Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social phobia into clinical practice: study protocol for a cluster-randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia.</p> <p>Methods/Design</p> <p>The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale.</p> <p>Discussion</p> <p>We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study.</p> <p>Trial Registration</p> <p>German Clinical Trials Register (DRKS) DRKS00000570</p

Genetic and morphologic determination of diatom community composition in surface sediments from glacial and thermokarst lakes in the Siberian Arctic

Lakes cover large parts of the climatically sensitive Arctic landscape and respond rapidly to environmental change. Arctic lakes have different origins and include the predominant thermokarst lakes, which are small, young and highly dynamic, as well as large, old and stable glacial lakes. Freshwater diatoms dominate the primary producer community in these lakes and can be used to detect biotic responses to climate and environmental change. We used specific diatom metabarcoding on sedimentary DNA, combined with next-generation sequencing and diatom morphology, to assess diatom diversity in five glacial and 15 thermokarst lakes within the easternmost expanse of the Siberian treeline ecotone in Chukotka, Russia. We obtained 163 verified diatom sequence types and identified 176 diatom species morphologically. Although there were large differences in taxonomic assignment using the two approaches, they showed similar high abundances and diversity of Fragilariceae and Aulacoseiraceae. In particular, the genetic approach detected hidden within-lake variations of fragilarioids in glacial lakes and dominance of centric Aulacoseira species, whereas Lindavia ocellata was predominant using morphology. In thermokarst lakes, sequence types and valve counts also detected high diversity of Fragilariaceae, which followed the vegetation gradient along the treeline. Ordination analyses of the genetic data from glacial and thermokarst lakes suggest that concentrations of sulfate, an indicator of the activity of sulfate-reducing microbes under anoxic conditions, and bicarbonate, which relates to surrounding vegetation, have a significant influence on diatom community composition. For thermokarst lakes, we also identified lake depth as an important variable, but sulfate best explains diatom diversity derived from genetic data, whereas bicarbonate best explains the data from valve counts. Higher diatom diversity was detected in glacial lakes, most likely related to greater lake age and different edaphic settings, which gave rise to diversification and endemism. In contrast, small, dynamic thermokarst lakes are inhabited by stress-tolerant fragilarioids and are related to different vegetation types along the treeline ecotone. Our study demonstrated that genetic investigations of lake sediments can be used to interpret climate and environmental responses of diatoms. It also showed how lake type affects diatom diversity, and that such genetic analyses can be used to track diatom community changes under ongoing warming in the Arctic

Paleo-Ecology of the Yedoma Ice Complex on Sobo-Sise Island (Eastern Lena Delta, Siberian Arctic)

Late Pleistocene permafrost of the Yedoma type constitutes a valuable paleo-environmental archive due to the presence of numerous and well-preserved floral and faunal fossils. The study of the fossil Yedoma inventory allows for qualitative and quantitative reconstructions of past ecosystem and climate conditions and variations over time. Here, we present the results of combined paleo-proxy studies including pollen, chironomid, diatom and mammal fossil analyses from a prominent Yedoma cliff on Sobo-Sise Island in the eastern Lena Delta, NE Siberia to complement previous and ongoing paleo-ecological research in western Beringia. The Yedoma Ice Complex (IC) cliff on Sobo-Sise Island (up to 28 m high, 1.7 km long) was continuously sampled at 0.5 m resolution. The entire sequence covers the last about 52 cal kyr BP, but is not continuous as it shows substantial hiatuses at 36–29 cal kyr BP, at 20–17 cal kyr BP and at 15–7 cal kyr BP. The Marine Isotope Stage (MIS) 3 Yedoma IC (52–28 cal kyr BP) pollen spectra show typical features of tundra–steppe vegetation. Green algae remains indicate freshwater conditions. The chironomid assemblages vary considerably in abundance and diversity. Chironomid-based TJuly reconstructions during MIS 3 reveal warmer-than-today TJuly at about 51 cal kyr BP, 46-44 and 41 cal kyr BP. The MIS 2 Yedoma IC (28–15 cal kyr BP) pollen spectra represent tundra-steppe vegetation as during MIS 3, but higher abundance of Artemisia and lower abundances of algae remains indicate drier summer conditions. The chironomid records are poor. The MIS 1 (7–0 cal kyr BP) pollen spectra indicate shrub-tundra vegetation. The chironomid fauna is sparse and not diverse. The chironomid-based TJuly reconstruction supports similar-as-today temperatures at 6.4–4.4 cal kyr BP. Diatoms were recorded only after about 6.4 cal kyr BP. The Sobo-Sise Yedoma record preserves traces of the West Beringian tundra-steppe that maintained the Mammoth fauna including rare evidence for woolly rhinoceros’ presence. Chironomid-based TJuly reconstructions complement previous plant-macrofossil based TJuly of regional MIS 3 records. Our study from the eastern Lena Delta fits into and extends previous paleo-ecological Yedoma studies to characterize Beringian paleo-environments in the Laptev Sea coastal region

