Everybody has won and all must have prices

This dissertation presents four articles as part of the Improve Project (project 100019_159425) funded by the Swiss National Science Foundation (SNSF) and granted to Franz Caspar as principal investigator and Thomas Berger and Martin grosse Holtforth as co-applicants. The Improve Project is concerned with psychotherapy integration and investigates the effects of combining Bernese cognitive-behavioral therapy (CBT) with elements of emotion-focused therapy (EFT) or aspects of self-regulation theory (SR) in a randomized controlled trial with add-on design. The project falls in the category of assimilative integration, which reflects common integrative practice but lacks empirical support. Previous research and research gaps are presented which the Improve Project and this dissertation aim to fill. Article one of this dissertation presents the study protocol of the Improve Project. Article two describes a study examining the therapeutic adherence to the two treatment conditions CBT + EFT and CBT + SR. Article three, a meta-analysis, was conducted to evaluate the current state of research on defense mechanisms in longitudinal studies. Article four presents a study investigating change in defense mechanisms over the course of psychotherapy depending on treatment condition and diagnostic group. An introduction to the topic of psychotherapy integration is followed by the four articles. On the basis of the presented results, possibilities and limitations of this dissertation are discussed and an outlook for future research in the field of psychotherapy integration is given. Bridging the gap between research and practice may well produce treatments that are rooted in both clinical reality and empirical validation

Could Mesophyte Canopy, Bark, and Leaf Litter Traits Drive Future Flammability of Upland Oak Forests?

In the absence of canopy-opening disturbances, upland oak forests in the eastern United States are shifting to shade-tolerant, fire-sensitive tree species (i.e. mesophytes) via a hypothesized positive feedback loop of less flammable, self-promoting conditions, termed mesophication. To evaluate species-specific impacts on mesophication, I quantified canopy, bark, and leaf litter traits of five hypothesized mesophytes [red maple (Acer rubrum), sugar maple (A. saccharum), American beech (Fagus grandifolia), hickory (Carya spp.), and tulip poplar (Liriodendron tulipifera)] and four upland oaks [black oak (Quercus velutina), chestnut oak (Q. montana), scarlet oak (Q. coccinea), and white oak (Q. alba)] in central Kentucky. Red maple, sugar maple, and American beech had increased canopy depth with stem size, smoother bark, and small, thin leaves when compared to oaks. My findings suggest that some mesophytes, such as red maple, sugar maple, and American beech, may decrease future forest flammability by reducing understory light and increasing fuel moisture

Mehr Unzufriedenheit mit der Öffentlichen Sicherheit im vereinten Deutschland: eine Zusammenstellung objektiver und subjektiver Indikatoren zur Kriminalität

'In jeder Gesellschaft ist ein gewisses Ausmaß von Kriminalität normal. Steigt die Kriminalität jedoch ungewöhnlich oder stetig an, so kann dies als Indikator für eine Beeinträchtigung der Lebensqualität angesehen werden. Die Beschreibung der Sicherheitslage durch die amtliche Kriminalberichterstattung reicht jedoch zur Beurteilung der Wohlfahrtsminderung durch Kriminalität nicht aus. Die Zufriedenheit der Bürger mit dem Schutz vor Kriminalität, die Beunruhigung über Kriminalität sowie das Gefühl persönlicher Bedrohung sind dafür ebenfalls von Bedeutung. Die Gegenüberstellung objektiver und subjektiver Indikatoren der Kriminalität zeigt, daß die Wahrnehmung der Öffentlichen Sicherheit nicht in Übereinstimmung mit der Entwicklung und Verteilung der faktischen Kriminalbelastung stehen muß.' (Autorenreferat

