Growth curves of common factors in psychotherapy: Multilevel growth modelling and outcome analysis.

OBJECTIVE A large body of literature discusses change mechanisms underlying psychotherapy with an emphasis on common factors. The present study examined how different comprehensive common factors change over the course of therapy and whether this change was associated with clinical outcome at discharge. METHOD Three hundred forty-eight adults (mean age = 32.1, SD = 10.6; 64% female) attended a standardized 14-week day-clinic psychotherapy program. They provided longitudinal data on common factors based on weekly assessments. Additionally, pre- and post-assessment questionnaires on clinical outcome were completed. Using multilevel modelling, we predicted common factors by time (week in therapy). Multiple linear regression models tested the association between changes in common factors and clinical outcome. RESULTS The common factor 'Therapeutic Alliance' was best fitted by linear growth models, whereas models for the common factors 'Coping', 'Cognitive Integration' and 'Affective Processing' indicated logarithmic changes over time. 'Coping', that is change in patients' ability to cope with their individual problems, was most closely linked with outcome. CONCLUSIONS The present study provides evidence for the changeability of common factors over the course of therapy as well as their specific contributions to psychotherapeutic progress

Rey Visual Design Learning Test performance correlates with white matter structure

Objective: Studies exploring relation of visual memory to white matter are extensively lacking. The Rey Visual Design Learning Test (RVDLT) is an elementary motion, colour and word independent visual memory test. It avoids a significant contribution from as many additional higher order visual brain functions as possible to visual performance, such as three-dimensional, colour, motion or word-dependent brain operations. Based on previous results, we hypothesised that test performance would be related with white matter of dorsal hippocampal commissure, corpus callosum, posterior cingulate, superior longitudinal fascicle and internal capsule. Methods: In 14 healthy subjects, we measured intervoxel coherence (IC) by diffusion tensor imaging as an indication of connectivity and visual memory performance measured by the RVDLT. IC considers the orientation of the adjacent voxels and has a better signal-to-noise ratio than the commonly used fractional anisotropy index. Results: Using voxelwise linear regression analyses of the IC values, we found a significant and direct relationship between 11 clusters and visual memory test performance. The fact that memory performance correlated with white matter structure in left and right dorsal hippocampal commissure, left and right posterior cingulate, right callosal splenium, left and right superior longitudinal fascicle, right medial orbitofrontal region, left anterior cingulate, and left and right anterior limb of internal capsule emphasises our hypothesis. Conclusion: Our observations in healthy subjects suggest that individual differences in brain function related to the performance of a task of higher cognitive demands might partially be associated with structural variation of white matter region

Hematopoietic reconstitution by multipotent adult progenitor cells: precursors to long-term hematopoietic stem cells

For decades, in vitro expansion of transplantable hematopoietic stem cells (HSCs) has been an elusive goal. Here, we demonstrate that multipotent adult progenitor cells (MAPCs), isolated from green fluorescent protein (GFP)-transgenic mice and expanded in vitro for >40–80 population doublings, are capable of multilineage hematopoietic engraftment of immunodeficient mice. Among MAPC-derived GFP+CD45.2+ cells in the bone marrow of engrafted mice, HSCs were present that could radioprotect and reconstitute multilineage hematopoiesis in secondary and tertiary recipients, as well as myeloid and lymphoid hematopoietic progenitor subsets and functional GFP+ MAPC-derived lymphocytes that were functional. Although hematopoietic contribution by MAPCs was comparable to control KTLS HSCs, approximately 103-fold more MAPCs were required for efficient engraftment. Because GFP+ host-derived CD45.1+ cells were not observed, fusion is not likely to account for the generation of HSCs by MAPCs

Relation of white matter anisotropy to visual memory in 17 healthy subjects

We performed a Rey visual design learning test (RVDLT) in 17 subjects and measured intervoxel coherence (IC) by DTI as an indication of connectivity to investigate if visual memory performance would depend on white matter structure in healthy persons. IC considers the orientation of the adjacent voxels and has a better signal-to-noise ratio than the commonly used fractional anisotropy index. Voxel-based t-test analysis of the IC values was used to identify neighboring voxel clusters with significant differences between 7 low and 10 high test performers. We detected 9 circumscribed significant clusters (p< .01) with lower IC values in low performers than in high performers, with centers of gravity located in left and right superior temporal region, corpus callosum, left superior longitudinal fascicle, and left optic radiation. Using non-parametric correlation analysis, IC and memory performance were significantly correlated in each of the 9 clusters (r< .61 to r< .81; df=15, p< .01 to p< .0001). The findings provide in vivo evidence for the contribution of white matter structure to visual memory in healthy people

Nitrogen deposition in appropriate assessment under Article 6 (3) of the Habitats Directive: Critical Load, thresholds of insignificant impacts, and bagatelle