Evidenzbasierte Psychotherapie der Panikstörung mit und ohne Agoraphobie : ein Überblick zur S1-Leitlinie der Deutschen Gesellschaft für Psychologie

Alpers GW, Gerlach AL, Heinrichs N. Evidence-based psychotherapy of panic disorder with or without agoraphobia. Psychotherapeut. 2011;56(6):535-548.From the evidence reported in the recent guidelines [Heinrichs et al. (2009) Evidenzbasierte Leitlinie zur Psychotherapie der Panikstorung mit und ohne Agoraphobie. Hogrefe, Gottingen] the following conclusions can be drawn with respect to the treatment of panic disorder with or without agoraphobia, as well as for agoraphobia without panic disorder: Every psychotherapy should be preceded by suitable diagnostics and a case formulation. The effectiveness of every psychotherapy should be evaluated with well established measures. For the treatment of panic disorder without agoraphobia, cognitive behavioral treatment (CBT) and applied relaxation have been shown to be effective (evidence grade 1). For panic disorder with agoraphobia, CBT, combination treatment (CBT plus medication), as well as panic-focused psychodynamic psychotherapy in the outpatient setting have shown short-term effectiveness (evidence grade 1). Longer lasting effects have been documented for CBT (evidence grade 1). For agoraphobia without panic disorder, CBT with a focus on situational exposure can be recommended (evidence grade 1)

Association between pernicious anemia and gastric carcinoid tumor: a report of a clinical case

Os tumores carcinóides gástricos são raros, representando ≤ 1% dos tumores gástricos e 8,7% de todos os carcinóides gastrentestinais. Os autores descrevem o caso clínico de uma mulher de 32 anos admitida por anemia macrocítica, e cuja investigação etiológica revelou tratar-se de uma anemia perniciosa (AP). Realizou uma endoscopia digestiva alta (EDA), onde se encontraram 6 nódulos bem delimitados no corpo e fundo gástricos. O resultado histopatológico foi consistente com o diagnóstico de tumor carcinóide, bem diferenciado. Após exclusão de metastização secundária (por TC e cintigrafia com octreótido), tendo em conta o envolvimento multifocal do tumor e a presença de metaplasia intestinal completa no corpo e fundo gástricos, a doente foi proposta para gastrectomia total que decorreu sem intercorrências. Iniciou terapêutica com vitamina B-12, com excelente resposta clínica e analítica. O objectivo da publicação deste caso assenta no alertar para o risco do aparecimento dos carcinóides gástricos nos doentes com AP e da necessidade de realização de EDA imediatamente após o diagnóstico da mesma. Nos carcinóides gástricos tipo I que não apresentam doença à distância, a evolução é benigna

Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study

Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context

Dispersal distances and migration rates at the arctic treeline in Siberia – a genetic and simulation-based study

