Implementation of outpatient schema therapy for borderline personality disorder: study design

ABSTRACT: BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD) in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. METHODS/DESIGN: Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. DISCUSSION: The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. TRIAL REGISTRATION: The Dutch Cochrane Center, NTR (TC = 1781

Business model innovation for eco-efficiency: an empirical study

Business model has the potential to create value and capture value for companies, which is critical for their sustainable development [1]. The concept of eco-efficiency can be a useful concept to link an enterprise’s business with sustainable development as well as achieving long-term profits [2,3]. Extant lit- erature reveals that there is a need to study business model innovation and eco- efficiency under one text to achieve a win-win rationale to increase profits while reducing environmental impact [4,5]. This empirical study conducted 8-in-depth case studies with manufacturing companies across UK and China. The author synthesized the cases and concluded the measures of business model innovation for eco-efficiency in five categories, namely (1) Selling of service model, (2) Direct selling model, (3) Collaboration strategy, (4) Whole system design strat- egy, and (5) Technology renovation strategy. The empirical finding suggests the adaptation of strategy and exploitation of the technologies are essential to busi- ness model innovation when manufacturing companies seeking to implement eco-efficiency

Global Soil Moisture Patterns Observed by Space Borne Microwave Radiometers and Scatterometers

Within the scope of the upcoming launch of a new water related satellite mission (SMOS) a global evaluation study was performed on two available global soil moisture products. ERS scatterometer surface wetness data was compared to AMSR-E soil moisture data. This study pointed out a strong similarity between both products in sparse to moderate vegetated regions with an average correlation coefficient of 0.83. Low correlations were found in densely vegetated areas and deserts. The low values in the vegetated regions can be explained by the limited soil moisture retrieval capabilities over dense vegetation covers. Soil emission is attenuated by the canopy and tends to saturate the microwave signal with increasing vegetation density, resulting in a decreased sensor sensitivity to soil moisture variations. It is expected that the new low frequency satellite mission (SMOS) will obtain soil moisture products with a higher quality in these regions. The low correlations in the desert regions are likely due to volume scattering or to the dielectric dynamics within the soil. The volume scattering in dry soils causes a higher backscatter under very dry conditions than under conditions when the sub-surface soil layers are somewhat wet. In addition, at low moisture levels the dielectric constant has a reduced sensitivity in response to changes in the soil moisture content. At a global scale the spatial correspondence of both products is high and both products clearly distinguish similar regions with high seasonal and inter annual variations. Based on the global analyses we concluded that the quality of both products was comparable and in the sparse to moderate vegetated regions both products may be beneficial for large scale validation of SMOS soil moisture. Some limitations of the studied products are different, pointing to significant potential for combining both products into one superior soil moisture data set. © The Author(s) 2008

A practical guide to single-cell RNA-sequencing for biomedical research and clinical applications.

RNA sequencing (RNA-seq) is a genomic approach for the detection and quantitative analysis of messenger RNA molecules in a biological sample and is useful for studying cellular responses. RNA-seq has fueled much discovery and innovation in medicine over recent years. For practical reasons, the technique is usually conducted on samples comprising thousands to millions of cells. However, this has hindered direct assessment of the fundamental unit of biology-the cell. Since the first single-cell RNA-sequencing (scRNA-seq) study was published in 2009, many more have been conducted, mostly by specialist laboratories with unique skills in wet-lab single-cell genomics, bioinformatics, and computation. However, with the increasing commercial availability of scRNA-seq platforms, and the rapid ongoing maturation of bioinformatics approaches, a point has been reached where any biomedical researcher or clinician can use scRNA-seq to make exciting discoveries. In this review, we present a practical guide to help researchers design their first scRNA-seq studies, including introductory information on experimental hardware, protocol choice, quality control, data analysis and biological interpretation

Design of an international multicentre RCT on group schema therapy for borderline personality disorder

Background Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. Methods/Design An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients’ and therapists’ experiences with GST, and studies on variables that might influence the effectiveness of GST. Discussion This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation and additional investigations, it will contribute to an evidence-based understanding of which treatment should be offered to patients with BPD from clinical, economic, and stakeholders’ perspectives