Asymmetrische Information auf Immobilien- und Hypothekenmärkten

Die Entscheidung eines Haushaltes eine Wohnimmobilie zu kaufen oder zu mieten ist seit über 30 Jahren Gegenstand immobilienwirtschaftlicher Forschung. Diese Entscheidung wird von vielen Faktoren beeinflusst, wie z.B. Portfolioentscheidungen, Zugang zu Hypothekenmärkten, persönlichen Erfahrungen und Einstellungen der privaten Haushalte sowie asymmetrische Information. Aus der Bandbreite der Informationsasymmetrien wird in dieser Dissertation der individuelle Nutzungsgrad der Haushalte als zentraler Bestandteil in die behandelten Modelle integriert. Der Nutzungsgrad stellt einen Gradmesser dar, wie schnell und intensiv die Haushalte ihre Immobilie abnutzen. Empirische Arbeiten von Galster (1983), Shilling u.a. (1991) und Gatzlaff u.a. (1998) haben die Existenz von heterogenen Nutzungsgraden bestätigt. In der Literatur zu Mietmärkten sind heterogene Nutzungsgrade seit jeher Gegenstand der Forschung, in Hypothekenmarktmodellen haben sie bisher noch keine Berücksichtigung gefunden. In Teil II werden zwei verschiedene Modelle zu Wohnimmobilienmärkten entwickelt, die auf den Arbeiten von Rothschild und Stiglitz (1976) und Bester (1985, 1987) basieren. Das Hauptresultat der beiden Modelle ist: In einem Wohnimmobilienmarkt mit heterogenen Nutzungsgraden, die exklusives Wissen der Haushalte sind, mieten die Haushalte mit hohen Nutzungsgraden eine Immobilie, während die Haushalte mit niedrigen Nutzungsgraden eine Immobilie kaufen. Teil III befasst sich mit der Finanzierung von Wohneigentum privater Haushalte. Die beiden Hypothekenmarkt-Modelle beinhalten erstmals den privaten heterogenen Nutzungsgrad der Haushalte. Die heterogenen Gruppen von Haushalten können zwischen unterschiedlichen Kontrakten wählen, die durch den Hypothekenzinssatz und die anfängliche Eigenkapitalquote charakterisiert sind, und selektieren sich so selbst in den jeweils für sie vorgesehenen Kontrakt. Hypothekenschuldner mit einem hohen Nutzungsgrad, die eine hohe anfängliche Eigenkapitalquote wählen, lassen die Kredit wahrscheinlicher ausfallen und eine Zwangsvollstreckung folgt. Die empirischen Ergebnisse von Fürstenberg (1969), Campbell und Dietrich (1983), Hendershott und Schultz (2000) und Deng u.a. (2000) können wiederholt bestätigt werden. Die entwickelten Modelle reihen sich in die Forschung von Brueckner (2000), Harrsion u.a. (2004) und BenShahar (2006, 2008) ein und ergänzen diese um asymmetrische Information bzgl. des individuellen Nutzungsgrades der privaten Haushalte

Endocyclic ring opening of cyclopropanated piperidines: An approach to the asymmetric total synthesis of Meptazinol

Erforschung neuer Wege zur Synthese von funktionalisierten Azepanen durch RIngerweiterungen an zyklopropanierten Piperidinen. Anwendung der neuen Erkenntnisse bei der Synthese des Wirkstoffes Meptazinol

Comprehensive analysis of transitions in ribosomal DNA chromatin states in S. cerevisiae during different growth phases

In the nucleus of eukaryotes DNA is assembled into a large nucleoprotein complex, called chromatin. Histones form the basic chromatin component, the nucleosome. Nucleosomes impair the access of proteins to DNA and may interfere with DNA-dependent processes such as transcription, replication and DNA repair. To make DNA accessible, chromatin has to be a highly dynamic structure. How genomic loci adopt different functional states is still poorly understood. Thus, defined model loci are used to characterize chromatin transitions on the molecular level. One of these model loci is the ribosomal DNA locus in Saccharomyces cerevisiae (hereafter called yeast). Transcription at the ribosomal DNA (rDNA) multicopy gene locus by RNA polymerase I (Pol I) and III (Pol III) accounts for more than 50% of the total RNA production in exponentially growing yeast cells. Although the Pol I transcribed 35S rDNA locus is one of the most actively transcribed loci in the whole genome, around half of the 35S ribosomal RNA (rRNA) genes adopt a nucleosomal, transcriptionally inactive, “closed” state, whereas the other half is in an actively transcribed and nucleosome depleted, “open” state. These states are not stable but change dynamically e.g. during the cell cycle, DNA repair, or growth phase transitions. The exact mechanisms driving these changes in 35S rDNA chromatin are still largely unknown. When yeast cells transit to stationary phase Pol I transcription is downregulated and rRNA gene chromatin adopts a closed state. Whereas downregulation of RNA polymerase I transcription depends largely on the Tor pathway, the rDNA chromatin transition is dependent on the presence of the deacetylase Rpd3. This thesis showed that the maintenance of the open chromatin state in stationary phase in rpd3∆ cells is dependent on Pol I transcription. I provided evidence that Rpd3 might negatively influence Pol I initiation with transition to stationary phase at the level of the specific initiation factor CF (core factor) or via the Pol I stimulating factor Net1. Additionally, this thesis shows that the Pol I subunit Rpa49 is important for the fast and effective loading of Pol I and for the reopening of rDNA copies upon the transition from stationary phase to exponential growth. From the results, I could propose a model for the chromatin state transitions upon entry and exit from stationary phase. I suggest, that upon exit from exponential phase, Pol I transcription is largely downregulated via the Tor kinase pathway, but a sufficient amount of transcription is still ongoing during the diauxic shift and at post-diauxic growth phase leading to the persistence of open copies. With transition to stationary phase, the deacetylase Rpd3 mediates the complete shutdown of Pol I transcription and thus closing of the copies. This process is potentially mediated via CF or Net1. Upon exit from stationary phase, Pol I transcription is re-established and this is accompanied by the transition of closed copies to the open chromatin state. The chromatin state transition is established even with low Pol I loading rates, but to achieve high Pol I transcription rates and fast chromatin state transitions, the subunit Rpa49 is required

Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS)

Background Bronchiolitis imposes the largest health care burden on non-elective paediatric hospital admissions worldwide, with up to 15 % of cases requiring admission to intensive care. A number of previous studies have failed to show benefit of pharmaceutical treatment in respect to length of stay, reduction in PICU admission rates or intubation frequency. The early use of non-invasive respiratory support devices in less intensive scenarios to facilitate earlier respiratory support may have an impact on outcome by avoiding progression of the disease process. High Flow Nasal Cannula (HFNC) therapy has emerged as a new method to provide humidified air flow to deliver a non-invasive form of positive pressure support with titratable oxygen fraction. There is a lack of high-grade evidence on use of HFNC therapy in bronchiolitis. Methods/Design Prospective multi-centre randomised trial comparing standard treatment (standard subnasal oxygen) and High Flow Nasal Cannula therapy in infants with bronchiolitis admitted to 17 hospitals emergency departments and wards in Australia and New Zealand, including 12 non-tertiary regional/metropolitan and 5 tertiary centres. The primary outcome is treatment failure; defined as meeting three out of four pre-specified failure criteria requiring escalation of treatment or higher level of care; i) heart rate remains unchanged or increased compared to admission/enrolment observations, ii) respiratory rate remains unchanged or increased compared to admission/enrolment observations, iii) oxygen requirement in HFNC therapy arm exceeds FiO2 ≥ 40 % to maintain SpO2 ≥ 92 % (or ≥94 %) or oxygen requirement in standard subnasal oxygen therapy arm exceeds >2L/min to maintain SpO2 ≥ 92 % (or ≥94 %), and iv) hospital internal Early Warning Tool calls for medical review and escalation of care. Secondary outcomes include transfer to tertiary institution, admission to intensive care, length of stay, length of oxygen treatment, need for non-invasive/invasive ventilation, intubation, adverse events, and cost. Discussion This large multicenter randomised trial will allow the definitive assessment of the efficacy of HFNC therapy as compared to standard subnasal oxygen in the treatment of bronchiolitis

Perspectives of hospital emergency department staff on traumaâ informed care for injured children: An Australian and New Zealand analysis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138230/1/jpc13644_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138230/2/jpc13644.pd

51 Paediatric emergency clinicians are rarely exposed to non-airway critical procedures: a predict/PERN study

© 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. BACKGROUND: Recent studies suggest that approximately one per thousand paediatric ED attendances may require some sort of critical procedure, with intubation being by far the most common. It is unknown how often critical non-airway procedures such as chest decompression, CPR, ED thoracotomy, defibrillation, pacing, and advanced vascular access techniques are performed by paediatric emergency clinicians.OBJECTIVE: To determine the recent performance or supervision, and confidence for various paediatric critical non-airway procedures by senior paediatric emergency clinicians.DESIGN/METHODS: Web based survey of senior paediatric emergency clinicians regarding performance, supervision, and confidence relating to critical non-airway procedures in children aged 0-18 years. The survey was distributed through Paediatric Emergency Research Networks (PERN) in the UK and Ireland, USA, Canada, Europe, South America, Australia and New Zealand.RESULTS: 1602 clinicians responded to the survey, with an overall response rate of 65%. 1508 (94%) respondents reported their most recent non-airway procedural experience. In the last 12 months, 979 (64%) had personally inserted an intraosseous line, 283 (19%) a central venous line, and 265 (18%) an arterial line. In the same time period, 962 (64%) had performed CPR, 190 (13%) had performed needle thoracostomy, 245 (16%) had performed tube thoracostomy, 380 (25%) had performed DC cardioversion or defibrillation, and 57 (4%) had performed transcutaneous pacing. 18 (1%) had performed pericardiocentesis, 19 (1%) a venous cutdown, and 21 (1%) ED thoracotomy. More than 70% of respondents had never supervised or performed pacing, pericardiocentesis, venous cutdown or ED thoracotomy. 332 (22%) and 348 (23%) had never performed or supervised insertion of a central venous line or arterial line respectively.Procedural confidence for intraosseous lines and CPR was high, while confidence increased with increasing patient age for central venous access and arterial lines. ED thoracotomy, pericardiocentesis and venous cutdown had the lowest frequency of respondents reporting confidence in performing the procedure.CONCLUSIONS: More than half of the paediatric emergency clinicians surveyed had performed CPR and inserted an intraosseous needle within the last 12 months. Performance of other non-airway critical procedures was less common, and associated with less procedural confidence