A strong temperature increase in the Arctic is expected to lead to latitudinal treeline shift. This tundra–taiga turnover would cause a positive vegetation–climate feedback due to albedo decrease. However, reliable estimates of tree migration rates are currently lacking due to the complex processes involved in forest establishment, which depend strongly on seed dispersal. We aim to fill this gap using LAVESI, an individual-based and spatially explicit Larix vegetation simulator. LAVESI was designed to simulate plots within homogeneous forests. Here, we improve the implementation of the seed dispersal function via field-based investigations. We inferred the effective seed dispersal distances of a typical open-forest stand on the southern Taymyr Peninsula (northern central Siberia) from genetic parentage analysis using eight nuclear microsatellite markers. The parentage analysis gives effective seed dispersal distances (median ∼10&thinsp;m) close to the seed parents. A comparison between simulated and observed effective seed dispersal distances reveals an overestimation of recruits close to the releasing tree and a shorter dispersal distance generally. We thus adapted our model and used the newly parameterised version to simulate south-to-north transects; a slow-moving treeline front was revealed. The colonisation of the tundra areas was assisted by occasional long-distance seed dispersal events beyond the treeline area. The treeline (∼1&thinsp;tree&thinsp;ha−1) advanced by ∼1.6&thinsp;m&thinsp;yr−1, whereas the forest line (∼100&thinsp;trees&thinsp;ha−1) advanced by only ∼0.6&thinsp;m&thinsp;yr−1. We conclude that the treeline in northern central Siberia currently lags behind the current strong warming and will continue to lag in the near future.</p

Paleo-Ecology of the Yedoma Ice Complex on Sobo-Sise Island (EasternLena Delta, Siberian Arctic)

Late Pleistocene permafrost of the Yedoma type constitutes a valuable paleo-environmental archive due to the presence of numerous and well-preserved floral and faunal fossils. The study of the fossil Yedoma inventory allows for qualitative and quantitative reconstructions of past ecosystem and climate conditions and variations over time. Here, we present the results of combined paleo-proxy studies including pollen, chironomid, diatom and mammal fossil analyses from a prominent Yedoma cliff on Sobo-Sise Island in the eastern Lena Delta, NE Siberia to complement previous and ongoing paleo-ecological research in western Beringia. The Yedoma Ice Complex (IC) cliff on Sobo-Sise Island (up to 28 m high, 1.7 km long) was continuously sampled at 0.5 m resolution. The entire sequence covers the last about 52 cal kyr BP, but is not continuous as it shows substantial hiatuses at 36–29 cal kyr BP, at 20–17 cal kyr BP and at 15–7 cal kyr BP. The Marine Isotope Stage (MIS) 3 Yedoma IC (52–28 cal kyr BP) pollen spectra show typical features of tundra–steppe vegetation. Green algae remains indicate freshwater conditions. The chironomid assemblages vary considerably in abundance and diversity. Chironomid-based TJuly reconstructions during MIS 3 reveal warmer-than-today TJuly at about 51 cal kyr BP, 46-44 and 41 cal kyr BP. The MIS 2 Yedoma IC (28–15 cal kyr BP) pollen spectra represent tundra-steppe vegetation as during MIS 3, but higher abundance of Artemisia and lower abundances of algae remains indicate drier summer conditions. The chironomid records are poor. The MIS 1 (7–0 cal kyr BP) pollen spectra indicate shrub-tundra vegetation. The chironomid fauna is sparse and not diverse. The chironomid-based TJuly reconstruction supports similar-as-today temperatures at 6.4–4.4 cal kyr BP. Diatoms were recorded only after about 6.4 cal kyr BP. The Sobo-Sise Yedoma record preserves traces of the West Beringian tundra-steppe that maintained the Mammoth fauna including rare evidence for woolly rhinoceros’ presence. Chironomid-based TJuly reconstructions complement previous plant-macrofossil based TJuly of regional MIS 3 records. Our study from the eastern Lena Delta fits into and extends previous paleo-ecological Yedoma studies to characterize Beringian paleo-environments in the Laptev Sea coastal region

Strengthening global-change science by integrating aeDNA with paleoecoinformatics

Ancient environmental DNA (aeDNA) data are close to enabling insights into past global-scale biodiversity dynamics at unprecedented taxonomic extent and resolution. However, achieving this potential requires solutions that bridge bioinformatics and paleoecoinformatics. Essential needs include support for dynamic taxonomic inferences, dynamic age inferences, and precise stratigraphic depth. Moreover, aeDNA data are complex and heterogeneous, generated by dispersed researcher networks, with methods advancing rapidly. Hence, expert community governance and curation are essential to building high-value data resources. Immediate recommendations include uploading metabarcoding-based taxonomic inventories into paleoecoinformatic resources, building linkages among open bioinformatic and paleoecoinformatic data resources, harmonizing aeDNA processing workflows, and expanding community data governance. These advances will enable transformative insights into global-scale biodiversity dynamics during large environmental and anthropogenic changes