Determination of precipitation return values in complex terrain and their evaluation

To determine return values at various return periods for extreme daily precipitation events over complex orography, an appropriate threshold value and distribution function are required. The return values are calculated using the peak-over-threshold approach in which only a reduced sample of precipitation events exceeding a predefined threshold is analyzed. To fit the distribution function to the sample, the L-moment method is used. It is found that the deviation between the fitted return values and the plotting positions of the ranked precipitation events is smaller for the kappa distribution than for the generalized Pareto distribution. As a second focus, the ability of regional climate models to realistically simulate extreme daily precipitation events is assessed. For this purpose the return values are derived using precipitation events exceeding the 90th percentile of the precipitation time series and a fit of a kappa distribution. The results of climate simulations with two different regional climate models are analyzed for the 30-yr period 1971-2000: the so-called consortium runs performed with the climate version of the Lokal Modell (referred to as the CLM-CR) at 18-km resolution and the Regional Model (REMO)-Umweltbundesamt (UBA) simulations at 10-km resolution. It was found that generally the return values are overestimated by both models. Averaged across the region the overestimation is higher for REMO-UBA compared to CLM-CR

The effect of silica-containing binders on the titanium/face coat reaction

The interactions of CP-Ti and Ti-6Al-4V with investment molds containing alumina/silica and yttria/silica face coat systems were studied. Containerless melting in a vacuum was employed and small test samples were made by drop casting into the molds. The effects of the face coat material and mold preheat temperatures on the thickness of the alpha case on the castings were evaluated with microhardness and microprobe measurements. It was found that the thickness of the alpha case was the same, whether a yttria/silica or alumina/silica face coat was used, indicating that the silica binder reacted with the titanium. Hence, the use of expensive refractories, such as yttria, represents an unnecessary cost when combined with a silica binder. It was also found that the alloyed titanium castings had a thinner alpha case than those produced from CP-Ti, which suggests that the thickness of the alpha case depends on the crystal structure of the alloy during cooling from high temperatures. Furthermore, castings made in small yttria crucibles used as molds exhibited little or no alpha case

Rationale and design: telepsychology service delivery for depressed elderly veterans

BACKGROUND: Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. METHODS: We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that inhome Telepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use). DISCUSSION: Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services. TRIAL REGISTRATION: National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701)

Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings

Recently, the National Institute of Mental Health (NIMH) introduced the Research Domain Criteria (RDoC) initiative to address two major challenges facing the field of psychiatry: (1) the lack of new effective personalized treatments for psychiatric disorders, and (2) the limitations associated with categorically-defined psychiatric disorders. While the potential of RDoC to revolutionize personalized psychiatric medicine and psychiatric nosology has been acknowledged, it is unclear how to implement RDoC in naturalistic clinical settings as part of routine outcomes research. In this paper we present the major RDoC principles and then show how these principles are operationalized in the Menninger Clinic’s McNair Initiative for Neuroscience Discovery-Menninger & Baylor College of Medicine (MIND-MB) study. We discuss how RDoC-informed outcomes-based assessment in clinical settings can transform personalized clinical care through multimodal treatments

Disseminating Evidence-Based Practices for Adults With PTSD and Severe Mental Illness in Public-Sector Mental Health Agencies

Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19-43%), contributes a significant illness burden, and hinders mental health care. Yet, few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the paper is to describe strategies and efforts to disseminate trauma-focused empirically-based practices (EBPs) in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are: set clear goals; nurture broad-based organizational commitment and key stakeholder involvement; implement specialty training efforts to provide information and change attitudes; provide on-going supervision; conduct fidelity monitoring; and ensure accountability to the extent possible

Bevacizumab continuation versus no continuation after first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a randomized phase III non-inferiority trial (SAKK 41/06)

In this trial, stopping bevacizumab after completion of induction chemotherapy was associated with a shorter time to progression, but no statistically significant difference in overall survival compared with the bevacizumab continuation strategy. Non-inferiority could not be demonstrated. Treatment costs are substantially higher for continuous bevacizumab treatmen

Experience and Outcomes of a Pharmaceutical Care Leadership Residency Program

The University of Minnesota College of Pharmacy’s Ambulatory Care Residency Program has graduated 22 residents from its Leadership Emphasis program from 1999 to 2014. The Leadership Emphasis program is unique in its design, providing a set of experiences over two years focused on developing leadership skills in practice development, establishing personal influence, advocacy in the profession, and teaching. The program’s design has focused on bringing value to three distinct audiences: pharmacists enrolled in the program, the local pharmacy practice community, and the College of Pharmacy. This paper explores the program’s contributions in each of these areas. Program graduates from 1999-2009 were interviewed and cited the independent, yet mentored, activities of the program as instrumental to their professional and personal development. The program has provided significant value to the College of Pharmacy, primarily in the form of instructional support, service to faculty practice sites and development of new practice sites for APPEs. Teaching and precepting hours offset the salary of the residents, resulting in financial benefits for the College. In the second year of the program, residents pursue development of new practice sites, 15 of which have been sustained to provide at least a half-time pharmacist position, having a direct impact on pharmacy practice development in the region. The program provides a win-win-win situation for all the stakeholders involved. Schools and colleges of pharmacy are encouraged to consider whether a similar program may assist in achieving its own goals in practitioner development, teaching and learning, and community engagement

Therapist fidelity with an exposure-based treatment of ptsd in adults with schizophrenia or schizoaffective disorder

This study examined therapists’ fidelity to a manualized multi-component cognitive-behavioral intervention for posttraumatic stress disorder (PTSD), including exposure therapy, among public sector patients with a psychotic disorder. Therapists’ competence and adherence was assessed by clinicians at the master’s level or higher who rated 20% of randomly selected audiotaped sessions (n = 57 sessions, coded by two independent raters, with strong interrater agreement). Adherence ratings indicated that therapists complied well with the protocol, and competency ratings typically averaged above “very good” (6 on 7-point Likert scale). Findings suggest that therapists can effectively deliver a manualized cognitive-behavioral intervention for PTSD, with exposure therapy, to patients with severe mental illness without compromise to the structure of sessions and/or to the therapeutic relationship. These data add needed support for the implementation of cognitive-behavioral interventions, including exposure therapy, as effective treatments for PTSD in complicated patient populations such as those with severe forms of mental illness