Die Ermittlung und Bewertung der Auswirkungen von Stickstoffeinträgen in der FFH-Verträglichkeitsprüfung ist in Deutschland seit fast zehn Jahren Gegenstand einer intensiven Fachdiskussion. Zuletzt hat sich ein Forschungsprojekt im Auftrag der Bundesanstalt für Straßenwesen (BASt) mit dieser Frage beschäftigt und eine Fachkonvention für den Projekttyp Straße erarbeitet. Diese Fachkonvention, die auch auf andere Projekttypen übertragbar ist, basiert grundsätzlich auf dem Maßstab der Critical Loads zur Beschreibung der Empfindlichkeit von FFH-Lebensräumen gegenüber Stickstoffeintrag. Liegt die gebietsspezifische Gesamtbelastung mit Stickstoffeinträgen über dem standort- und vegetationstypspezifisch zu ermittelnden Critical Load, so wird für die FFH-Verträglichkeitsprüfung ein mehrstufiges Schwellenwertkonzept zur Bestimmung von irrelevanten bzw. bagatellhaften Zusatzbelastungen empfohlen: Unterschieden wird ein vorhabenbezogenes absolutes Abschneidekriterium von 0,3 kg N ha-1a-1 und eine rezeptorbezogene Bagatellschwelle von 3% des jeweiligen Critical Loads. Beide Schwellenwerte sind als sehr niedrig und der Zielsetzung der FFH-Richtlinie entsprechend vorsorgeorientiert einzustufen.Mit dem Bewertungsansatz werden alle Anforderungen, die sich aus den fachlichen und rechtlichen Maßstäben für die FFH-Verträglichkeitsprüfung ergeben, berücksichtigt. Zugleich handelt es sich um einen praxistauglichen Bewertungsansatz, der auch dem Grundsatz der Verhältnismäßigkeit Rechnung trägt. Das vorhabenbezogene Abschneidekriterium soll für jedes zu genehmigende Vorhaben gelten. Für die Größenordnung von 0,3kg N ha-1a-1 für den vorhabenbezogenen Stickstoffeintrag in ein FFH-Gebiet sprechen verschiedene Argumente: Einträge in dieser Größenordnung liegen deutlich unterhalb der messtechnischen Erfassbarkeit und deutlich unterhalb jeder bekannten Schwelle von Zusatzbelastungen, die negative Wirkungen für die Biodiversität auslösen können; unterhalb dieser Größenordnung ist eine Ermittlung von Belastungen und Beeinträchtigungen mit derzeit verfügbaren Modellen und Eingangsdaten auch aufgrund der Unsicherheiten und fehlenden statistischen Signifikanz nicht mehr sinnvoll möglich. Zusatzbelastungen eines Vorhabens in dieser Größenordnung stellen somit lediglich ein theoretisches Risiko dar und können keine erheblichen Beeinträchtigungen im Sinne der FFH-RL auslösen. Somit können auch nur diejenigen projektbezogenen Zusatzbelastungen, die oberhalb dieses Abschneidekriteriums liegen, für eine kumulative Prüfung mit weiteren Projekten und deren gemeinsamer Wirkung geprüft werden. Die Bagatellschwelle von 3% des Critical Loads wird demgegenüber gebietsbezogen angewendet und kann daher auch durch das Zusammenwirken mehrerer einzelner Vorhaben überschritten werden. Die Anwendung soll unabhängig von der Höhe der Überschreitung der Critical Loads in der Gesamtbelastung möglich sein. Die Bagatellschwelle ist an der spezifischen Stickstoffempfindlichkeit der FFH Lebensräume, die durch die Critical Loads vorsorgeorientiert beschrieben wird, ausgerichtet. Eine Auswertung der Ergebnisse der Wirkungsforschung, insbesondere zu Randeffekten entlang von Straßen, hat ergeben, dass der Wert von 3% des maßgeblichen Critical Loads sicher unterhalb von feststellbaren negativen Wirkungen auf den Erhaltungszustand von FFH-Lebensräumen liegt.For the last ten years impacts from nitrogen deposition within appropriate assessments has been a controversial issue discussed by many experts in Germany. More recently results from a R&D project funded by the Federal Highway Research Institute (BASt) have been published to establish a method on the assessment for road projects. Adverse effects are assessed in a staged approach based on the concept of critical loads: if total environmental Deposition is lower than critical loads of the most sensitive feature of the site, no likely significant effects have to be expected. Project contributions up to a de-minimis value of 0.3kg N ha-1y-1 are considered as being too small to be measurable. Neither could nitrogen deposition of up to this value be detected in the field nor could damages be attributed to projects contributing such small amounts. Project contributions lower than the proposed threshold thus exert only hypothetical risks that do not justify or even demand refusals of Project under Article 6.3. Only project contributions above the cut off criterion have to be considered within an appropriate assessment in combination with other projects. With view on the protected site another threshold of 3 % of the critical load is applied that can be exceeded not only by single projects but also in combination. Its application does not depend on background deposition. It depends on the specific sensitivity of the habitat precautionarily described by critical loads. Examination of scientific results on the effects, particularly along roads has shown that a value of 3% of a particular critical load clearly lies below detectable adverse effects on the conservation status of natura 2000 habitats. Both thresholds are very low and thus in line with the precautionary approach prescribed by the Habitats Directive. The assessment approach encompasses legal as well as scientific confidence. It also adheres to the principle of proportionality and has proven to be functional in practice. As nitrogen inputs up to 0.3 kg N ha-1y-1 cannot be realistically attributed to a particular project, they should rather be described as diffuse part of the background deposition. High background deposition in turn should be lowered by the most efficient measures to stay in accordance with the requirement under the Habitats Directive to avoid deterioration. Very small project contributions as accepted by the proposed process will not constitute an obstacle for this

International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention.

The ISH Statement on blood pressure lowering and stroke prevention was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne Australia, 5-7 December 2002. The meeting was conducted under the auspice of the Austin Hospital Medical Research Foundation, Melbourne