelccaya Ice Cap show that during the "Little Ice Age" period there was (1) a general increase in particulates (both insoluble and soluble, starting around 1490 A.D. and ending abruptly in 1880 A.D.; (2) an initial increase in net accumulation (1500-1720 A.D.) followed by a period of decreased net accumulation (1720-1860 A.D.); (3) more negative delta-O-18 values beginning in the 1520's and ending around 1880 A.D. The "Little Ice Age" event is evident as a perturbation in all five ice core parameters.

Problems in estimating the response functions of natural climatic recording systems [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): High-resolution proxy records of climate, such as varves, ice cores, and tree-rings, provide the opportunity for reconstructing climate on a year-by-year basis. In order to do so it is necessary to approximate the complex nonlinear response function of the natural recording system using linear statistical models. Three problems with this approach were discussed, and possible solutions were suggested. Examples were given from a reconstruction of Santa Barbara precipitation based on tree-ring records from Santa Barbara County.

High-resolution natural recording systems: intercomparisons of the response to interannual climatic variability [abstract]

The goal of this work is to examine the properties of recording mechanisms which are common to continuously recording high-resolution natural systems in which climatic signals are imprinted and preserved as proxy records. These systems produce seasonal structures as an indirect response to climatic variability over the annual cycle. We compare the proxy records from four different high-resolution systems: the Quelccaya ice cap of the Peruvian Andes; composite tree ring growth from southern California and the southwestern United States; and the marine varve sedimentation systems in the Santa Barbara basin (off California, United States) and in the Gulf of California, Mexico. An important focus of this work is to indicate how the interannual climatic signal is recorded in a variety of different natural systems with vastly different recording mechanisms and widely separated in space. These high-resolution records are the products of natural processes which should be comparable, to some degree, to human-engineered systems developed to transmit and record physical quantities. We therefore present a simple analogy of a data recording system as a heuristic model to provide some unifying concepts with which we may better understand the formation of the records. This analogy assumes special significance when we consider that natural proxy records are the principal means to extend our knowledge of climatic variability into the past, beyond the limits of instrumentally recorded data.

Co-oscillation of a fjord basin’s circulation with decade-long oceanographic, hydrologic, and climatic regimes: Puget Sound 1916-'87 [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): Oceanographic, hydrologic, and climatic data collected during 1916-'87 in Puget Sound's Main Basin (~200 m x 5 km x 100 km) and approaches oscillate at low frequency between two regimes (I, II). The oscillation accounts for a large fraction of the interannual variability (41-75%) and the zero crossings between regimes span approximately a decade. ... The transition between regimes is accompanied by substantial changes in the horizontal pressure and density fields between the Pacific coast and the mixing zones leading to the Basin, as well as within the Basin itself.

Climatic indicators in an ice core from the Yukon [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): Stable isotope data obtained from snow and ice cores retrieved from an altitude of 5340m on Mt. Logan (60°30'N; 140°36'W) indicate that "isotopic seasons" are not generally in phase with calendar seasons. The former are phase lagged with respect to the latter by up to several months and appear to be correlated with SST'S and ocean heat transfer curves and/or the position of the Aleutian low rather than with air temperature or the temperature difference between the ocean surface and the core site.

Trans-Sierran climatic contacts during the last 12,000 years [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): The early-Holocene warm period, ca. 9000 years ago, is a realistic analog for the possible effects of greenhouse warming. At that time the vegetation of the western Sierra Nevada resembled that currently found east of the crest. ... Tourism, water supply, and the logging industry will be negatively effected if climate changes during the next century are in the direction and magnitude of those of the early Holocene. Increased precipitation in the eastern Sierra could offset some of the effects.

Associations among chlorophyll concentration and climatic variables for Suisun Bay and the Sacramento-San Joaquin Delta [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): The recent changes in phytoplankton production and community composition within the Suisun Bay and Sacramento-San Joaquin Delta may be related to climate. Chlorophyll a concentration, decreased by 42% (spring-summer) and 29% (fall) between 1972 through 1976 and 1977 through 1981. The decrease in biomass was characterized by a shift in phytoplankton community dominance from Skeletonema spp., Cyclotella spp. and Coscinodiscus spp. to Melosira granulata. The possible influence of climate on phytoplankton abundance was suggested by multivariate statistical analyses that demonstrated an association between changes in phytoplankton community composition and abundance between 1975 and 1982 and the climate related variables wind velocity, precipitation, river flow and water temperature.